How To Evaluate When Your Voice Is in Trouble + When To Seek Help

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At some point, everyone experiences some small problem with their voice. Usually, the voice recovers within 24–36 hours. Maybe you hear a change in the quality, range, voicing control, or endurance. But how do you know if you’re in trouble with your voice as a performer? 

First, it should never hurt to make sound. If it does, then you have a sure sign that you are either doing too much, singing too hard, or the tissue is damaged. The old adage “no pain, no gain” does NOT apply to voice. A healthy voice is able to maintain control of voicing throughout their normal vocal range, and should not hear a “split” or “double tone” (diplophonia). An audible “double pitch” or sudden loss of voicing for a note or range of the voice is a sign of vocal trouble. Go see your laryngologist. A healthy voice can execute s messa di voce (soft-loud-soft) throughout the vocal range. A healthy voice can glide from low pitch to high pitch and back down in a seamless manner, with no sudden “gear shifts” or sudden change in overall quality.

Any sudden complete loss of voice, particularly following a yell, scream, singing prolonged high notes, or following extended crying, is also a sign of tissue injury. There are tiny blood vessels that line the vocal fold tissue. If a blood vessel breaks, you have a vocal fold hemorrhage (no, you don’t taste blood), which can cause (a) sudden and complete loss of pitch or vocal power, (b) the blood to be pushed into a blood blister (hemorrhagic polyp), or (c) you may experience repeated small periods of mini-bleeding from the blood vessel (varix) which can trigger vocal fold stiffness. Due to capillary fragility in the two days surrounding their menstrual cycle, a vocal fold hemorrhage is more common in women who may use aggressive voice during those delicate days. A vocal fold hemorrhage can also occur when using the voice aggressively in the presence of aspirin, alcohol, and anticoagulants. If a vocal fold hemorrhage is suspected, the singer should go on complete voice rest and be immediately evaluated by a laryngologist. Complete voice rest for 5–7 days often helps the vocal folds fully heal and the singer can avoid more serious long-term injury to the vocal folds. When in doubt, check it out with your laryngologist. 

Hoarseness in the morning can signal reflux. Many performers experience reflux, also known as GERD or LPR. This may be due to dietary habits, weight, or lifestyle. Performers strive on positive stress, but have to deal with negative stress on a daily basis. Performers use increased intra-abdominal pressure (“support” for the voice), so singing after a meal is particularly challenging. If you eat late, just go to bed later. There should be a solid 2-hour period of no eating before bedtime. Foods that elevate reflux risks are carbonated beverages, chocolate, coffee, spicy foods, fried foods, fatty foods and alcohol. Eating or drinking quickly, or eating large amounts at one time also increase reflux risks. 

If you have immediate relatives with a reflux history, it’s wise to take precautions now, which can avoid swelling of the posterior and membranous aspect of the vocal folds. Choosing foods with higher pH value can really make a difference. Remember, a higher pH is better (just like a GPA!) Typical symptoms of reflux is “morning voice” that is low pitched, dry, and/or “crunchy,” and many reflux patients complain of a “lump in the throat” or difficulty swallowing. The irritation at the posterior aspect of the vocal folds causes the singer to work harder to close the membranous vocal folds (to achieve voicing), which often results in Muscle Tension Dysphonia (MTD).

If one side of your throat feels sore or tender, you may be experiencing MTD. There are different types of MTD, but all result is either a breathy, tight, squeezed, or sore throat. A laryngologist can quickly determine if MTD is present. Vocal exercises and attention to physical posture often fully resolve MTD, but the underlying trigger for MTD needs to be determined.

“My voice has a little tickle when I am singing high. Is that normal?” When you sing at higher pitches, the vocal folds vibrate more times per second, which results in some heat dissipation, and requires additional control of breath support, laryngeal control, and coordinating the text to be intelligible. A little tickle often signals that you need either a sip of water or you’re singing too loud on that note for the amount of preparation (or capacity) of your voice. If the breath inhalation just before a high note is through the mouth, there is an additional risk of drier air passing through the vocal folds, which may trigger greater sensitivity to a “tickle.”

If you experience vocal fatigue after singing for less than 30–45 minutes, it may be a sign of not enough range of motion (change of pitch, loudness, rate, pauses) or it may signal something (even small) on the vocal fold edge. Vocal fatigue after singing 2–3 hours nonstop may occur, but any vocal fatigue should resolve in 24–36 hours. If you experience fatigue or change of normal voice quality after 24–36 hours, go see your laryngologist.

As a performer you should never feel a “push” from the throat. You should feel the sound bouncing off your face and skull, connected to steady breath support, with a slight sensation of vibration in the throat (but not overpowering). An efficient voice does not hurt the performer or the audience. If you have any concerns about your voice, visit a laryngologist.

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The views expressed in this article are solely that of the individual(s) providing them,
and do not necessarily reflect the opinions of Backstage or its staff.

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Dr. Linda Carroll
Dr. Linda Carroll maintains a private practice in voice pathology and voice training in NYC and NH, and serves as research scientist at the Children’s Hospital of Philadelphia. She holds dual undergraduate degrees in voice performance and music education, and Masters/Doctoral degrees in Applied Speech Science from Columbia University. Her expertise is laryngeal function and vocal health in the voice profession. Her studio has over 60 Grammy nominations.
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