Performers generally look upon vocal problems with dread. There are few things worse than having to walk on stage with the fear of your voice not functioning properly. An ear, nose, and throat doctor specializes in disorders of the voice, among other things, and can often make the difference between a successful show and a canceled one.
I recently had a chance to talk with one of Los Angeles' leading ENTs, Dr. Joe Sugarman. His Beverly Hills office is lined with platinum records from grateful artists he has assisted. Sugarman's long list of patients from the performing arts makes him very sensitive to the vocal demands placed on performers, and he provides great insight into vocal health and longevity.
Sugarman would rather see his patients out performing well and not in need of his services, and proper vocal technique is his advice for preventing problems in the first place. "The best way for a singer or performer to stay away from needing to see a doctor is to see a voice coach on a regular basis," he says. "It's no different than a tennis player working with a physical therapist or their trainer. If the performer is working well with their trainer, then they should stay out of trouble."
The time to see a doctor is when- ever you first suspect something is wrong, long before a minor issue becomes a major one. "Singers know when they're having problems," Sugarman says. "The important thing is to be proactive at the first sign of a problem and not to wait."
Even a common cold can become serious when you're dealing with the rigors of touring or Broadway. "If you end up with an upper respiratory infection and you have to perform, that's a good way to injure yourself," Sugarman warns. "If somebody is an accountant, it doesn't really matter if they have a sore throat and a cold, but if you've got to go out and do three shows on tour without a day to rest, you could really damage yourself. Most singers, once they've been through that, are proactive and they'll contact their ENT when they think they've got a problem."
Sometimes performers get into vocal situations they aren't properly prepared for, such as an actor with little stage experience performing in a musical or play. This can be a recipe for serious vocal issues, especially when doing eight shows a week. "That's a setup for real problems," Sugarman says. "Once they get into trouble, they're going to keep getting into trouble, because they don't have correct technique. So while it's possible for someone like me to patch them up in the short run, you can't keep putting Band-Aids on the problem."
Sugarman treats surgery as a last resort. "Whenever possible, I avoid operating on people, and I certainly avoid operating on people until they are correctly trained, since they're just going to be back with the same problem."
Many singers keep a list of food and drink to be avoided. The main reason a singer should be concerned with diet, Sugarman explains, is a very common condition known as acid reflux: "Acid reflux is a step below heartburn; it's just a little bit of acid coming up on an individual when they're asleep at night. This is especially bothersome for singers because it swells the vocal cords." And thick vocal cords make for singing problems. "Vocal cords are like guitar or violin strings," he says, "and a thick string can only make a low note, so once the vocal cord is irritated—either by misuse, infection, or acid reflux—a singer has to work harder." This can lead to more swelling, then a blister, then a callous (or vocal nodule), which can ultimately require surgery. Sugarman says the usual warning signs of reflux are waking up with a husky voice and having to do a lot of throat clearing.
The good news is that reflux can usually be controlled with some simple steps. Sugarman advises his patients to avoid late-night eating, spicy food, tomato sauce, alcohol, garlic, caffeine, and carbonated beverages. They can further control reflux by elevating the head of the bed and using an over-the-counter antacid such as Zantac or Gaviscon. If they're still having the problem after taking these steps, he recommends they come in to see him.
Although it should be obvious to everyone by now, it still bears repeating: Singers, actors, and everyone who makes a living with their voice should not smoke. "It's impossible to maintain your range as a singer if you're a smoker, because it's like putting sandpaper on your vocal cords," says Sugarman. "Anyone who's serious about their singing career really can't smoke if they want to be singing 10 years down the line."
"It's a lot of hard work; it's like being an Olympic athlete in training," Sugarman says of being a singer. "There's this myth about sex, drugs, and rock 'n' roll. The successful singers I know take very good care of themselves. They exercise, don't smoke, eat the right things, get the right training, and work very hard. There's a lot of very nonglamorous things involved in getting ready for that 90 minutes of glamorous singing."
John Henny has been involved with the voice for more than 25 years, working with singers, actors, and public speakers. In addition to running his own Los Angeles studio, he also travels extensively, holding master classes and training teachers in vocal technique. His students have appeared on Broadway and national television and been signed to major recording labels.