Common voice problems in singers

Voice problems in singers are quite common. If you have voice issues you want Dr. Reena Gupta on your side! She is not only a highly qualified voice doctor (ENT/Laryngologist) but she is also passionate about singing and driven by the desire to ensure singers are able to thrive in their careers.

Dr. Gupta discusses some real case studies of singers she has seen and helped. Hopefully, you can learn from these cases and avoid vocal health issues but if you do find yourself with vocal issues make sure you get seen by a qualified ENT/Laryngologist ASAP.

This article contains stories of the most common voice disorders seen in my office. The goal is to help you filter through some of the misinformation so that you may begin to understand where your symptoms are coming from.  Hopefully, this will also dispel some of the fear that surrounds voice problems.

CASE 1 THROAT CLEARING

An 18-year-old singer complains of a month-long history of throat clearing.  She notes that when she feels a lot of mucous, she clears her throat more and finds herself more vocally fatigued. Her range is more limited and she becomes hoarse quickly after starting singing.  If she rests her voice, it returns to normal, but the feeling of mucus in her throat persists.

Relevant Data and Its Interpretation:

• Good days and bad days ? this  is not an injury like a polyp, which  would not allow for “normal” days

• Throat clearing? mucous on the cords, most commonly due to reflux or allergies

• Progresses to hoarseness and fatigue? there is a compensatory technique issue

By reading her history, we can narrow the possibilities down to reflux or allergies. She likely also has developed compensatory technique issues due to laryngitis (inflammation). Either reflux or allergies will result in mild vocal fold swelling and throat clearing worsens this. The mild swelling will increase rapidly when singing, because of the intensity of voice. Attempts to sound clear, despite this swelling, will result in poor compensatory behaviors, producing fatigue. Nasal exam of the patient confirmed allergic swelling.

The video confirms this:

VIDEO 1 Prominent blood vessels, thick white mucous, and irregular vocal fold edges are consistent with allergic laryngitis.

CASE 2 THROAT PAIN

A 42-year-old professional singer complains of pain while singing. He has noted that for the first 30 minutes of singing, he does not have pain but then towards the end of his set, he has pain. After performing and doing meet and greets,  he notes pain. The pain resolves overnight but then resumes again in the morning when he starts to talk.

The pain is located in his throat and neck, but he cannot point to it. Ibuprofen alleviates the discomfort, but he does not want to rely on these, knowing there is a vocal risk and that it is masking his symptoms. He first noted this several months ago, after a weekend of performing, where the monitors were not working well. He denies significant change to his vocal quality but is hoarse by the end of a night.

Relevant Data and Its Interpretation:

• Normal vocal quality most of the time? no  vocal fold  pathology (such as nodules, polyps, cysts, etc.)

• Hoarseness after performing for a while? swelling sets in over time, due  to muscular/ technique issues

• Pain with voice use? almost always muscular compensation

• Relieved  with ibuprofen  this helps  muscular/ligament pain  and argues for a muscular cause

Again, the story has provided a  very good sense of the diagnosis.  Indeed, this patient is suffering from muscle tension dysphonia, which means muscular misuse for voice production. This most commonly occurs when a singer is forced to “push” or compensate for something (i.e., a long set, poor monitors, singing out of their range,  singing when sick, etc.).  During these periods of stress, muscular misuse patterns are established and then become habitual. Because these patterns are not optimal for voice use, the muscles that are being used cause pain.

CASE 3 WIDENED VOCAL BREAK, DECREASED VOCAL RANGE

A 32-year-old soprano has noted increased width of her vocal break, as well as increased effort to comfortably reach her highest notes. These were previously very easy for her as she has been in vocal training consistently throughout her career. She noted symptom onset 4  weeks ago,  after a  cold. While her vocal quality (tone) is normal, she is very concerned that it feels different when she is singing.  Her range is not diminished but the sound is airier in her upper range. She denies pain but does note vocal fatigue.

Relevant Data and Its Interpretation:

• Wider break?  the problem on vocal fold edge or muscular problem  (like Case 2); the break is difficult to navigate and any abnormality of the edge causes this break to widen. Poor technique may also cause this

• Normal vocal tone ? may still be either of the two above problems but if it is a vocal fold edge problem, it is something small because her tone is normal

• Airy? vocal folds are not closing; still could be either of the two problems

In this case,  history alone is not sufficient to diagnose the patient. An examination using videostroboscopy (aka scope) demonstrates very mild swelling in the mid-vocal cord.  This is enough to cause the symptoms described and can result from an illness that causes laryngitis. Because the middle of the vocal folds contact first, they bear the brunt of the vocal force and swell with excessive force. During an illness, if the singer continues to sing, the middle of the folds may swell more than the rest of the folds. This will cause airiness because this swelling does not allow the rest of the cords to close completely.

VIDEO 2 Mild striking zone  (mid-cord) swelling producing airiness from lack of closure, decreased range  (because straight edges are needed on higher notes), and increased effort (because the swelling must be compressed to eliminate air escape).

Conservative treatment with voice rest, therapy,  and steroids will result in resolution of this.

The main purpose of these case studies is to show that most common vocal complaints are from simple medical problems.

Hopefully, you derive some peace of mind from understanding what problems are suggested by these common complaints.  It is important to note that without timely evaluation and treatment, many of these can potentially lead to serious vocal complications.

A quick evaluation will get you on the path to treatment, but while you wait for that appointment, I  hope you no longer fear that you have nodules or even something more vocally ominous.


For more vocal health advice why not download iSingmag’s free eBook

Good Vocal Care For Singers.

http://www.ohniww.org

Dr. Reena Gupta is the Director of the Division of Voice and Laryngology at the Osborne Head and Neck Institute (LA, California). She is a laryngologist/voice specialist who has devoted her career to caring for professional voice users. Dr. Gupta’s desire to care for voice patients stems from her passion for the vocal arts. She began singing in elementary school and continued through college and medical school, while pursuing her love for the art of medicine. She completed residency at New York University School of Medicine in Head and Neck Surgery and the prestigious fellowship in Laryngology and Care of the Professional Voice at Drexel University College of Medicine. Dr. Gupta strongly believes in advocating for performers and designs treatment plans that enable her patients to thrive in their careers.