Signs of voice injuries

Voice injuries to the singer are like muscle injuries to the athlete. If singing is your career you are at risk of voice injury at some point. Top ENT/Laryngologist Dr Reena Gupta explains how to recognise when you might be at risk, the warning signs and how to avoid injury in the first place.

We are in a time in the music industry when the demand placed on the voice is extremely high. Music is written in a way that’s harder to sing, performances are even more frequent, voice use for non-performance purposes is on the rise (phones, Bluetooth, etc.), and rest is nearly impossible.

There are also more people vying for the same spotlight, making every note that much more important. In that context, it’s easy to understand why singers feel pressure and push their voices. However, what these desperate measures prove is that pushing often leads to falling over the edge.

It is not the intention of this article to suggest that singers should panic and seek a laryngologist’s help immediately. Rather, it is my hope that by understanding the voice better, a singer is more aware of when to worry and when to wait to seek care. Unlike a guitar string, a singer cannot directly see if they needs to tune the string or if it is snapped. The singer cannot guess the extent of their injury just by hearing that their voice is off. However, there are warning signs that help a singer know when to ring the alarm bell.

Protecting your most important asset.


Setting yourself up for success before injury strikes

Tip # 1. Develop a relationship with a laryngologist when you don’t need it. Unexpectedly running into trouble on the day you are supposed to be in the studio and then hoping to find a laryngologist, booking an appointment, meeting them, liking them, and getting the best care is unrealistic.

Tip # 2. Learn about the voice. Singers are notoriously unaware of how their instrument works. This disconnect occurs, in large part, because the vocal folds are hidden inside of the neck. However, the more the singer knows about the mechanism of their voice, the better they are technically and the less likely they are to get injured.

Tip # 3. Learn your voice. The only way to know if your voice is off is to know what it sounds like when it is on. Daily practice and vocal self-evaluation allows you to hear minor changes early. Know your vocal range and record it. Record and listen to the quality of your voice so you can recognize if it changes.

Naturally, to do this you will need to…

Tip # 4. Have an excellent and trusted vocal coach. We are very poor judges of our own voices. The outside ears of a trusted vocal coach allow you to get an unbiased take on your voice and your technique. This also allows someone else to know your baseline so that changes are detected early.

Which brings us to…

Tip # 5. Don’t ignore voice changes. This might mean you go into the doctor at times you could’ve avoided. But it also means you won’t wish you had come in sooner. Singers get one day of symptoms before they should be seen.

Now you’re suspecting a problem.

Tip # 1. Check yourself. The voice is a very fragile instrument, which worsens with even mild triggers, such as eating a pizza the night before or talking to a friend on the phone for an hour.
Test yourself- attempt to sing softly. Attempt to sing to the upper part of your normal range quietly. If you can do this, you are probably okay. Evaluate what has happened over the past 24 hours and see if you can account for the change. If you can account for the change, rest your voice and see what happens.

If you can’t, then you should:

Tip # 2. Confirm it with your vocal coach. Remember the person we suggested you find earlier? Ask them. Do they hear what you hear? Can you work it out with them in one voice lesson? Use those unbiased ears you’ve developed a relationship with and see what they think.

If they agree with you then you should…

Tip # 3. Seek help early. Do not wait more than 24 hours. Most voice problems, if treated within 24 hours, are reversible. After that, the chances go down.

You know your voice and this is not it.

The above refers to the mild changes that may occur over a vocalist’s career from things like allergies, reflux, voice overuse, incorrect technique, or fatigue. But sometimes there are more dramatic changes.

Signs that you should worry and be seen urgently:

  • You’ve lost more than 3 notes (usually off the top)
  • Your voice change was sudden
  • Your voice change occurred while singing
  • Your voice change occurred while you were sick
  • You have pain when you sing
  • The quality of your voice has become more hoarse or raspy
  • Voice production is more effortful

Signs you should worry but not run in the next day:

  • You’ve lost 1-2 notes
  • Your voice change has been gradual
  • You used to be able to sing something you cannot any more (and “used to” was more than 3 months ago)
  • You feel tired after singing
  • You cannot sing quietly
  • You do things that are vocally damaging (i.e., smoke, yell, have uncontrolled allergies)

Signs that everything is probably okay:

  • Your speaking voice quality sounds normal
  • Your range is intact
  • You do not feel tired after singing (note: feeling tired is different than feeling that you’ve worked your voice)

In the end, there is never a singer who has regretted getting a laryngologist’s view of their vocal folds. When in doubt, rigid stroboscopy is a quick and painless way to know the status of your vocal folds. If there is a question, the answer is probably to get yourself checked.

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.