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This handout is designed to jump-start your vocal rehabilitation process. It contains tips and tricks to managing vocal hygiene and decreasing vocal fold injury to begin the healing process. Not all the ideas will apply to you, but take your time and read through these pages to discover what will.

Hydration

Well hydrated folds vibrate more easily than dry folds, and are less likely to succumb to injury.

  • Drink enough WATER (not juice, tea,soda, etc) so that your urine is pale.
  • Decaf does not mean no caffeine! Balance out every caffeinated and decaffeinated drink with an equal amount of water.

Tips

  • Carry a bottle of water in your purse/car .
  • Keep a case of water in the refrigerator at work .
  • Buy washable plastic bottles; remember to wash daily to prevent contamination.

Drinking water helps combat internal dehydration. But there is also external dehydration that can have the same drying effects on your vocal folds with the same consequences .

  • Limit use of air conditioners.
  • Place a hot air stearn humidifier in your bedroom at night (during the dry winter months especially).
  • Use a personal steam inhaler (available at most drugstores for less than $30). This delivers humidified air directly into your nose and mouth (and to your vocal folds) .
  • STOP smoking
  • Reduce second-hand smoke; sit in the non-smoking section, limit time in smoky environments (more on bars/restaurants later).

Irritants
Besides the dehydrating effects, smoke is also a laryngeal (vocal fold) irritant. The heat alone of a cigarette (cigar, etc) can cause changes to the delicate covering of the vocal folds. Smoking causes increased reflux and decreased lung functioning as well cancer (not only to the lungs, but the larynx/vocal folds, and mouth). Other irritants include cleaning supplies, chemicals, paint, some personal oral care products, etc. Limit exposure to these substances.

  • If you are painting, staining or cleaning -leave windows open for maximum ventilation. Wear a mask .
  • Cough drops/lozenges: menthol and eucalyptus lozenges can be irritating to the very sensitive vocal fold mucosa. If you want to suck on lozenges, buy the fruity or honey kind instead. Grether's Black Current pastilles are great, as are sugarfree gummy bears

Reflux
There are 2 common types of reflux -Gastroesophageal reflux (GER) as commonly seen on TV commercials, and Laryngo-pharyngeal reflux (LPR). LPR is the type that involves the vocal folds. LPR is when stomach acid comes up the esophagus from a lax upper esophageal sphincter and spills over onto the larynx (voice box). This may cause irritation and swelling of the vocal folds. LPR can also cause increased mucus production and the need to constantly clear one's throat which can also lead to swollen vocal folds. To reduce LPR:

  • Avoid hot, spicy, fatty, acidic, caffeinated foods; including fried foods, chocolate, citrus, and tomato-based foods .
  • Avoid easting late at night
  • A void alcohol
  • Avoid lying flat when sleeping (attempt to elevate the head of your bed 6" by putting bricks under your bed posts, or adding pillows under your head).
  • Avoid over-eating
  • Maintain a healthy weight for your body type.
  • Limit caffeine, alcohol, chocolate and peppermint as these items may relax the Upper Esophageal Segment (UES)

You may be advised by your physician to take anti-LPR medications. These include:

  • Proton Pump inhibitors (PPIs) (ex: Protonix, Nexium, Prilosec, and Prevacid). These medications 100 % eliminate the production of acid in the stomach. These medications should be taken Ihr to 30 min before the biggest meal of the day, preferably one containing protein. PPIs are activated by food in the stomach, so they are only effective when taken before a big meal.
  • H2 blockers (ex: Tagamet, Zantac). These are anti-histamines that neutralize acid produced in the stomach. These medications should be taken right before going to bed.

Phonotrauma
Phonotrauma is a long, fancy word for injury to the vocal folds from voice use. Types of phonotrauma, as well as tricks for preventing them are as follows:

  • Screaming - don't do it. There is no real way around this recommendation. Screaming involves lots of lung pressure exerted on tightly stretched, lengthened vocal folds, and is a recipe for vocal fold disaster. Except in matters of danger or threat, it is unnecessary and harmful to scream.
    - Cheer at sporting events silently; no one except you will know. Remember you can always jump up and down and clap
    - Same goes with rollercoasters, sledding, skiing, screaming over car/truck/boat motors.
    - Get up and go talk to the person, instead of screaming for them.
    - Whistle, use gestures, instead of screaming for someone .
  • Speaking in loud environments, including bars, restaurants, sporting events, parties, choirs, church, professional meetings, etc. These situations cause you to raise the volume of your voice, and frequently the pitch, vithout you even knowing it. Try as you might to say, "I'm not being loud," you are. This does not mean you can never leave your house again. The last thing a therapy treatment should do is curb one's personality. That said, here are some tips to avoid phonotrauma in loud environments.
    - Wear an earplug in one ear. These can be purchased from most drugstores for less than $3 for a pack of 6 or 8. When inserted, you hear your own voice through bone conduction in your head, making you much more aware of how loudly you are speaking. You may also be able to hear others better, as the earplugs filter out "noise."
    - Stand very close to the person you are talking to, even direct your mouth towards their ear so you don't have to shout.
  • Telephone: We all tend to increase our volume when speaking on the telephone. To avoid phonotrauma:
    - limit talking on the phone in a room where there is music playing, other people talking, etc. (Increased background noise)
    - limit talking on your cell phone with music on in the car, while walking on a street with a lot of traffic, while on the bus, or while in the car with your windows down. (Increased background noise)

Vocal Fatigue
Should you feel vocal fatigue, even by following the above instructions, there are a few quick tips:

  • Take a vocal nap. If you speak for a long period oftime, take a 5 minute break .
  • Email a friend instead of calling them.
  • Plan for times of heavy voice use to be surrounded by time of calm, silence.

Overall Health
Your general, overall health affects your voice. Remember that your vocal instrument is inside your body. So, if your body is tired, your voice is tired. Some tips to maintaining great health are:

  • Exercise! Includes more than just the gym-walk to work, take the stairs, park far away from your destination.
  • De-stress. Take some tie out for you. Stretch periodically throughout the day, get 7 -8 hours of sleep .
  • Wash your hands a lot to avoid catching illnesses. If you do get sick, get a ton of rest, and limit voice use .
  • For women-right before menstruation, the vocal folds can become puffier from fluid retention and increased vascularity. This might make voicing more effortful-so go easy on these days. The same is true for during pregnancy.

FOR TEACHERS ... go to www.voiceacademy.org

 

References:
Koufman, lA. (1991). The otolaryngologic Manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 101(Pt2SuppI53), 1-78

Verdolini K Ostrem J DeVore K McCoy S. National Center for Voice and Speech's Guide to Vocology. Iowa City, Iowa: National Center for Voice and Speech 1998,