The Five Commandments of Vocal Health

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Pop-superstar Adele was recently forced to cancel the remainder of her tour due to voice damage for the second time in five years. Her latest voice setback has prompted a vigorous debate on social media about vocal health. Voice doctors, teachers and gurus are trying to explain why so many stars are currently having voice problems.

The list of voice to do’s and don’ts is extensive: from famed Soprano Shirley Verret becoming a loner on show days to preserve silence, to stories of legendary tenor Franco Corelli having his wife hold a cross to his larynx in order to obtain divine protection for his voice.

The next five commandments are a compilation stemming from my own investigation into voice health myth and science.

First Commandment: Thou shall be silent

If your voice is tired, one of the best strategies is in fact to remain silent, and by that I mean complete silence, no talking, singing or making weird sounds. The average vocal cord is only 23 millimetres long and is composed of very thin, sensitive, pliable, soft tissue. Typically, it takes at least 48 hours for this tissue to recover from a mini-trauma such as getting tired from singing or talking too much. It’s also been shown that different people produce different levels of collagen subtypes in their vocal cords. Collagen has a direct impact on vocal stamina. Roughly speaking, the more collagen in the vocal cords, the greater the stamina and elasticity of the voice.

Second Commandment: Thou shalt not smoke or vape

It goes without saying that smoke irritates the delicate tissues of the vocal cords and lungs. Not enough research has been done to arrive at a definitive conclusion as to whether or not vaping is damaging to the voice. However, speech therapist Kristie Knickerbocker has warned readers in an article in Voice Council Magazine that, in her opinion, people are deciding that electronic cigarettes are safe because of the lack of evidence against them. She offers people this view: ”In my clinical opinion, you are still inhaling something that is manufactured and exposing your most delicate tissues to foreign materials that may or may not be toxic.”

Third commandment: Thou shall be alert for acid reflux

Known also as gastroesophageal reflux (GERD), acid reflux is one of the most popular ailments of singers. It occurs when fluids — mostly acidic — from the stomach move up and down between the stomach and the esophagus. Sometimes the fluids make their way up to the throat and larynx, in which case it is called laryngopharyngeal reflux or LPR. The throat and larynx are not, of course, made to withstand the levels of acidity found in the stomach.

The symptoms of GERD and LPR are constant throat clearing, excess mucus, hoarseness, sensation of lump in throat, laryngospasm, difficulty to warmp up the voice, and sore throat. It’s important to mention that acid reflux is not always accompanied by the typical heartburn. That’s why endoscopy followed by a proper assessment from an ENT becomes really useful to determine GERD and its preferred treatment. Usually the specialist prescribes proton pump inhibitors to block acid production and changes in diet that include avoiding coffee, alcohol, and fatty foods.

Fourth commandment: Thou shall avoid the use of blood thinners

You’ve got a headache … So a good solution would be to take an Advil, right? Sorry, wrong! If you use your voice professionally and have any kind of ache that becomes too bothersome, please use Tylenol instead, or other products based on acetaminophen. Advil as well as Motrin and Nuprin contain ibuprofen as its active ingredient, which is a blood thinner. Blood thinners increase the odds of having a voice hemorrhage. (An even more powerful blood thinner is aspirin — which is much better used to prevent clots than to calm a headache).

There are also natural blood thinners: garlic and ginger are the most popular among singers. Any given singer might think he/she is taking good care of the instrument by eating tons of raw ginger, when the truth is that they might be actually increasing the risk of having a vocal cord hemorrhage. One doesn’t need to completely avoid these natural blood thinners and anti-inflammatory medications. Instead, take them in prudent quantities.

Fifth Commandment: Keep calm and drink water

Singers are always looking for the magic elixir that will make their voice young and beautiful forever. Well, I’ve found it — loads and loads of water!

At the risk of being obvious, keeping well hydrated seems to be the #1 vocal advice offered by gurus, voice teachers, doctors, and speech therapists. Although there is no magic number, common advice is to drink 6 to 8 glasses of water a day. The best (and most practical) way to check if one is drinking enough water is to verify the color of one’s urine: it should be pale. Also, if you drink tea, coffee, or alcohol, you need to know that these liquids may cause dehydration. It might be necessary to adjust your water intake accordingly.

Everything affects the voice, including your thoughts. The most sound strategy for vocal health is to take a holistic approach and to listen to your body without ignoring science and facts. For example, if a steaming cup of espresso makes you sing like Pavarotti, then by all means have your cup of coffee, but please know that it’s probably more a psychological crutch than physiologic effect.

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