1. Always follow the hydration guidelines that were presented under Voice Care. As stated there, vocal folds that are well lubricated vibrate more efficiently and are less susceptible to injury. Singers are less likely to develop pathologies, such as, vocal nodules (nodes), polyps, cysts, etc. if they consistently drink water.
2. ALWAYS warm up the voice, even if pressed for time. Your vocal cords and surrounding structures are made of muscles and cartilage. They must be stretched in a healthy manner to avoid injury and to optimize vocal performance. Warming up can also improve the endurance of your voice. After singing, Cooling down the voice (in the same manner as a warm up) has also been shown to be beneficial, especially if you’ve ended your singing on the higher or lower end of your range.
3. Sing with correct postural alignment. Be sure that your lower back, upper back, and neck are in proper placement for singing. Singing with poor posture can restrict proper breathing patterns and add tension to the larynx.
4. Do not sing out of your natural range for extended periods of time.
5. For singers and actors, the use of character voices, loud voices, and excessive voice use all present a challenge. Be aware of pushing your voice when attempting to project. Learn how to project your voice properly, with correct placement, phrasing, and breath support.
6. Never completely stop “one on one” vocal instruction. For various reasons, a singer’s technique can change subtly and quickly. A singing instructor will modify any negative changes and reinforce the things you are doing right. Even professional athletes work closely under the guidance of a coach.

** If you are hoarse for more than two weeks, you should see an Ear Nose, and Throat (ENT) physician and a speech-language pathologist.

Reflux

Two types of reflux:

GERD (Gastro-Esophageal Reflux Disease): Contents from the stomach return through the bottom esophageal sphincter and back into the esophagus. This causes swelling and irritation of the tissue in the esophagus. People with GERD feel like they have “heartburn” or indigestion. These symptoms become especially prominent when the person lies down.

LPRD (Laryngo-Pharyngeal Reflux Disease): When reflux makes it all the way up through the top sphincter and into the back of the throat, it is called LPRD. The throat, voice box, and lungs are much more sensitive to stomach acid so smaller amounts of reflux into this area can result in more damage.

Why don’t I have heartburn or stomach problems?

People with LPRD rarely feel like they have heartburn or indigestion. In fact, approximately 70% of people with LPR do not report any heartburn at all. LPR can damage the throat without a person ever knowing it is happening.

Common Symptoms of laryngeal-pharyngeal reflux disease (LPRD):

1. Hoarseness (may be most noticeable in the morning)
2. Ongoing cough or chronic throat clearing
3. Feeling of a lump or pain in the throat
4. Problems swallowing
5. Bad or bitter taste in the mouth (especially in the morning)
6. Post-nasal drip
7. Referred ear pain
8. Asthma-like symptoms
9. Singing: Difficulty with high notes: prolonged warm-up

How is LPRD diagnosed?

The 24-hour Pharyngeal-Esophageal pH monitoring is highly specific and sensitive to the accurate diagnosis of LPRD. A small tube is passed through the nose into the esophagus in order to monitor the amount and type of reflux during a typical day. This way, it can document if you have LPR as you go through your daily routine.

How do I treat and manage my reflux?

Reflux is managed with a combination of dietary modification, life-style modification, and medication. Your physician may prescribe medications, such as Pepcid, Zantac, Prilosec, Prevacid, or Nexium.

Dietary Modification:
The following foods have been shown to increase reflux for many people:

• Spicy, acidic and tomato-based food
• Acidic fruit juices
• Caffeinated beverages
• Alcohol
• Tobacco
• Fatty foods
• Strongly flavored mints

Life-style modification:

• Avoid reclining right after meals
• Eat meals at least 3 hours before bedtime
• Elevate the head of your bed 4-6 inches with books, bricks, or a block of wood to achieve a 10-degree slant
• Avoid tight belts and other restrictive clothing
• Maintain a healthy body weight.

Vocal Cord Surgery

The decision to proceed with surgery of this nature is made following an examination by an otolaryngologist, also known as an ear, nose, and throat physician. The degree of voice rest following this type of surgery is dependent upon the level of vocal cord involvement.

Mild Level (vocal fold injection): Absolute voice rest day of surgery and next day, with gentle voice use for the next week. A speech pathology consult is often scheduled to assess progress of the voice. More voice rest is recommended as needed on an individual basis.

Moderate Level (thyroplasty): Absolute voice rest day of surgery and next day, with gentle voice use for the next one to two weeks.

Involved Level (vocal nodules, polyps, cysts): Absolute voice rest for 3 days. Gentle return to voice over the next two weeks with careful voice use for up to 4 to 6 weeks. Guided singing if ok with physician. A speech pathology consult is often scheduled to assess progress of the voice.

** For all types of surgery, additional voice therapy with a speech pathologist may be recommended. This can range from a couple follow-up visits, to one time weekly over the course of several weeks.

** Return office visits to see the physician will be determined based on individual need. In general, you should expect to follow-up after surgery at 1 week, 3 weeks, 6 weeks, and 3 months.