VOCAL HEALTH – Insight for the emerging vocalist


Keith Urban Gets His Voice Back
In The Vocal Injury 101 Series, Megan Gloss shows how you can avoid vocal injuries that affect popular singers.
Case: Keith Urban
Diagnosis: Vocal polyp

Urban has battled vocal issues throughout much of his career.
But he didn’t consider it serious enough for surgical intervention until a polyp developed on his vocal cord, forcing him to push for the higher notes that once felt effortless in his register.
He lost his falsetto altogether – the golden ingredient of many songs that drove the fans wild.

Thanks to the advancements of surgery and working to strengthen his voice with a vocal coach, Urban emerged better than ever.

“I think if a footballer in their 40s was given their knees back like they were in their early 20s, that’s kind of how I feel right now,” Urban said recently.

“It’s an extraordinary feeling of freedom. I don’t have to push the pedal down to 70 mph to reach those notes anymore.”

Vocal polyps, like the ones that effected Urban, and vocal nodules have key similarities and differences.
What are vocal polyps and nodules?

The American Speech-Language-Hearing Association describes nodules as benign growths that form on the vocal cords as soft, swollen spots, most often resulting from vocal abuse, such as repeated vocal strain.
These spots can develop into harder, callus-like growths that have the potential to become larger and stiffer the longer the vocal abuse continues.

While similar to nodules, polyps can take on a number of forms. They can appear on one or both vocal cords as a swelling or bump, a stalk-like growth, or a blister-like lesion.

Most are larger than nodules and can be compared to blisters, while nodules are more similar to calluses.
What are the symptoms?

According to Dr. Henry Hoffman, ENT from the University of Iowa, nodules and polyps can cause similar symptoms, including hoarseness, breathiness, rough or scratchy sounds present in the voice, harshness, a shooting pain from ear to ear, a lump-in-the-throat sensation, neck pain, a decreased pitch-range and vocal fatigue.
Singers whose voices demonstrate these symptoms for more than 2 weeks should consult an ENT, Hoffman said.
An evaluation of vocal quality, pitch, loudness and the ability to sustain the voice will determine if either polyps or nodules could be a factor.

How do you treat and recover from them?
Both polyps and nodules can be treated medically, surgically and/or behaviorally.
Surgical intervention usually involves removing the nodule or polyp from the vocal cord; however, this approach is most suitable when the nodule or polyp is large or has existed for a lengthy period of time.
Today’s medical advancements have made it so these growths can be treated and surgically removed via laser, causing less scaring of the vocal tissues and strong recovery prognosis.

However, Hoffmann warns that laser surgery could yield some risk and advises singers to avoid it.
“Although we taught a course on lasers in laryngology for about 18 years – and still use them – we haven’t used lasers for nodules or polyps for many years due to concerns about thermal damage (scarring) and the availability of better instrumentation,” he said.

It’s more common for singers to receive and benefit from behavioral intervention, or voice therapy in response to polyps or nodules, even after a surgical procedure.
Voice therapy can involve teaching and implementing better vocal technique to decrease the risk of vocal nodules or polyps due to vocal strain or abuse and using voice treatments to alter pitch, loudness and/or breathe support for healthier singing.
Stress-reduction techniques and relaxation exercises also can be incorporated and beneficial for singers.

How can you avoid them?
Most vocal coaches advocate a healthy and organic singing technique, allowing the voice to grow through good breath support and vocal placement and not pushing or forcing the voice excessively beyond its natural capabilities, especially when nursing the voice back to health during the recovery process.
Teachers often can train singers in healthy ways to create dramatic sounds or vocal effects.
If you suspect your voice might be suffering from polyps or nodules, see an ENT, and resist the urge to force the voice to avoid further damage.

Also, implement healthy vocal rest practices and work regularly with a reputable vocal coach.
Urban’s New Found Freedom
Urban’s success in surgery, combined with a healthier approach to technique has even inspired his songwriting.

“I think getting my voice back has sort of been a metaphor for finding my voice more so as well as an artist, broadening it, really, to the things that I want to write about and I feel ready to write about that I guess I haven’t in recent years,” he said.

Shania Twain’s Vocal Comeback
Case: Shania Twain
Diagnosis: Dysphonia
In the early 2000s, country superstar Shania Twain was at the top of her game.

She had four multi-platinum-selling albums and was ranked as one of the biggest selling female recording artists of all time, making and breaking records with hits like “Come On Over,” “Man! I Feel Like a Woman,” “You’re Still the One” and “From this Moment On.

And, she possessed one of the most distinguishable voices in music.
Twain began noticing vocal issues during what would become her final tour.
A loss of vocal power
She was said to have felt her vocal power “dwindling.”

What was it that silenced Twain?
A condition known as dysphonia.
What is dysphonia?
Dysphonia is a voice disorder referring to the impaired ability to produce sound using the vocal organs – a phonation disorder.
It is not a singing term, but refers exclusively to roughness, tension or abnormality in the speaking voice.
The dysphonic voice can be hoarse or excessively breathy, harsh or rough and uneven-sounding.
Dysphonia can have many causes, everything from genetic factors to nodules – even psychological stress.

This is why it is important to seek a specific diagnosis from a qualified specialist in the event of your voice becoming hoarse for a sustained period of time.
In the case of Twain, it appears that there were several contributing factors: stress from her failed marriage, a loss of confidence, and perhaps issues of technique coupled with a demanding schedule.

How do you treat it?
The Nation Center for Voice and Speech advises that singers who have been hoarse for four weeks seek medical treatment.
More serious conditions are evidenced by persistent hoarseness, difficulty in swallowing, a sore throat, choking when swallowing, persistent ear aches, coughing up blood, weight-loss and loss of appetite.
Every attempt should be made to identify and eliminate causative factors such as stress, smoking, alcohol and technique related issues.
Singers with this condition should drink plenty of water to avoid a dry throat. Also, there should be complete vocal rest for two to three days – this includes not speaking or whispering.

Going one step further
The Department of Speech Pathology and Audiology at the University of Iowa says some singers might benefit from speech therapy during the recovery process or from working with a vocal technique teacher or coach in between vocal rest and recovery.
The therapy could take several weeks or months before any improvements can be noticed.

How can you avoid it?
Singers should do their best to minimize stress.
But this isn’t the only strategy; singers need to maintain proper hydration use healthy vocal exercises to keep the voice in shape and work towards a healthy vocal technique which keeps the strain off of the voice muscles.

Megan Gloss is a classically trained vocalist and journalist based in the United States.


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