ENT; Prevention

Can we talk about the value of voice care?

ENT; Prevention

The human voice is a powerful and complex instrument. It’s also one of the most overlooked.

Lesley Childs, M.D., a laryngologist who specializes in voice care, voice disorders and vocal cord surgery at UT Southwestern, says talking for long periods of time and singing, in particular, can be like a marathon for the vocal folds (or vocal cords). “If you’re a professional singer,” she said, “you have to train daily and keep your instrument in shape.”

Few know that better than Maelyn Jarmon, the Frisco native who recently won Season 16 of “The Voice,” the 12-week singing competition on NBC. During a recent interview, she said, “I am very committed to vocal health. You have to be willing to put in the work.”

At UT Southwestern, otolaryngology is a nationally recognized area of specialty care. Better known as ear, nose, and throat or ENT care, otolaryngology will be among the medical specialties at UT Southwestern Frisco, UTSW’s new specialty clinic opening in December. The multidisciplinary team will provide care for a range of conditions − everything from ear infections and strep throat to vertigo and voice disorders. 

At UT Southwestern’s Voice Center in Dallas, Dr. Childs regularly works with performers from the Dallas Opera, Dallas Summer Musicals, and touring musicians who come through the Metroplex, as well as a multitude of local singers and performing artists. She also cares for preachers, teachers, broadcasters, and lawyers – any professional who relies on their voice for their livelihood.

“I combined my personal and professional passions,” said Dr. Childs, herself a gifted soprano who has recorded songs for Walt Disney Records. “Most people don’t realize that there are doctors who specialize in the voice.”

An apparatus in three-part harmony

Many people probably aren’t aware of the intricacies of their vocal apparatus, either.

“I combined my personal and professional passions. Most people don’t realize that there are doctors who specialize in the voice.”

Lesley Childs, M.D.

Dr. Childs describes it as three subsystems all working together: 

  • The power source encompasses the lungs and the breath behind the sound we produce. 
  • The vibratory system, or our two vocal folds, are located in the middle of the throat and are anchored to the larynx. Made of pliable tissue overlying muscle, they open and separate to allow breath through, and vibrate together to produce sound. (Best known as vocal cords, the term vocal folds is more anatomically correct.) 
  • The resonating system is everything above the vocal folds and it is responsible for individualizing our voice and speech patterns. 

Our throat, mouth and nasal passages – vocal tract resonators – modify and amplify the vibrations created by our vocal folds.

“There is a complex science behind all of the acoustics,” said Dr. Childs. “If I were to remove two individuals’ vocal folds, both sets of folds would more or less sound the same when vibrating outside the body. The resonating systems is what helps make our voices distinct.”

4 ways we wear out our voices

It’s easy to take our voices for granted. Here’s just a few ways we do it, according to Dr. Childs:

  1. Yelling and screaming: It can feel cathartic to hoot and holler at a concert or game, but keep in mind that you’ll be making your vocal folds work overtime. Normal speaking pitch requires vibrations of about 100 to 200 times per second. When you yell or scream that rate can rise to 1,000 times per second with a significant increase in intensity. These phonotraumatic behaviors can lead to swelling of the vocal folds,  laryngitis, and even short-term voice loss.  
  2. Excessive coughing and throat clearing: When you have a cold, you can get into a pattern of coughing and throat clearing. Both are traumatic to the vocal folds. If it becomes a chronic problem it may lead to abnormal growths on the vocal folds such as polyps, cysts, or nodules. 
  3. Vocal fry: Speaking in the lowest of the registers with a gravelly voice has become trendy is recent years. (Thank pop culture trendsetters such as Britney Spears and Kim Kardashian.) But doing it persistently over time can create vocal fatigue and a limited vocal range − a major problem for performers.  
  4. Oversinging: Pushing your voice on a regular basis can lead to hoarseness. If hoarseness lasts longer than two weeks, it may be a sign of more serious problems, such as a vocal fold hemorrhage or vocal fold polyps, cysts or nodules. Those can be treated with a combination of voice rest, voice therapy and, in some cases, surgery. Stars like Adele, John Mayer, and Keith Urban have made headlines in recent years for having undergone vocal fold surgery.

The keys to keeping your voice on key

So how do you protect your precious voice? “Vocal hygiene is the medical term we use to refer to the various and sundry things we do to help care for the vocal folds,” said Dr. Childs. “There’s definitely some voodoo on the subject out there on the internet, though.”

Here are a few science-based voice-care strategies she recommends:

  1. Stay hydrated: Drinking plenty of water thins secretions and mucus. “Like good oil for a car engine, thinner mucus keeps our vocal engine running cleaner,” she said. We need mucus because it keeps our vocal folds lubed up, but if it gets too thick, it can work against us, causing excessive throat clearing and coughing.
  2. Be a steam player: Steam is one of the only ways to more directly hydrate the vocal folds, because steam passes right over them. You can use a steam inhaler or do it the old-fashioned way using a pot of boiling water. A room humidifier will also keep the air moist, especially in dry climates and during the winter months.

3. Limit alcohol and caffeine: Both alcohol and caffeine can dry you out by dehydrating the body. Decongestants can also be drying if they’re used regularly over a long period of time.

4. Pace your voice: Think about how much you use your voice in a given day. UT Southwestern’s voice therapists recommend that for every 60 minutes of voice use (in a normal adult larynx), your voice needs about 10 minutes of rest.

UT Southwestern established the Voice Center in 2008, and its team of fellowship-trained laryngologists and voice therapists have all received specialized training on how to treat people with vocal injuries. They also work with singers and performers to help them to preserve their voices and to produce their sound more efficiently.

When UT Southwestern Frisco opens in November, laryngologist Kathleen Tibbetts, M.D., will be available for voice care appointments in Frisco. She will also provide a seamless connection to the Voice Center in Dallas.

We only get one set of vocal folds and one voice. Make it last a lifetime.

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