Friday, December 27, 2013

Care of Your Speaking Voice

You and your larynx... what you need to know
Vocal cordsYour voice reflects many different aspects of your personality. It's what makes you unique. Lifestyle choices and differences in daily vocal use or misuse can affect the health and stability of your vocal cords. We do know that the effects of smoking and drinking alcohol can have detrimental effects on the voice and may lead to cancer of the larynx.Keeping a healthy voice throughout your lifetime.
1.Don't smoke! Don't smoke! Don't smoke! Also, stay away from smoke-filled environments.
2.Hydration matters. Drink at least 8, 8-ounce glasses of water per day (64 ounces); more if you drink caffeine, alcohol, or if you're exercising. Hydration appears to affect voice in at least two ways. First, well-hydrated vocal cords vibrate with less "push" from the lungs. Second, well-hydrated cords resist injury from voice use more than dry cords, and recover better from existing injury than dry vocal cords. Increased systemic hydration also has the benefit of thinning thick secretions (Titze, 1988; Verdolini-Marston, Druker, & Titze, 1990; Verdolini, Titze, & Fennell, 1994; Verdolini et al., 2002; Titze, 1981; Verdolini-Marston, Sandage, and Titze, 1994).
3.Eliminate excessive throat clearing. Chronic throat clearing can result in irritation and swelling of the vocal cords. Try sipping water, humming, or using a "baby" throat clear.
Limit alcohol intake.
4.Alcohol irritates laryngeal epithelium and mucosa, and has been linked to laryngeal cancer risk.
5.Avoid vocally abusive behaviors.
  • Decrease overall volume; if you're talking one-on-one in a small room, talk quietly!
  • No shouting/yelling; find another way to let people know that it's dinner time or that they have a phone call!
  • Watch excessive phone talking; you may not realize how loud you're talking while on the phone. Ask your listener!
  • Don't whisper! It may actually make your voice worse!
  • Don't talk in the presence of a lot of background noise! Talk to someone only when they are an arm's length away.
  • Don't try to talk or sing when you have a bad cold or laryngitis.
6.Avoid chronic use of mouthwash.Most mouthwashes have a high alcohol content, which can be irritating to the larynx. If you wish, use mouthwash to rinse your mouth... if you must gargle, switch to a mouthwash without alcohol or use warm salt water.
7.Posture matters.Good posture allows better airflow and reduces tension and strain. Poor posture can be improved with an exercise program designed to strengthen and realign the body for optimal support.
Exercise regularly to keep your body, mind, and spirit healthy. Try yoga for the extra benefit of stretch, relaxation, and strengthening, as well as good posture.
9.Get sufficient sleep daily .Early to bed, early to rise makes your voice healthy and wise.
10.Always warm up your voice before or cool down after prolonged speaking or singing. Try quiet lip or tongue trills up and down your range, or softly and quietly hum five-note descending scales in the middle of your range.

Monday, December 9, 2013

Sharp Pain - Front Neck (Daughter said stretch neck mom, heard THUMP)

I am a 53 year old woman .... hypothyroid, diabetes 2-Sjogrens. History of irregular cervical lymph nodes, and am in 5 days heading to an oncologist to evaluate lumps I have here there (crook of arms, and up to bicep and a large node left side in axilla that are painful. My voice keeps getting hoarse and dry cough. I DO NOT SMOKE OR DRINK......... BUT TONIGHT I was quite scared because a very QUICK SHARP PAIN upon exhale/inhale and speaking or laughing! My question is this: is there a condition, rather a scenario, possibly from edemas tissue from my GERD? or ??? that MIGHT cause some anatomy to catch in the front neck like inside that a nail scraping or a PINCH...... deep in front, possibly such as a spasm, deep inside front throat/neck.... larynx area then my baby girl, said MOM YOU LOOK scrunched up, stretch your neck and I felt a click/ but in ear hear this release or move out of spot? as a thud..... as it seemed to simply be a misplaced? Something that then became a "click free" pain went away....... it was a scary weird fast onset, pain I thought that's it, I am in trouble, I had been laughing and thought I BUSTED MY insides of this area.

On another factoid sometimes I hear a click click in throat along with the heart beat..... like 1x every 2 months for a hour? I am a sensitive flower. I would really appreciate some idea how to explain to the physician, I speak oddly and feel if I say too much, I become confusing, thank you.

Melissa Kim M.S., CCC-SLP replies...  

Although there are many symptoms of acid reflux that present in the head and neck area, I cannot say I would typically associate sharp pain with respiration with this condition. I would certainly suggest that you mention this incident to your physician.

Best of luck to you!

Singing Voice

After nose and throat surgery 2 years ago I am not able to sing soprano. My Dr. said I would be able to after a few months. Still no luck. Should I go back and be evaluated with my nose and throat Dr. about this?

Melissa Kim M.S., CCC-SLP replies... 

Yes, I would recommend that you return to your surgeon for re-assessment.

Good luck!


Sunday, December 1, 2013

Nodules / Polyps / Cysts

I have been confused.  My voice range has decreased a bit and when I talk too much my throat starts to burn. I thought I had vocal nodules and went to an ENT.  He checked my vocal cords with a reflecting mirror & told me I had very small nodules but after 5 months I went to another ENT and he checked my vocal cords with an endoscope (camera).  He said there was nothing wrong with my vocal cords.  Then, the question is why has my voice range decreased a bit? My voice isn't hoarse but why is my voice range decreased a bit?

Melissa Kim M.S., CCC-SLP replies... 

Difficulties with range are often simply a matter of technique, which can and does change over time, particularly in response to underlying structural changes such as vocal fold nodules. This is one reason why even professional singers continue to study with teachers of singing. If your physician feels that your larynx is healthy, I would suggest seeking out an experienced singing voice teacher.

Good luck!

Thursday, November 21, 2013

Medical Recommendation

I have a raspy voice which came on gradually last fall so that I had to give up singing. Yes, I smoked for years, but have not smoked since last fall. Can you recommend treatment or physician type that I should be contacting to obtain treatment. I am being treated now for rhinitis. What do singers do when they lose their voice? Whom do they see? Thanks.

Melissa Kim M.S., CCC-SLP replies... 

I would suggest that you seek out a consultation with a laryngologist, an Ear, Nose, and Throat physician who specializes in the diagnosis and treatment of voice disorders. Ask your physician for a referral, or visit the American Academy of Otolaryngology's website at If you choose to do an "Advanced Search" on that site you can narrow your search to the subspecialty of laryngology.

 Best of luck to you!


Thursday, November 14, 2013

Lost Use of One Vocal Cord & Severe Swallowing Problem

My wife had surgery to remove most (2/3's) of a benign meningioma, followed by 6 wks. of proton treatments. Surgery/follow up care resulted in loss of use of one vocal cord but, more troublesome, is her difficulty swallowing. Has received a mixed message that thyroplasty may or may not help the swallowing. Can you give us some probabilities?

Melissa Kim M.S., CCC-SLP replies...

Medializing a paralyzed vocal cord may, in some cases, improve overall swallowing function. Without details as to the results of a recent instrumental swallowing evaluation, I cannot remark as to whether or not such a procedure would be helpful in your wife's particular case. I would be happy to comment further if such results were available, or I would suggest consultation with a laryngologist (an Ear, Nose, and Throat physician who specializes in the treatment of voice disorders).

Good luck!

Wednesday, October 30, 2013

Neck Damage

Recently I had a chiropractic adjustment to my neck. The next day I knew something was wrong. I had popping sensations at different parts of my neck. Now I am burping all the time. After a big meal it is worse, and I feel pressure in my upper chest. After I have burped all day my throat is mildly sore constantly. What damage do you think was done? Do you think it is permanent? Should I go get it checked? As you can imagine any type of intervention is very scary for me now.

Thanks so much.

Melissa Kim M.S., CCC-SLP replies...

There could be any number of explanations for your symptoms, so to even guess as to your diagnosis via email is not possible. It would make sense to see a physician, and I would actually suggest that you begin with your family doctor. There are a number of different specialties that might be appropriate for consultation, including otolaryngology, orthopedics, gastroenterology, or speech pathology, and your family doctor can direct you in terms of where to best begin after examining you.

Best of luck to you!


Saturday, October 26, 2013

Thickened Vocal Cords

I have been having trouble singing for the past 3-4 months. (I lead worship service at my church and have been singing for years). I went to a local ENT and he told me that my vocal cords are "thickened".. approximately twice as thick as normal. He did not say what caused this, how to treat it, or if it CAN be treated. He was more interested in chatting with my husband than he was with discussing my condition with me. I, MOST OF THE TIME, can get through one song at church, sometimes two, before I get really hoarse and sometimes lose my voice all together for a few hours. Some days, if we are busy at work and I have to talk a lot, I will go home from work in the same condition. What can I do to get back to being able to sing? *I am 42 years old, do not smoke (NEVER have)! Thanks for your time!

Melissa Kim M.S., CCC-SLP replies... 

In order to determine prognosis and appropriate intervention, the reason for your vocal difficulties and "thickened" vocal folds must be established. If you were not satisfied with the outcome of your evaluation, I would strongly suggest that you seek out a second opinion.

Good luck!

Hoarseness for 2 Consecutive Months

I have been a physical ed. & health ed. teacher for the last 37 years. A few months before the summer, my voice was hoarse. During my summer vacation, my voice was back to normal. The last 2 months of school, my voice is hoarse again. I do NOT scream at my students but use my voice for intervals of 3 hours everyday. A break for 50 minutes. Another 2 hours talking to my students, rest 30 min. another 2 hours with the students. My doctor examined my throat and saw everything was fine. There is NO pain, swelling, etc. I am supposed to see the otolaryngologist in Jan. 2015. I am drinking tea each day to sooth my throat when at rest. Staying away from a lot of caffeine, NON-SMOKER too. When will my voice return back to its normal state? Remember, NO pain, No swelling. Non-Smoker. Use voice everyday.

Melissa Kim M.S., CCC-SLP replies...

If your larynx was determined to be healthy by an Ear, Nose, and Throat physician, it is very possible that your speaking voice difficulties are secondary to muscle tension dysphonia, a general term to describe excessive and unnecessary tension of laryngeal muscles during voicing. Muscle tension dysphonia is often seen in response to an underlying condition, such as acid reflux, that causes irritation and subsequent compensatory change in vocal technique. Treatment involves intervention for any underlying condition, and voice therapy with a speech pathologist who specializes in the treatment of voice disorders; ask your physician for a referral. 

Good luck!

Friday, October 18, 2013

Tips for Professional Voice Users and Singers

Professional voice users, including both speakers and singers, can follow particular guidelines to promote optimal vocal fold health and function. 
1. Consult an Ear, Nose, and Throat Doctor (ENT). Consult an otolaryngologist, or ENT, to obtain a baseline evaluation of your voice when you are healthy.  Establishing a healthy picture of your larynx serves as a source of comparison if you encounter voice difficulties in the future.  Search for an otolaryngologist by name, location, or subspecialty through the American Academy of Otolaryngology - Head and Neck Surgery at For a listing of voice centers nationwide, please see our   National Voice Center Referral Database.
2. Maintain adequate hydration. Many physicians and clinicians propose that consuming approximately 64 ounces of non-alcoholic fluids per day is necessary to maintain adequate hydration.  Research supports that adequate hydration allows vocal cords to vibrate with less "push" from the lungs, especially at high pitches.  In addition, well-hydrated vocal cords resist injury from voice use more than dry cords, and recover better from existing injury than dry cords.  Increased systemic hydration also has the benefit of thinning thick secretions.  (Titze, 1988; Verdolini-Marston, Druker, & Titze, 1990; Verdolini, Titze, & Fennell, 1994; Verdolini et al., 2002; Titze, 1981; Verdolini-Marston, Sandage, and Titze, 1994).
Individuals who experience external dehydration, such as those individuals living or working in a very dry environment, may benefit from the use of a humidifier or vaporizer.  Dr. Katherine Verdolini of the University of Pittsburgh Voice Center recommends the use of a hot water vaporizer versus a cool-mist device.  The reason is that cool-mist devices vaporize everything in their reservoirs, including any chemicals or germs.  On the other hand, hot water vaporizers create vapor by boiling water, and because water has a lower boiling point than most chemicals, only water is delivered into the air. It is important to check with your doctor before beginning any hydration program.  Drinking large quantities of water can be harmful for some individuals with serious health conditions.
3. Always warm-up and cool-down. Warming-up the voice is important before prolonged speaking or any singing engagements.  A simple, yet effective vocal warm-up is to perform lip-trills while gliding up and down the full extent of one's pitch range.  Additional exercises are discussed on the Vocal Warm-Ups page. Although frequently ignored, vocal cool-downs may also be used to prevent damage to the vocal cords.  The simple practice of gentle and relaxed humming can serve as one excellent, easy form of cooling-down.
4. Know your range.  Avoid singing pieces at the extremes of your vocal range.  To determine your range, perform light glides or lip trills to your highest and lowest notes.  Record these notes by checking them on a piano.  Make sure that pieces in your repertoire fall above the lowest and below the highest extremes of your range. To view average vocal ranges for soprano, mezzo soprano, alto, tenor, baritone, and bass voices, see those put forth by the New Harvard Dictionary of Music at
5. Know the potential side effects of your medications. Many commonly prescribed medications can have significant effects on the voice.  For a listing of medications and potential adverse effects on the voice, see the list compiled by the National Center for Voice and Speech at
6. Screen yourself daily for vocal cord swelling. Screening yourself for potential vocal cord swelling will help you to determine whether you should perform on a particular day, or take a vocal rest.  Tasks for daily screening are found on the   Vocal Screening   page.
7.  When singing with a band, use monitors.  Have some small speakers facing you on stage so you can hear yourself adequately and modify your volume accordingly.
8.  Avoid vocally abusive behaviors.
  • Decrease overall volume.
  • No shouting/ yelling.
  • Don't whisper!  It may actually make your voice worse.
  • Don't talk in the presence of a lot of background noise!  Talk to someone only when they are an arm's length away.
  • Don't try to talk or sing when you have a bad cold or laryngitis.
9.  Avoid behaviors that may exacerbate acid reflux. Certain behaviors and foods may exacerbate acid reflux and yield poor vocal performance.  Please see the page on Reflux Changes to the Larynx for more information and suggestions for modifications to reduce reflux.
10. Consider speaking voice training. There is often a discrepancy between singing voice and speaking voice. Even a trained singer may demonstrate excellent technique during sung performance, but exhibit abusive speaking habits, undermining vocal functioning. To ensure a healthy balance of the entire voice, regardless of whether speaking or singing, singers may benefit from speaking voice training from an acting coach or a speech-language pathologist.   
11.  Don't smoke!  Don't smoke!  Don't smoke!    We can't say it enough.

Monday, October 7, 2013

Lingual Tonsils

What are the lingual tonsils and where are they? My ENT diagnosed me with an infection in June and subsequently prescribed antibiotics. After three rounds I still suffer from the original symptoms of throat tightening and a gagging feeling. Please help me to diagnose what is wrong.

Melissa Kim M.S., CCC-SLP replies...  

The lingual tonsils are masses of lymphatic tissue at the base of the tongue.

If you feel that you have not received an accurate diagnosis, and are continuing to experience symptoms, I would suggest that you seek out a second opinion. There could be any number of possible causes of your symptoms, and a diagnosis cannot be made via email.

Best of luck to you!

Monday, September 30, 2013

Chronic Cough

My boss is a 63 year old male who has suffered w/chronic cough for nearly 15 yrs. He's seen over a dozen doctors, been through every test imaginable, tried countless medications and nothing has helped. I began researching Vocal Cord Dysfunction about 6 months ago and this last series of tests confirmed that this is most likely the problem. He was advised that raising his pitch will elevate the need to cough. He was also informed that his vocal cords operate backwards? Forgive me because I don't really understand, but apparently upon inhale they're closing and on exhale they're opening? Whatever is going on, it's horrible. He's absolutely exhausted. He's a mental health professional who facilitates workshops to the public. His coughing has become debilitating. Please help!! It's not acid reflux, he's not a smoker, it's not sleep apnea, he doesn't have allergies, not too much mucus. Could a vocal cord problem be causing all of this coughing? How can we fix it? Thanks so much for any help you can offer.

Melissa Kim M.S., CCC-SLP replies... 

To start, I would suggest that he seek out consultation with a laryngologist (an Ear, Nose, and Throat physician who specializes in laryngeal disorders). An accurate diagnosis is necessary to establish an appropriate treatment plan, and this is just not something that is possible via email.

 Speaking more generally, the differential for chronic cough is very broad, including pulmonary disease, medication side effect, acid reflux, sensory neuopathy, and behavioral cough. If cough is related to "irritable larynx syndrome," which can include cough as well as paradoxical vocal fold motion, then relief with is obtained with acid reflux management, expert speech pathology intervention, and use (as necessary) of medications to change the nervous system's threshold for triggering the cough and paradoxical motion. A voice center where a speech language pathologist partners with a otolaryngologist to treat patients in a combined fashion would most likely have a team that is familiar with this disorder.

Best of luck to you!

Wednesday, September 11, 2013

Breathiness and Loss of Lower Range

I am a former professional singer, voice teacher, and choir director. During the last 2 or 3 months, I have experienced increasing breathiness and loss of my lower range. The symptoms seem to moderate some when I sing or talk for a few minutes. However, more recently, I have noticed phonation has not yielded much improvement. I have thought that my voice is simply growing older (I am 65) or that the allergy de-sensitization injections I am receiving may have caused changed some transitory changes. Now, your website suggests that I may be suffering from GERD. If so, I am unaware of it. I sleep on my back with a CPAP machine. In the last year and a half, I lost 150 + lbs. Can you give me any advice?

Melissa Kim M.S., CCC-SLP replies...

There could be any number of explanations for your symptoms; the only way to determine causative factors and potential treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck!

Thursday, September 5, 2013

Something in the Back of my Throat

Hello, for the past three to four months I have noticed the feeling of mucus in the back of my throat. I cough or clear my throat and clear or yellowish mucus does come up, but never a lot. I just feel it there especially in the evenings and mornings. My throat is raspy and my upper register for my singing voice is very thin and almost non-existent. I decided to take out dairy and gluten and stay away from cats but other than that I don't know what to do. I have asthma and allergies, but I have never had drainage for this long. What should I do?

Melissa Kim M.S., CCC-SLP replies...

There are any number of possible explanations for the sensation of chronic mucous. I would suggest that you see an Ear, Nose, and Throat physician for an evaluation and treatment recommendations.

Good luck!

3 Years of Hoarseness

For over 3 years I have had persistent vocal cord inflammation. Tests have been upper GI, Allergy, Pulmonary, ENT, Rheumatoid and Psychiatry. Also x-rays, CT Scans, and extensive blood work. Laser vocal cord surgery twice with biopsy. The last surgery revealed Strep and now I am taking Augmentin. This condition remains undiagnosed. I am an RN and have not been able to work for over a year. I have no other symptoms. My vocal cords for over 3 years have been a constant source of itchy, irritation and rattle feeling 24/7 resulting in severe, chronic and extreme clearing of my throat that never goes away except when I am asleep. I have an ENT specialist that has been treating me for a year and a half at the University of Michigan hospital. But he has no answers either. Any other perspective would be appreciated. Thank you.

Melissa Kim M.S., CCC-SLP replies...

It certainly sounds as though you have consulted all of the appropriate professionals, so I don't know that I could offer any additional advice. I will say that in the absence of any possible medical explanation, some individuals suffering from symptoms involving the head and neck area find relief via alternative medicine (e.g., meditation, acupuncture, hypnosis, etc.)

Best of luck to you!

Monday, August 26, 2013

Low Raspy Voice

I just have a question regarding a very low, raspy voice.. I've always had it, but it is hard for me to speak up (I feel like I'm screaming if I do) and talking for lengths of time or in a crowded place it gets sore.

I was born at 25 weeks and was on breathing tubes and hooked up to a nebulizer while in NICU and 3 months or so after I came home. My father recently told me due to the breathing tubes I have scar tissue.

I'm now 25 (female), have never smoked or drank or done drugs. Ive had regular checkups and nothing out of ordinary comes up.

I was just curious as to whether scar tissue could cause such a raspy voice? I love my voice but I'd like to be able to project my voice and not feel so sore after talking for long periods. Do you have any suggestions or resources?

Melissa Kim M.S., CCC-SLP replies...

Yes, vocal fold scarring as the result of prolonged intubation (placement of a breathing tube) can result in altered vocal quality. The only way to determine if this is the cause of your "raspy" voice, and to learn of possible treatment strategies, is to be evaluated by an Ear, Nose, and Throat physician.

Good luck!

Injured Vocal Cords

My friend is visually impaired and had an infection in her vocal cords that has impaired her ability to speak in a normal range voice. She is talking in a very high register, sounds like it is complete from her head but I can see the strain on her throat / neck area when she attempts to speak. I am trying to find her a braille device so that she can type in and it will speak for her since she needs to rest her voice but now I'm not certain that 'resting ' her voice will suffice. Any suggestions?

Melissa Kim M.S., CCC-SLP replies... 

In order for me to give specific advice as to appropriate treatment, I would need a formal diagnosis. I assume your friend has been evaluated by an Ear, Nose, and Throat physician? If so, please let me know what the diagnosis is and I'd be happy to assist! 

Thank you for your question.