Hoarse Voice Since Last 5 Years

Hello, I lost my natural sweet voice 5 yrs ago during pregnancy. Now my voice sounds like a man and has no high pitch. I saw a laryngologist and after all the tests he said it is possible that my vocal cords were permanently damaged due to acid reflux during pregnancy. I want to get a second opinion from you. Also if there is anything I can do to get the voice somewhat better... 

Melissa Kim M.S., CCC-SLP replies...
Unfortunately, I cannot offer a second opinion via email. It certainly is possible for vocal cord damage to occur as the result of chronic acid reflux; however, the only way to know if this is the case, and to determine appropriate treatment strategies, is to see a laryngologist. What did your physician offer you in terms of management? If you do not feel as though your symptoms were appropriately addressed, seek out a second opinion with a physician who can examine you directly.

Best of luck to you.

Voice Issues

I'm a 19 year old female and have been singing since I was very young. I have always been able to sing into the soprano range using my head voice but usually stick to alto or soprano II. Lately, I have been having a lot of trouble when I try to do higher notes. My voice cracks or the sound comes out shaky. I don't want to harm my voice but I also don't want to lose my range. Is it possible that I could have hurt it in some manner? I always warm up before singing so I'm not sure what's going on. Thank you for your prompt reply!

Melissa Kim M.S., CCC-SLP replies...
If the problem is persistent, I would suggest that you see an Ear, Nose, and Throat physician to rule out the possibility that something structural is contributing to the problem. If the larynx is determined to be healthy, it's very possible that the issue is primarily one of technique, in which case an experienced voice teacher would very likely be of great help.

Good luck to you!

Vocal Nodules

My 4 year old has developed nodules on his vocal cords. He does not make much noise in general. Can you advise what treatment we should give him? What home treatments we should give him? I appreciate your response.

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

Voice therapy with a speech pathologist is the treatment of choice for young children with vocal cord nodules. If the nodules persist after appropriate treatment, I would suggest re-assessment.

Good luck!

Voice Screenings

The Johns Hopkins Voice Center would like to announce our voice screening program! The speech-language pathology team provides assessments to professional and semi-professional voice users, or any lay person experiencing vocal difficulties. This program may also be beneficial for healthy voice users as a tool to establish baseline vocal performance, which may be a source of comparison if one encounters problems in the future.

Voice screenings are offered on the last Tuesday of every month from 3:00 - 5:00 pm; the charge for the screening is $15.00 that may be paid at the time of the appointment.

Your voice screening will include:

1. A review of your voice history to identify any potential problems.
2. Visualization of the larynx with a small endoscope (camera) that is passed (painlessly) through the nose. This is optional for the squeamish, but the most objective way to look at the vocal cords.

If there is any indication of a voice disorder, you will be referred for a full voice evaluation under the supervision of both a physician and speech-language pathologist to make a formal diagnosis. A full evaluation will require a referral from your primary care physician, and you will be required to ensure authorization and coverage by your insurance. If you have questions regarding your insurance coverage for a full voice evaluation, please call 443-849-2087.

Speech-language pathologists cannot provide a formal diagnosis but can isolate need for further evaluation with a physician. At that time, the two professionals will discuss your case and determine any need for therapy, surgery, medications, etc.

Participants may register by calling 443-849-2087, or e-mail questions or to mkim@gbmc.org. E-mail requests will be confirmed with a reply.

Looking forward to sharing this great opportunity with you!

Vocal Warm-Ups

Many singers engage in some form of daily routine or warm-up prior to singing; however, many singers do not know the rationale behind choosing various warm-ups or their actual function. Unfortunately, these questions also elude researchers. A study by Elliott, Sundberg, & Gramming (1995) attempted to determine if vocal warm-ups prior to singing yielded the same effect as warming up other parts of the body, i.e., increasing blood flow to muscles thereby decreasing their thickness and increasing their pliability. Although the results of this study were inconclusive as to the exact effect of vocal warm-ups, several reasons still support the use of vocal warm-ups. Elliott, Sundberg, & Gramming emphasized that changing pitch undoubtedly stretches the muscles. They also noted that many singers subjectively indicated improved vocal functioning following warm-ups.

Warm-ups should not be confused with vocalises. Warm-ups, as in weight training, are used to stretch the muscles to prepare them for work without injury. Vocalises are tasks aimed at acquiring a particular skill, i.e., the actual exercise itself. For example, some schools of thought encourage simple, quiet glides across the range as an effective warm-up. On the other hand, using a staccato (short) "ha-ha-ha" on 1-3-5 of a scale is to encourage onset and flexibility. Many singers will use a variety of vowels, consonants, or arpeggios to "warm" the voice; however, these techniques may actually be encouraging articulatory precision or vowel balancing as in rapid "me-may-mah-mo-mu," or balancing "registers" as in sung single vowels on 1-5-6-5-1, etc.

Vocal Cool-Downs

Although unfortunately and frequently ignored, vocal cool-downs may also be used to prevent damage to the vocal cords. During speaking and singing, blood flow to the larynx is increased. Stopping immediately after prolonged speaking or singing may contribute to a pooling of blood in the larynx, weighing the vocal cords down. Damage may result as one attempts to speak on these potentially swollen folds. An analogy can be drawn to other physical exercise. After running for prolonged periods of time, an athlete is encouraged to walk for several minutes to maintain blood flow and prevent cramping. The same propensity for "cramping" may apply to laryngeal activity. The simple practice of gentle, relaxed humming can serve as an excellent form of cooling-down.

Vocal Function Exercises

Once "warmed," the singer may proceed to daily exercises. The work of Sabol, Lee, & Stemple (1995) explains that many of the exercises prescribed for vocal flexibility are actually calisthenic exercises. Other exercises focus on training the perception of various resonances. A teacher may also recommend the use of isometric exercise, that focuses on improving vocal functioning at the level of the vocal cords. Vocal Function Exercises, first described by Barnes and modified by Dr. Joseph Stemple, are "a series of direct, systematic voice manipulations (exercises), similar in theory to physical therapy for the vocal folds, designed to strengthen and balance the laryngeal musculature, and to improve the efficiency of the relationship among airflow, vocal fold vibration, and supraglottic treatment of phonation."

Optimally, one should hear an example of Dr. Stemple's Vocal Function Exercises to ensure accuracy and efficiency. Most speech-language pathologists are familiar with the exercises, but a compact disc featuring examples of the Vocal Function Exercises is at Plural Publishing.

The Vocal Function Exercises should be done twice in a row, two times per day. They should be produced as softly as is possible with an easy onset (initiation of sound) and forward placement of the tone (avoid a swallowed or dark vocal sound).

Sustain the vowel sound "eee" for as long as possible on the musical note F above middle C for women, below middle C for men. The tone should be produced as softly as possible, but without breathiness. A good supported breath should proceed voice. The "eee" should be produced with an extreme "forward" tone focus; almost, but not quite nasal. The goal is to sustain the sound without breaks for as long as possible. Sustain an "eee" as long as possible.

Glide from your lowest to your highest note on the word "knoll" or on a lip or tongue trill. Voice should be soft, and a forward focus used. If breaks occur, continue to glide without hesitating.

Glide from a comfortable high note to your lowest note on the word "knoll" or on a lip or tongue trill. Voice should be soft, and a forward focus used. If breaks occur, continue to glide without hesitating.

Sustain the musical notes C-D-E-F-G, each as long as possible on the word "ol" ("old" without the "d"). Lips should be rounded; a sympathetic vibration should be felt on the lips.