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Voice Care Guidelines
Table of Contents:
Hydration
Voice Rest
Medications
Gastroesophageal Reflux Disease
Diet
Smoking
Lozenges
Throat Sprays
Gargles
Nasal Hygiene
Hydration:
Very
Important. Drink 2-3 quarts of
water throughout the day, or until your urine is pale. (pee pale,
unless it is
colored due to the intake of multiple vitamins). It is
important to drink large quantities of
water to keep the tissues moist and healthy,
preventing drying and damaging of
the vocal cords. It is also good to keep a vaporizer available during
any
episode of laryngitis or vocal abuse. This keeps tissue in an optimal
condition. We prefer the use of a
standard vaporizer; cool or warm mist does not make a difference since
moisture
is the important issue. Ultrasonic vaporizers are not recommended and
one
should avoid direct exposure to the ultrasonic mist, since its particle
size
could induce wheezing. Note: the
vaporizer should be cleaned weekly with a preparation such as impregnon
or a
weak vinegar solution.
Voice
Rest: The voice was not made to be abused on a regular basis.
Frequent rest periods are important if you use
your voice for extended periods of time. A "vocal nap" is
suggested. This period of time could extend from minutes
to hours. Symptoms of dryness and voice
fatigue are an indication of vocal abuse. If these symptoms
do
occur, you may be asked
to rest your voice at a more regular interval.
Remember, when laryngitis is present, voice rest is a must.
If
you do not have to speak, don't! Rest your voice! Avoid vocal
excess, as this
may be as harmful as talking loudly. Screaming or loud talking causes
trauma to
the vocal cords. Whispering causes poor airflow and excess strain of
the vocal
muscles, which may be as harmful as screaming.
Medications:
It is best to avoid such drugs as aspirin, ibuprofen or
similar drugs unless
your health care provider prescribes them. Tylenol is acceptable for
headaches
and muscular aches and pains. Remember that aspirin products have a
tendency to
thin your blood, which may enable you to bleed more easily onto your
vocal
cords. You should check with your health care provider concerning all
medications
that you take.
Gastroesophageal
Reflux Disease: This is a problem created by gastric content
refluxing from the
stomach, up the esophagus, and onto the vocal cords.
Chemicals such as caffeine, cigarette smoke,
and alcohol, can cause an increase in stomach acid. Symptoms
of "heartburn” are not always
present. Gastroesophageal reflux (GER) patients will commonly have
early-morning hoarseness. If you have a
tendency to eat or drink late at night or have known gastroesophageal
reflux disease
(GERD), you may want to help yourself by keeping the head of your bed
elevated.
This may be achieved by sleeping on two pillows or elevating the head
of the
bed with cinderblocks. This will decrease the likelihood of acid reflux
and will
discourage gastric emptying. Avoid foods that cause
heartburn. Taking
Gaviscon tabs, an antacid, two hours after each meal and at bedtime may
also
prevent acid reflux. If the problem becomes severe, patients may need
to take
medications to decrease the acid production in the stomach. These may
be
prescribed by your health provider. Many are now available over-
the-counter to
decrease acid production.
Diet:
It is best not to eat within two hours of bedtime, since this habit may
cause
reflux esophagitis, as noted above. Regular coffee is a stimulant, due
to the
increased caffeine content, which may
cause the" jitters". Thus, decaffeinated coffees and teas are a must. Caffeinated
beverages are a diuretic and may also worsen the drying of secretions.
There is
also Throat-Coat tea, which is made from a similar bark. Remember,
these are
all medications and keep in mind what purpose they are serving.
Honey, lemon,
and tea should be used as directed, since it can cause a change in your
mucous.
Alcohol is a depressant, which also has a diuretic property and can
cause
dehydration of your vocal cords. Spicy foods may cause irritation to
the throat
and stomach and should be eaten earlier in the day. Temperatures of
foods, both
hot and cold, could cause bums and this should be watched at all times.
When
considering diet in relationship to voice care, we cannot forget dairy
products. They should be avoided, as they may create thick mucous and
phlegm,
which in turn will force throat clearing, which causes irritation. Many
people
have mild allergies or lactose intolerance, which can upset the stomach
and
create significant
problems with gastrointestinal upset and possible dehydration.
Smoking:
Smoking should be avoided as much as possible, as we know the Surgeon
General's
report has shown this to be a significant health hazard. We must
remember that
secondhand smoke is also harmful. "Voice users" in particular should
stay away from smoking for other reasons. The most important being that
smoking
causes an increase in temperature in the back of your throat giving
rise to
coughing, decreased elasticity of the lungs, and most importantly,
dryness that
can lead to cracking, which would then create an area for invasion of
bacteria. Hacking coughs cause vocal problems due to
sudden abusive closing of the vocal cords.
Smoking can also affect gastroesophageal reflux.
Lozenges:
These may be helpful or even cause severe problems. Care should be take
choosing the products. Cough drops are good when used to coat the
throat or to
prevent a tickle, but the same coating could cause increase in mucous
before
singing. Thus, the mouth and throat should be rinsed, before
vocalizing, with
table temperature water. We prefer cough drops such as Ricola or
Fisherman's
Friend. Try
to remember why you are using the lozenge and match it to the effect
you are
trying to achieve. Some throat lozenges
can cause irritating effects, thin your mucous and cause other problems
as
well. These should not be overused, since removal of mucous or thinning
it can cause
more problems than good. Some lozenges,
such as Slippery Elm, are made from the bark of the Slippery Elm tree
and are
very helpful. Many lozenges contain
menthol and eucalyptus-these products are astringents and should be
used with
caution
Throat
Sprays: The use of throat sprays can be
helpful in moisturizing the throat. But, be careful not to choke
yourself since
sudden spasm could injure the vocal cords by slamming them together.
Therefore,
when using sprays, they should be used only during exhalation. Keep in
mind,
when choosing a spray, that these products may contain medications or
numbing
agents. Again, please understand what
you are using, and trying to achieve, since you do not want to injure
your
voice. Numbing of the throat may allow one to use the voice to extreme
causing severe
damage. Vocal pain is a warning sign and should be heeded, not mocked.
We are presently
using a spray called Entertainer's Secret, which was formerly known as
Moisture-IO. This contains Aloe Vera and glycerin.
Gargles:
These should be used with the same caution as which throat
sprays are used.
Gargles can irritate the throat, cause anesthesia, and burn.
These also change the natural composition of the
mouth and throat. Using a simple
mouthwash may help soothe the mouth, but high concentrations of alcohol
can
worsen the throat problems. A mild salt
solution is simple and safe. We hope
that these helpful hints will prevent problems with your throat in the
future.
Nasal Hygiene:
The nose is an intricate part of the vocal mechanism. It is a
resonator and
should be kept clear at all times.
Nasal douching is important to clean the passages and may be done with
Alkalol nasal
douching solution or with salt water. Salt solution may be
prepared daily using
1/3 teaspoon of salt in one (1) cup of water with a pinch of baking
soda, or
commercially prepared solutions. By
cleaning the nasal passages, bacteria and debris can be removed.
Saline nasal sprays may be used, such as Ocean
Spray, Ayr or Salinex.
It is important to note that if you prepare your
own solutions that these do not contain preservatives and that bacteria
can
grow in a very few days. To further
moisten the tissue, you may use Denver Nasal Ointment or
Neosporin. Also, decongestant sprays should not be used
repeatedly, since rebounding or swelling of nasal tissue can occur.
Remember,
before using any product which is questionable, please call our office.
Your healthcare provider, voice/singing coach,
and speech pathologist are always available to answer your questions.
These guidelines are not
intended to replace a thorough history and physical examination.
If you are having difficulty with your voice, please call 303
953
6767 to schedule a consultation.
