Vocal Hygiene

Richard K. Adler, Ph.D., CCC, SLP, F-ASHA

adlerri@mnstate.edu

Misuse?
Abuse?
Phonotrauma?
Controversial Terminology

1. Andrews (1999):
– Distinguishes vocal abuse from misuse
– Inappropriate pitch is a form of vocal misuse
– Inappropriate volume is a form of vocal misuse
– Definition: Inappropriate and injurious vocal
practices
Latest Preferred Terminology

z Verdolini from her article in the Division #3

Perspectives (1998) entitled: “The language
we use in clinical practice.”
z Defined “phonotrauma”
– “Voice use patterns leading to traumatic tissue
changes of the vocal folds”
– Division 3 current consensus is to use
phonotrauma instead of misuse or abuse
Phonotrauma Continued

z Alison Behrman of NYU

z Article in the AJSLP (August, 2006) entitled
“Facilitating behavioral change in voice therapy: The
relevance of Motivational interviewing”
z Misuse or abuse reflects a “blame” on the patient’s
part
z She stated that the terms misuse and abuse should
be abandoned and are archaic
Aronson (1990)

z Defined causal factors leading to vocal

misuse or phonotrauma
– Life Stresses
– Psychosocial issues
– Hoarseness
– Excessively High Pitch
– Extrinsic/Intrinsic Muscle cramping
– Lump or tightness in the laryngeal or pharyngeal
areas
Vocal Hyperfunction

z Excessive laryngeal muscle tension

z Sometimes functional dysphonia
z May occur in the TG client
z Avoid throat clearing and coughing habitually
z Don’t yell, cheer or scream habitually
z Avoid second hand smoke
z Don’t sing beyond a comfortable range
Tissue Changes Occur in
Phonotrauma

z Development of nodules
z Development of polyps in some cases
z Development of Contact ulcers
z Thickening of the vocal folds
z Poor hydration (or lack thereof) leads to
dryness of laryngeal tissues and increases
risk of misuse/abuse (Andrews, 1999)
Causes of Vocal Fold Irritation

z Andrews outlines several major causes

– Laryngeal tension
– Over-contraction of the posterior cricoarytenoid
muscle
– Excessive elevation of the larynx when not
needed for swallowing
– Singing with poor technique
– Endocrine imbalance
Causes continued

z Bulimia induced spasms and increased

acidity
z Smoking
z Alcohol or drug abuse
z Excessive/harsh coughing
z Excessive and/or harsh throat clearing
z Use of inappropriate pitch levels
z Airborne irritants/allergies
Psychosocial Issues (often found in
Transsexual/Transgender Clients)

z Contribute to phonotrauma
– Depression
– Lack of self confidence
– Fears
– Guilt
– Anxiety
Other Causes (Stemple, 2000)

z GERD
z Allergies
z Sinus infections
z Meds
z Poor diet or generally poor nutrition
z Fatigue
z Illegal Drug Usage
Psychotrauma and Voice Transition

z Probe psychosocial issues

z Include “voice, speech” counseling
z Andrews: Some patients don’t like to seek
counselor or psychologist’s help
– More comfortable talking with their voice
professional
– SLPs versed in psychological paradigms
– SLPs work on self esteem, social interactions
Professionals

z Psychologists
z Counselors
z Social Workers
– Understand the dynamics of the need for voice
change during the transition process
– SLPs work on habituating and carry-over of the
new voice and non-verbal aspects of transition
SLPs Awareness of Psychosocial
Issues for Voice Transition: FEAR

z Fear: Loss of job, family, friends, self respect,

marriage
– Spastic Dysphonia
– Hysterical Aphonia
– Chronic Cough
 GUILT

z Guilt
– Family Strife
– Family is non-accepting
– Rejection by children
z Vocal polyps/nodules
z Spastic Dysphonia
z Chronic throat clearing
 RAGE/ANGER

z Anger at God
z At Family
z At ‘the system’
z At their children
z At him/herself
– Severe phonotrauma
– Inappropriate or poor Fo
– Obtrusive yelling or screaming
 DENIAL

z “I only have a cold”

z “My voice always gets this way”
z “No problem: I can still work”
– Vocal nodules/polyps
– Excessive throat clearing
– Poor singing Fo Range
 DEPRESSION/ANXIETY

z “I just can’t do this job anymore”

z “I am totally afraid to speak”
z “I can’t face the public”
z “I want to stay alone”
z “I don’t want to speak to anyone”
– Whispering
– Isolation; no need to speak and practice new
voice
 THROAT CLEARING

z Attempts at positioning the larynx effectively

for appropriate pitch changes
z Allergies or a cold present excessive mucous
z Safe throat clearing as a precautionary
measure
z Helps eliminate the ‘burning’ feeling or the
‘tightness”
 SAFE THROAT CLEARING

z Close mouth
z Gather and swallow saliva once
z Clear the throat with usual pharyngeal and laryngeal
movements used for swallowing but do not use the
vocal folds; repeat five times
z Swallow immediately
z Repeat steps three to four times
z Discuss benefits of this technique
 Safe Coughing

z Inhale through the nose

z Produce a cough that is short in duration
z Several durations in sequence
z Approximate the vocal folds about ½ to ¾ of the way
closed; do this slowly
z Avoid harsh coughing
z Use herbal, honey laden lozenges to soothe the
throat
z Drink hot/warm herbal tea preferably with honey but
brown sugar is a safe alternative/avoid white sugars
Components of a Vocal Hygiene
Program for TG/TS clients

z Progressive Relaxation
z Tea
z Diaphragmatic Breathing
z Easy onset of speaking
z Decrease or eliminate caffeine
z Decrease use of citrus juices
z Keep hydrated: This does not necessarily mean excessive pop
z Use of Low Sugar juices: No aspertaine or saccharine
z Avoid Smoking or second hand smoke
z Decrease or avoid alcoholic beverages
Components Continued

z Decongestants and antihistamines are drying

agents
z Safe coughing and throat clearing
z Avoid whispering
z Keep in good physical condition/check blood
pressure/cholesterol
z Avoid talking in loud environments
z Avoid excessive spicy foods
Components Continued

z 6-8 hours of sleep nightly

z Don’t strain voice during exercise
z Don’t hold the breath while speaking
z Treat GERD
z Vocal Rest
z Be aware of allergy to animal dander
z Try to use amplification if talking often and for long
periods of time
z Watch “speaking posture”
z Wear protective gear around chemical irritants
Vocal Hygiene Goals

z Journaling
z Safe throat clearing goal
z Safe coughing goal
z Identify two emotions or psychosocial issues
that affect the voice at work, home, social
situations
z Describe ways to deal with these issues
when are you “read”
Counseling for TG Clients
Voice Transition

z Within our scope of practice

z Deal with issues as they arise (Rao, 1997)
z Empower the client to assist in this area
z We do not “cure” negative emotions
z We can help identify emotional states
z Consult with the client’s psychiatrist or
psychologist
Empower the TG

z Make vocal hygiene personal

z Make vocal hygiene necessary
z Make vocal hygiene easy to comprehend
z Empower the client to use a safe voice even
if he/she thinks it’s too high or low in pitch
z Empower the client to participate in goal
setting for vocal hygiene to make it realistic