The ABC’s of Vocal Health

randy_buescherSometimes our voice does not work the way we want it to. It will feel tired, hoarse, be lower in pitch than normal, or have a different quality.

There are several reasons this can happen.

One common issue is reflux. Reflux occurs when the lower esophageal sphincter and upper esophageal sphincter are too relaxed. This allows stomach acid to enter the larynx, irritating the back ends of the vocal cords. Symptoms include morning voice (the voice is low in the morning, and takes a while to get going), a husky, dirty quality, and lots of phlegm. You may also experience globus, which is the sensation of something foreign in the larynx, like a popcorn kernel stuck there.

Sometimes, the best way to diagnose it is indirectly. This means going on a reflux management program for about a month to see if it improves combined with being vocally prudent. We will discuss what that means later.

Two other common problems are swellings on the edges of the cords with the most common being nodules or polyps.

Nodules occur over time. They don’t happen right away and be caused by prolonged vocal abuse or more likely overuse.

The most common forms of vocal abuse are talking over loud noise, bad singing technique, or screaming. However, most usually there is a strong overuse component.

Ask yourself this. If you had to rate yourself on a scale of 1-7, with one being quiet as a church mouse, and 7 being cannot stop talking, where would you stand on that scale? People that end up with nodules usually rate a 6 or 7. The vast majority of people that end up with irreversible nodules just never give a chance for vocal cord swelling to calm down. If you keep insulting the initial injury, tissue change occurs over time in the form of scar tissue. Think of it as callous on your cords. This can lead to surgery.

However, if you modify your habits, the swelling with resolve. Everyone will swell at times.

The symptoms for pre-nodules swelling are laryngitis, and loss of high soft swelling. If you are losing access to your upper voice or can only sing loudly in that part, chill out vocally by trying to be a one or two on the seven point scale I mentioned until that capability returns. Consider it a red flag and monitor things are that. If this has been going on a while and things do not resolve, a trip to the laryngologist is suggested; one that specializes in voice. You can contact me for a list of qualified ones in your area. If it continues not to resolve, surgery may be needed. Surgery today for this is a pretty routine procedure if you have the right surgeon.
Polyps are a whole different matter. Polyps happen very suddenly because of a traumatic episode. There is a sudden, severe change in voice. These need to be removed surgically, but with the right surgeon, normal voice will be restored.

Here are some suggestions to keep the normal voice healthy:

-Do not smoke.
-Stay hydrated. The color of your pee should be clear or pale yellow. Hydration keeps the cords moist which reduces friction.
-If you drink alcohol, try to drink clear alcohol, it reduces the chance of reflux.
-Avoid noisy situations.
-Get plenty of rest.
-Warm up the voice gently before singing. This should take 10-15 minutes.

While the voice is not extremely delicate, it does require care to work in a consistent, reliable manner.

Please contact me with any questions.


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Randy Buescher Randy Buescher is an internationally recognized expert in non-classical vocal technique. He is also well known as a clinician, author, vocal therapist, and researcher. His clients have won Tony Awards, Dove Awards, and Emmys, have been nominated for Grammies, and been American Idol finalists. He has also worked with artists from every major label.  He has presented and been a speaker for the Voice Foundation, NATS, Naras, and the Broadway Theatre Project, along with various universities, high schools and other institutions. Learn more about Randy at

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