For Melissa Kelley, MM, a soprano and voice teacher in New Jersey, recognition of the prevalence of acid reflux disease among singers has been a revelation. I and many singers I know have succumbed to acid reflux disease, and it is a voice killer, she said. For many of us, the cause of our debility was a big mystery until GERD [gastroesophageal reflux disease] was diagnosed, because the symptoms, except for the vocal dysfunction, were either slight or nonexistent.
According to Ms. Kelley, another unique problem among singers is vocal overuse. Singing with bad technique or singing inappropriate literature for one’s voice type can lead to serious physical problems.
Anthony Jahn, MD, Director of Otolaryngology at St. Luke’s Roosevelt Hospital in New York and Adjunct Professor of Voice Pedagogy at Westminster Choir College in Princeton, NJ, agrees. The effects of voice overuse and voice abuse, such as excess muscle tension in the throat, vocal fold edema, and nodules, are common in this group, especially in patients who are inadequately trained or ask their voice to perform tasks for which they were not adequately prepared.
Causes and Effects of Voice Problems
For clinicians and other professionals who help professional voice users-particularly singers-care for their voices, an understanding is needed of the delicate balance between the external and internal factors that allow the voice to function well is essential. Physical issues and emotional issues are the yin and yang of the singing voice, said Dr. Jahn. It is important to realize that for singers, structure and function are closely related, interdependent, and interactive.
Giving the examples that a singer may become stressed and depressed if he or she is unable to sing because of a damaged larynx, or that a singer with a type-A personality may develop excess muscle tension and laryngeal nodules, he emphasized that the importance for a clinician is to recognize and treat both, and be aware of how one feeds into the other.
Along with the external factors described above (such as voice abuse and overuse and acid reflux), other external factors that clinicians need to pay attention to are environmental stressors that may impair prime motor control necessary for good singing, such as exposure to smoke, dusty and dry auditoriums, and stage fog, as well as daily demands on the body. Performance schedules and commitments commonly lead to sleep deprivation, often substandard nutrition, and voice overuse, said Dr. Sataloff.