Cabaret Hotspot! Celebrates World Voice Day – April 16

By Guest Contributor
Patti Bottino Bravo




Vocal Health: When to Seek Help

“The human voice is the most perfect instrument of all.” –Arvo Pärt, classical composer

It’s your gift. It’s your passion. It’s your joy. It’s your income. It’s your voice. And just as a musical instrument needs tuning, so does your voice. Being in tune with obvious symptoms and attuned to the subtle changes in your voice is the first step in taking care of your “most perfect instrument.”

As a cabaret performer you may or may not have had the same vocal training and education as an elite vocal performer – opera singers, actors, broadcasters, voice-over artists, etc. And as such, you may not be aware of the effects of overuse, injury, or illness that may affect the quality and strength of your voice. Because “singers are at an increased risk of laryngeal pathologies and vocal cord symptoms” (Kwok & Eslick, 2019), this article will discuss the signs and symptoms of various voice disorders that require the professional attention of an otolaryngologist (ENT) or a speech-language pathologist specializing in vocology.

If you have ever experienced disturbances in the quality, pitch, loudness, or amount of vocal effort needed to produce your voice, you have experienced dysphonia. According to the American Speech Language and Hearing Association (ASHA) signs and symptoms of dysphonia include:

• Roughness, breathiness, strained or strangled quality
• Abnormal pitch (too high, too low, pitch breaks, decreased pitch range)
• Abnormal loudness/volume (too high, too low, decreased range, unsteady volume)
• Aphonia (loss of voice)
• Phonation breaks
• Asthenia (weak voice)
• Gurgly/wet sounding voice
• Hoarse voice
• Pulsed voice (fry register, creaks or pulses in sound)
• Tremulous voice (shaky voice; rhythmic pitch and loudness changes)
Other signs and symptoms in the way we use our voices, rather than how it sounds, include:
• increased vocal effort associated with speaking
• decreased vocal endurance or onset of fatigue with prolonged voice use
• variable vocal quality throughout the day or during speaking
• running out of breath quickly
• frequent coughing or throat clearing (may worsen with increased voice use); and
• excessive throat or laryngeal tension/pain/tenderness. (ASHA, n.d.)

These signs and symptoms can be experienced singly or in combination. And of special note, any symptoms that persist for more than two weeks REQUIRE THE ATTENTION of an ENT. If you choose to see an SLP/Vocologist first, medical clearance must be obtained before treatment for dysphonia can begin because the cause and severity of dysphonia cannot be determined from listening alone. The ENT or vocologist will need imaging of the vocal folds to determine the existence, nature, and severity of any vocal fold pathology. These may include vocal fold abnormalities (e.g., vocal nodules, edema, stenosis, or sarcopenia [muscle atrophy associated with aging]); inflammation of the larynx (e.g., arthritis of the joints in the larynx, laryngitis, laryngopharyngeal reflux); or functional causes including phonotrauma (e.g., yelling, screaming, excessive throat-clearing); muscle tension dysphonia (excessive use of muscle tension around the larynx); or vocal fatigue (e.g., due to effort or overuse) (ASHA, n.d.).

According to Kwok & Eslick (2019) “professional singers are at an increased risk of laryngeal pathologies and symptoms associated with vocal misuse and overuse, particularly hoarseness, GERD, edema, and polyps”. As we celebrate World Voice Day, and as we use our voices every day, stay in tune and attuned to any changes in both your speaking and singing voice. Be sure to seek the help of an ENT and SLP to help heal and restore your voice, and learn techniques to help you avoid future harm of your “most perfect instrument.”

Patti Bottino-Bravo, MS., CCC-SLP
Speech Language Pathologist
Owner/Brighton Speech Paths

American Speech Language and Hearing Association (ASHA.) (n.d.) Voice disorders. ASHA Portal.
Kwok, M., & Eslick, G.D. (2019). The impact of vocal and laryngeal pathologies among professional singers: A meta-analysis. Journal of Voice, 33, (1).
Phyland, D.J., Thibeault, S., Benninger, M.S., Balance, N., Greenwood, K.M. & Smith, J.A. (2013). Perspectives on the impact on vocal function of heavy vocal load among working professional music theater performers. Journal of Voice, 27, (3).