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Some examples of disorders of the voice are nodules, polyps, calluses, hemorrhaging folds, vocal fold paralysis, vocal fold paresis, vocal fold bowing, granulomas, polypoid degeneration, and Spasmodic Dysphonia. There are a multitude of factors that may start the decline of a voice, such as bacterial/viral infections, allergies, acid reflux, neck injuries, substance abuse, psychological stress, etc.
Voice problems may also result from a person's physical use of the voice, whether we call it overuse, underuse, misuse, or abuse. However, what most disorders have in common is some form of muscle imbalance. Even though, for example, paralysis and paresis may be caused by a virus, granulomas may originate from acid reflux, and polypoid degeneration originates from smoking, these irritants set the stage for muscle imbalance in and of themselves
The key to treating voice disorders is to address both the
muscle imbalance as well as reducing the impact of irritants.
Treating muscle imbalance Our body is brilliant at compensating in order to survive and in order to continue functioning. If you get too hot, you sweat to cool down. If you get dehydrated, a host of bodily functions begin to save energy for survival. If the larynx is hit by acid, the body creates mucus to try to protect it. If your foot is in pain, your whole body compensates in order to be able to move forward.
Likewise, if there is discomfort when singing or speaking (for whatever reason), the muscles of the vocal apparatus begin to compensate in order to produce sound. In fancy language we call this "maladaptive compensatory behaviors", and they become habits over time. Athletes know that it is often this secondary tension - the misalignment of the body - that can become a bigger problem than the original injury.
The athletes who have gotten to know their bodies well know that the initial treatment of an injury is of the essence for effective and expedient recovery. They also learn to train their muscles for maximum output. Although training methods evolve constantly, the key is always balance and "good form" in performing exercises to propagate a habitually effective use of the body. They also learn to recover from fatigue and how to treat their injuries.
The voice user would benefit by revering their instrument
and body in the way of an athlete.
Like the athlete, the vocalist wants to be able to optimize his instrument to his maximum physiological capacity. The daily voice user (most people) benefit greatly when the voice is operating functionally, and everyone who has been hit with a voice disorder knows what a debilitating effect it has on one's psyche. A voice disorder can hardly be healed without voice training.
The term "Muscle Tension Dysphonia" has been created to describe a severe muscle imbalance. We could argue that every vocal disorder has a grade of Muscle Tension Dysphonia. A good example of this condition has been noticed when a person has surgery to remove vocal fold nodules without any voice therapy. Often this person experiences the same kind of hoarseness after the surgery as she had before. The reason for this is that the muscles have adapted to the nodules being there, and even though the nodules now are gone, the muscles still function as if the nodules were present. This is a good example of how brilliantly our bodies (not always to our benefit) hold on to muscle memory.
Nodules (mostly women) and polyps (mostly men) are easy to blame for hoarseness and lack of range. However, the hoarseness and range reduction are more likely a result of the muscle tension/imbalance that led to the nodules, and have worsened with the presence of the nodules.
The good news is that with voice training, we are able to rebalance
the functioning of these muscles. We can implant new habitual ways
of using the muscles. We can strengthen and free the voice just as
we can develop any other muscle in our body.
However, depending on the severity of the condition and depending on the individual's desire for optimal condition, there may be more than voice training that needs to be addressed. I personally work closely with some of the top health providers in their respective fields. Solving a person's vocal problems, as well as helping the performing singer/speaker to optimal performance, becomes a team effort.
Removing/treating irritants Substance abuse - In this day and age no further comments should need to be made regarding the effects on the body and the voice from smoking and the abuse of alcohol and other substances.
Acid Reflux - Laryngeal reflux, where acid backs up and irritates the larynx, has been shown to be a major factor in many disorders. There are many ways to combat this and my view on the common treatment method is addressed in The Truth About Acid Reflux.
Sinus infections/allergies – Sinus dripping, a.k.a. postnasal drip, has a major effect on the health of the vocal cords (vocal folds) and the elasticity of the larynx. There are numerous methods to treat your sinuses in which pharmaceutical drugs are probably the least effective and the most destructive.
Remove irritants from your indoor environment. Mold, dust mites, dust, pollen from outdoors etc., are notorious for creating sinus problems (and other health problems). A high quality HEPA air filter should be a must for any serious voice user. In addition to trying to remove allergens, the task would be to boost the body's immune system to lessen the impact of irritants.
Chinese herbs (custom formulated by a specialist) have shown to be exceptionally effective without the side effects of pharmaceutical drugs. Osteopathy treatments and Acupuncture treatments are also very effective in treating sinus problems.
Recurring Laryngitis - Here is a condition where far too many rely on corticosteroids or cortisone (such as prednisone), often unaware of the accompanying lowered immune function, which sets the individual up for the next laryngitis. The suffix "–itis", whether gingivitis, gastritis or laryngitis refers to an inflammation. The most powerful anti-inflammatory substance is cortisone, which is produced naturally by the adrenal glands.
The trap of pharmaceutical drugs When you take manufactured cortisone, the adrenal glands see no need to continue their natural production, which is why there are numerous side effects. Many people already have weakened adrenal glands to begin with due to stress, substance abuse, irregular blood sugar levels, chronic illness, chronic pain, chronic inflammation, etc.
For someone with a recurring inflammatory condition such as laryngitis, the strategy to strengthen the adrenal glands (and learning to use the voice with less stress) would probably be more helpful rather than weakening them further by taking synthetic cortisone. Acid reflux might also be a precursor to laryngitis as the acid irritates the vocal apparatus. Consider then, the quite common tendency to administer cortisone together with acid-suppressing pharmaceuticals. One might want to think twice before taking out both the adrenal glands and the stomach acid production – two of the most vital functions for one's immune defense.
Add an antibiotic to this concoction, which not only kills the unfriendly bacteria (perhaps), but also kills the friendly bacteria necessary to fight any invader. One can imagine what the body must go through as it tries to compensate for this severely depressed immune system. In light of the quick reduction of the acute inflammation, this treatment option seems understandable.
If this is the big moment of your career and you are to sing at the Olympic opening ceremony, it might be necessary. However, in most cases such a shortsighted approach is hardly in the best interest of the individual.
There are numerous ways to treat an inflammation. Hydration - Constant hydration may be the simplest, yet most overlooked treatment for all voice disorders and should always be part of the plan. Read Hydration And The Singing Voice.
Fatigue - Few things wear down the voice as much as lack of sleep. Few things are as powerful for healing the body and the voice as sleep.
Humidity - The tissues of the larynx do not do very well in dry environments (the body in general does not do well in dry conditions). Indoor heating and air-conditioning dries the air. A voice professional is well served by using a humidifier in dry conditions. Note that cleaning the humidifier is a necessity (depending on the manufacturer) or it can create a breeding ground for bacteria and mold.
Nerve energy to laryngeal muscles - For many people, the condition of their spinal column has a direct effect on their voice (and health in general). If the 4th and especially 5th cervical vertebra is compressed (which is quite common), it directly affects the nerve energy to the larynx. In such cases, a Chiropractor trained in Applied Kinesiology, an Osteopath, an Acupuncturist, and/or a structural training program, such as The Egoscue Method, helps tremendously. Someone skilled in laryngeal massage can also make a difference.
What about Surgery? If surgery is chosen it would be considered a more desirable option if it was in addition to, rather than instead of, other strategies. It is advisable to research extensively and get many expert opinions both from surgeons and non-surgeons before an irreversible surgery is performed.
Conclusion. Realize that everything is connected. There is no need to separate the voice from the rest of the body. There is no need to separate body from mind. An affected voice affects your mental state and your mental state affects your voice. When you learn to rebalance the muscles involved in voice production, dramatic results can occur. These are skills that the average voice user is seldom exposed to.
When you also rebalance and strengthen the body and mind as a whole, you not only empower your voice and body, but your life in general. How you sound is of less interest than that you are able to experience the free functionality of your voice. Your voice is you.