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Presentation done by Mayo Clinic, Arizona State University, 2013
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Vocal folds, aka vocal cords, are two bands that come together and vibrate
to generate sound. Where are the vocal folds?
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Vocal folds are in your larynx, or the voice box. Please note, larynx, NOT
larinex, NOT larnex.
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Where is the larynx? Put your hand on your throat, then swallow. Do you
feel something moving up then down? That is your larynx.
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This is what your larynx looks like from the front. Trachea is like a folded
down straw tube.
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Your larynx has a very important role in your well being. Put a hand gently
on your throat and swallow. Do you notice your larynx moving up and
forward? This is done to protect your airway when you swallow food since
the esophagus (the food tube), is situated right behind your larynx.
Your larynx regulates airflow to and from your lungs, protect foreign objects
entering the airway, expels material by coughing/gagging, closes off the
airway to allow build up of positive pressure that’s necessary for heavy
lifting, pushing, etc. And, your vocal folds are inside the larynx.
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If you look at a view of larynx cut in half vertically, you can see 3 levels of
closure: epiglottis, ventricular/false and true vocal folds.
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Unlike other instruments, you cannot replace this one. Furthermore, your
entire body is the case for your instrument.
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Here I am phonating a male larynx. It sounded almost like this…. vvvvvvv
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If you and I, swapped our larynxes today, for the most part, I will still sound
like me, and you will still sound like you, because our unique voices are
shaped by the resonating structures in our faces. Isn’t that simply
amazing?
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Take a guess!
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Can you try to clap that fast in one second?
Listen to this, 400 times per second for soprano,
50-60 times per second for deep bass.
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Your vocal folds change in length from infancy to adulthood.
Shorter vocal folds produce higher pitches = hence, children’s voice is high
Longer and thicker vocal folds produce lower pitches.
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Advanced research in late 70’s (Hirano, 1977), early 80’s revealed the
following: the vocal folds are comprised of multiple layers that vary in
microscopic structure (histology) and mechanical properties, ultimately
affecting how they vibrate. The mechanical function of the vocal folds are
separated by Cover and Body.
The very top layer is the epithelium, you can think of it like a micro fine
seran wrap. It is fairly stiff and conforms to what is underneath but doesn’t
necessarily deform. Under the epithelium, there is the superior lamina
propia (SLP) divided into 3 sections. The superficial layer is gelatinous,
middle and deep layers make up the vocal ligament. Along with the
epithelium, the SLP account for most of the vocal fold vibration. The
vocalis muscles under the SLP usually doesn’t participate in vibration,
maybe in very low and loud phonation. Are you glazed over yet? Now
comes the fun stuff. If you are told by a laryngologist that you have vocal
fold swelling (edema), that means there are liquid gathering under the
epithelium. I want you to remember one thing: the SLP layer is not
replaceable. It does not regenerate. Have you heard of vocal cord
stripping? In this procedure, the surgeon takes off the SLP layer… Yikes!!!
Unfortunately, there are still some doctors performing this procedure for
vocal nodules. You need to have that vibratory upper layer to have a
normal voice. So if your doctor recommends this…. You know what to do
right? Run for your life!
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Another look at the vocal folds
These muscles control the vocal fold closure and opening
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The subglottic pressure (exhaled air from the lungs) open the vocal folds
from the bottom. The vocal folds are blown apart then suck right back in
due to the Bernoulli Effect (google this guys). The bottom part of the vocal
folds suck back in first. The vocal folds suck back in with harder impact
based on the loudness of the sound you make, which is related to
subglottic pressure, which is related to respiratory coordination with
phonation…. Ya, not simple.
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Here is a videostroboscopy of normal larynx and vocal fold vibration. Point
to left (which is actually on the right side of the viewer), right, epiglottis
(front side), false vocal folds, trachea and true vocal folds. Arytenoids bring
the vocal folds together. You cannot see the vocal folds vibrate with naked
eye. It simply moves too fast!
Stroboscopic light flashes light on the vocal folds with rate that is slower
than the actual vocal fold movement. Effectively, it tricks your eyes into
thinking that it’s seeing the movements in slow motion.
This clip shows vocal folds vibration in 30 frames per second.
-VF, shiny and moist, straight edges.
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This is the real, super slow mode of vibration. 4000 frames per second.
Remember I said for female that vocal fold vibrates about 200 times per
second? So high speed slows it down 20 times more per second.
This is my favorite image of vocal folds because it shows that you can have
a complete vocal fold closure (they meet) without squeezing the vocal
process (the backside) or having too much false vocal fold tension! No
need to have that pushing or straining sensation in the throat!
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Here is a trivia…
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Dislocation of your vocal cord
Injury to the lining of your vocal cord =scarring
Granuloma formation
Partial or total paralysis of your vocal cord
The vocal fold on bottom right show granuloma from intubation.
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In this video, the left vocal fold is bowed due to intubation during surgery. It
may be caused by subluxation = incomplete or partial dislocation of the
arytenoid (joints) The right side (left on screen) is moving well but the left
one doesn’t move well at all due to paresis/weakness. The vocal folds are
not meeting together to produce a regular vibration needed for normal
voicing.
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Let’s get back to voice disorders, specifically, what causes them. Most
importantly how to prevent them.
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One way of causing voice disorders is based on how you use your voice:
Functional voicing behavior that contribute to the development and
maintenance of laryngeal pathologies (disorders/disease). These patterns
of voicing, DO NOT have to be abusive based on technique.
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Hysterectomy – would required “pure estrogen therapy” some estrogen
contain testosterone which would cause lowering of pitch, permanently.
Anabolic steroids has increased sharply the risk of permanent virilization
(lowering in pitch) of voice.
Lung cancer can cause idiopathic paralysis of the vocal folds.
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Let’s talk about “sinus” problems and “post nasal drip.”
Sinus drainage causes pharyngeal irritation. So we take medication to
control sinus and allergies. These medications are known to cause
dryness. Dry vocal folds do not vibrate well.
Now, post nasal drip does not usually touch the vocal folds. However the
pharyngeal irritation is a real sensation so you end up throat
clearing…which is an abusive act for your vocal folds. Just drink water
instead of throat clearing.
Hormonal imbalance: Not just sex hormones. Example: Hypothyroidism
can cause tickle, cough and swelling of the vocal folds.
Alcohol/drug abuse is likened to taking a stradivarius (violin) and smashing
it over and over again.
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If the eyes are the mirror of the human soul, then the voice is the
barometer of human emotion. It reflects our deepest feelings and
intentions, and permits us to glimpse at the state of our emotional lives. We
may be unaware of our emotional reactions to stress, but our voices are
constantly vigilant. They respond to the stresses and strains of life on a
minute-to-minute basis.
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Conversion disorder is a mental disorder causing a wide variety of sensory,
motor, or psychic disturbances. Conversion voice disorders, can result from
severe stress. An individual develops the voice disorder as an avoidance
reaction to counteract the trauma that they are having difficulty facing. The
disorder permits the individual to avoid awareness of emotional pain, and is
completely subconscious.
Identity Conflict: sexual, social. A woman who wants to sound authoritative
in a male dominated board meeting…
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Congenital means condition present at birth.
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You can get these from scarring after surgery as well. Remember how Dr.
Lott showed a video of separating the web? Successful voice outcome
really depends how thick the web is.
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Airway is really small causing breathing problems. Stenosis means
narrowing. This requires surgical intervention.
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Cyst is caused by a blocked fluid duct in the vocal folds. Fluids and puss
gather. This is an internal lesion. A lesion is any abnormality in the tissue
of an organism.
This lesion requires a microsurgery where the surgeon very carefully
makes an incision on the lateral aspect of the epithelium, takes out the cyst
and covers it over with the cut epithelium, saving the SLP (remember the
jelly?) layer from damage.
Many famous people have had this…Rachel Ray, and Flicka to name a
couple.
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The laryngeal cartilages are not well formed at birth. They are soft and
sponge and collapse into the airway on inhalation.
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Failure of formation of the partition separating the pharyngotracheal canal
from the esophagus in embryonic life will result in open communication
between the airway and the esophageal lumen.
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These affect the way the vocal folds oscillate. Which means you will not
have a normal sounding voice.
Look these up online for detailed information. Of all these, vocal nodules
are the least severe and can be treated by voice therapy alone.
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These are voice disorders involving your brain. You can sing normally even
with Spasmodic Dysphonia, but not with laryngeal tremor.
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Aphonia means no voice. Whispering is considered no voice.
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Remember that the vocal folds appeared white, smooth, and straight in
earlier slides…
These look very angry, rough, and swollen.
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It is better to have nodules than any other laryngeal pathologies we are
going to see. Therapy helps to reduce the nodules.
Vast majority of the soprano singers have, and it is normal to have a slight
swelling in the mid-fold known as the “soprano pads” (term coined by Dr.
Joseph Stemple).
For this reason, it’s very important to have an image of your vocal folds at
baseline. Meaning, what your vocal folds look like you are singing well. We
call this a “wellness check.”
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Pendunculated (Tissue irruption or broken blood vessels pooching out on
the cover)
Sessile (BLISTER)
Polyps are fluid filled sac on the surface of the vocal folds. The cause can
be behavioral.
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Got smoke? The vocal folds gathered fluid in the COVER.
This is definitely not how you get your low notes!!!!
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This looks like a polyp doesn’t it?
Actually, a polyp looks more translucent.
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This can be congenital or caused by a ruptured cyst.
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Human Papilloma Virus:
Can get it from mother at birth, or it can be sexually transmitted. Dr. Lott
showed how these can be treated with KTP laser.
This is what Adele and Steven Tyler had.
Blood vessel breaks in vocal folds suddenly.
IT IS VERY IMPORTANT TO AVOID TAKING ASPIRIN and Ibuprofene
during heavy singing SINCE IT THINS THE BLOOD VESSELS.
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This is not a fresh hemorrhage…still very bad. Blood vessel can break in
vocal folds suddenly.
IT IS VERY IMPORTANT TO AVOID TAKING ASPIRIN and Ibuprofene
during heavy singing SINCE IT THINS THE BLOOD VESSELS.
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Presbylaryngis (aging voice) refers to age related structural changes of the
vocal folds. Some degree of vocal fold deconditioning and decreased
elasticity is part of the normal aging process. In fact, some degree of vocal
fold bowing is present in 72% of persons over 40 years of age. If the
atrophy and bowing becomes severe enough, significant dysphonia
(hoarseness), throat clearing, cough, and even aspiration (swallowing
difficulty) may result. As women get older the frequency (pitch) of their
voice gets lower (deeper). As men get older, the pitch of their voice gets
higher.
Gelatin in the vocal gets thicker and more viscous. This is the stiffening of
the system.
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Pre-cancerous white plaques on the vocal folds- you will sound hoarse
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This is a cancer of the vocal folds.
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Singers put more pressure on the stomach when singing, so we are more
susceptible to acid reflux.
Avoid eating close to singing time. I generally tell singers to eat a small
meal 2 hours before singing.
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A rock and roll singer’s raspy voice is his signature so quality may not be
what’s bothering him. Voice goal is different for each individual.
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What type of voice user are you?
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Vocal exercise physiology by Keith Saxon is a helpful book.
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Describe the component parts of voice production.
Then add artistry and alignment that affects optimal voice production for
vocal athletes.
Quite a complicating task don’t you think?
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Demonstrate low abdominal breathing technique to explain inspiratory and
expiratory volume. (I did not describe this for you during the lecture. Think
of a dry sponge being dunked into a pot of water. Do you have to make it
soak up water? No! It does that on it’s own. Now, take that sponge out, ring
the water out, hold the sponge tightly in your fist, then dunk your hand with
the sponge in the water pot. Will it soak up the water as easily as it did
without the hand holding it tight?) Now think of your body as that hand.
Your sponge are your lungs! When you inhale, think of freedom in
inhalation to the maximum capacity. Your diaphragm descends as the lungs
expand in 3D motion. As a result the diaphragm pushes down on your
viscera, which makes your belly pooch out. That is normal!!! Due to the
lung’s natural recoil, it will begin to shrink as we exhale. I know this is too
simple of an explanation but we have to start somewhere. The abdomen,
diaphragm, and your ribcages are involved in controlled exhalation.
You can inhale up to 90% of your vital capacity for singing.
It’s 60% during conversational system.
This goes to show that the system that you use for singing is very different
from speaking.
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Check it out!!
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Postural alignment per Alexander technique. Kristen Linklater’s technique
for freedom in voicing is also conducive.
Pointing out the weigh bearing joints in the body: the stars placed on the
skeleton.
Buoyant cervical discs: feel tall, not squashed.
All these affect the ease of respiration. A small change means a great deal
for a vocal athlete.
Atlanto-Occipital Joint: Head position affecting laryngeal position and
flexibility of the suboccipital muscles affect vocal function.
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Lateral symmetry affecting rib cage expansion.
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Artistry can mean a few different things. In general it means skilled quality...
something that isn't just thrown together, but that has to be practiced and
perfected, but it can also mean quality or skill separately depending on the
context.
The more complete your artistic understanding and execution, the better
your vocal production will be.
I sure sing badly if I am sight reading a new song!! And my throat hurts
afterwards!
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Memorize this. Imprint it in your mind!
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Sleep: your instrument and its case needs rest.
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Surround yourself with supportive people. It’s worth having a handful of
loving and caring people around you rather than 50 critical and negative
people.
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They are all false.
The water you drink, needs to be processed by your body to reach the
larynx at the cellular level.
If water touched your vocal folds, you’d have a coughing fit and you will
sound very bad.
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If your body is dehydrated, your laryngeal membranes produce thick
mucus!! So drink up (water) me hearties yo ho!!!
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Research shows us that hydrated vocal folds vibrate easier and withstand
impact better.
Plants: According to a University of Agriculture in Norway study, indoor
plants can reduce fatigue, coughs, sore throats and other cold-related
illnesses by more than 30 percent, partially by increasing humidity levels
and decreasing dust. Plants also clean the air.
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Even though you may not be bothered by the noise, your brain is one step
ahead of you. It will compete with the noise.
Have you heard of the Lombard Effect? Google this.
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Loud speaking = harder impact on your delicate vocal folds.
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Do not underestimate the importance of “chilling out”
Soft tissue therapy targeting somatic (bodywork) dysfunction and resulting
pain and restricted motion. This is accomplished by relaxing contracted
muscles, increasing circulation and lymphatic drainage, and stimulating the
stretch reflex of muscles and overlying fascia.
Remember that your muscles and soft tissues are like a complex spider
web. Tight throat usually mean a lot more muscle tension elsewhere in your
body.
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Explain warm up. It’s not going into a practice room and immediately
belting out an aria. It should involve a systematic and slow warming up of
your vocal muscles. Cool down involves stretching of the vocal muscles to
release the lactic acid build up and to bring down the temperature.
Check out this video of Straw Phonation by Professor Ingo Titze. This is a
great voice warm up and cool down technique that rebalances the
laryngeal musculature: http://www.youtube.com/watch?v=asDg7T-WT-0
Opera singers often have misconception of “correct” speaking pitch and
technique. “Talk like you are singing” is really not a correct way of using
your speaking voice. Remember, classical singing take higher subglottal
pressure than speaking. So you end up using an unbalanced vocal
production for speaking which takes less subglottal pressure than singing.
We need to speak with resonant oral tone at modal/chest pitch.
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The voice therapist’s job is to help you bring back to your optimal function.
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Your voice teacher helps you to achieve technique and artistry.
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Voice Savy ENT is a laryngologist.
Not every ENT is trained in laryngology. So do your home work when
finding a good laryngologist. They must be an ENT with laryngology
fellowship training.
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