Voicetrainer Blog

The Voice: Things You Should Know

Posted on September 2, 2015 in Medicine for the Voice


I had the pleasure of attending Dr. Adam Rubin’s lecture for vocal performers entitled “The Voice: Things You Should Know” at the recent annual Shenandoah University CCM Vocal Pedagogy Institute (http://www.ccminstitute.com/) in Winchester, VA.  He himself is a performer, as well as a Laryngologist with Lakeshore ENT in Detroit MI (http://www.lakeshoreent.com/).  He is very clinically active with vocal performers.  He published a book in 2014, The Vocal Pitstop (http://goo.gl/VH9SJL), a practical introduction to the voice and voice care.

Here are some highlights of his presentation:

  • The first goal of vocal health is prevention.  Care for your voice, in an effort to avoid injury in the first place.
  • Recognize potential vocal injury.  Appropriate and timely management is imperative with the primary goal towards avoiding scar development.  The vocal folds need to remain soft and supple, which scar is not.  There presently is no good long-term treatment for scar, and deep scar can be career ending.
  • The vocal fold is made up of 5 layers.  The most gelatinous layer is called Reinke’s space.  This is the voice user’s best friend as it is the most protective layer.  Those individuals who seem to have more resilient voices may actually have more resilient collagen in Reinke’s space.
  • How do you know if there is a voice problem? Listen to the voice… is it raspy or rough, breathy, peculiar sounding, with altered resonance, poor loudess, a change in baseline pitch, or a change in pitch range.  These are a good place to start.
  • If there is evidence of laryngo-pharyngeal reflux (LPR) on exam or the patient is symptomatic, he will treat with a proton-pump inhibitor (PPI) for a minimum of 3 months.
  • If the vocal folds are stiff as visualized on videostroboscopy following viral laryngitis, he considers a steroid injection into the vocal folds.
  • If there is evidence of vocal fold hemorrhage, he advises voice rest for 1 week, and no singing 6 weeks.
  • The performer or heavy voice user who is struggling with their voice needs to consider whether they can give less and still come off great, not 200% effort.
  • Use glycerin based lozenges, no mentholated or numbing lozenges.


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