VOICECARE FOR PROFESSIONAL VOICE USERS

Disorders of Vocal Abuse and Misuse
What are vocal abuse and misuse?
How is voice produced?
Who may be at risk for a disorder of vocal abuse or misuse?
What are some of the disorders of vocal abuse and misuse?
How are disorders of vocal abuse and misuse diagnosed?
How are disorders of vocal abuse and misuse treated?
What research is being conducted on disorders of vocal abuse and misuse?
Where can I get more information?
What are vocal abuse and misuse?
Vocal abuse is any behavior or occurrence that strains or injures the vocal folds (or vocal cords). This may include excessive talking, throat clearing, coughing, inhaling irritants, smoking, screaming, or yelling. Vocal misuse is improper voice usage such as speaking too loudly or at an abnormally high or low pitch. Frequent vocal abuse and misuse can damage the vocal folds and cause temporary or permanent changes in vocal function, voice quality, and possible loss of voice.
How is voice produced?
Voice is produced by vibration of the vocal folds. The vocal folds are two bands of smooth muscle tissue that lie opposite each other. They are located in the larynx or voice box. The larynx is positioned between the base of the tongue and the top of the trachea (windpipe), the passageway to the lungs.
When at rest, the vocal folds are open to allow an individual to breathe. To produce voice, the brain precisely coordinates a series of events. First, the folds come together in a firm but relaxed way. Once the folds are closed, air from the lungs passes through them, causing vibration and thus making sound. The sound from this vibration then travels through the throat, nose, and mouth (resonating cavities). The size and shape of these cavities, along with the size and shape of the vocal folds, help to determine voice quality.
Variety within an individual voice is the result of lengthening or shortening, tensing or relaxing the vocal folds. Moving the cartilages, or soft, flexible bone-like tissues to which the folds are attached, makes these adjustments possible. For example, shortening and relaxing the vocal folds makes a deep voice; lengthening and tensing them produces a high-pitched voice
Who may be at risk for a disorder of vocal abuse or misuse?
Disorders of vocal abuse and misuse are the most prevalent and preventable of the types of voice disorders. Anyone, from infants to the elderly, who uses his or her voice excessively may develop a disorder related to vocal abuse. Lawyers, teachers, clergy, cheerleaders, and professional voice users such as singers and actors often develop these types of voice disorders. Much of the chronic hoarseness experienced by children is caused by vocal abuse or misuse.
What are some of the disorders of vocal abuse and misuse?
The most common disorders resulting from vocal abuse and misuse are laryngitis, vocal nodules, vocal polyps, and contact ulcers. Health professionals who have training in voice and voice disorders often refer to these conditions as "hyperfunctional voice disorders."
Laryngitis is an inflammation or swelling of the vocal folds. It may be caused by excessive use of the voice, by bacterial or viral infections, or by irritants such as inhaled chemicals or the backup of stomach acid into the throat (gastroesophageal reflux). The voice of someone with laryngitis will often sound raspy, breathy, and hoarse.
Vocal nodules, which are small, benign (noncancerous) growths on the vocal cords, are among the most common voice disorders directly related to vocal abuse. This condition is often called "singer's nodes,teacher's nodes" because it is a frequent problem among professional singers,teachers,tele marketers. Vocal nodules are callous-like growths that usually form in pairs, one on each vocal fold. They form at the area that receives the most pressure when the folds come together to vibrate. The nodules develop from damage caused by repeated pressure on the same area much like a callous forms on areas of a person's feet that are irritated by tight shoes. The voice of a person who has vocal nodules usually sounds hoarse, low-pitched, and slightly breathy.
Vocal polyp. A vocal polyp, also called Reinke's edema or polypoid degeneration, is a benign growth that is similar to a vocal nodule but is softer, more like a blister than a callous. It most often forms on only one vocal cord. A vocal polyp is often associated with long-term cigarette smoking but may also be linked to hypothyroidism (decreased activity of the thyroid gland which is involved in the growth and development of children and energy control in adults), gastroesophageal reflux, or chronic vocal misuse. People who develop a vocal polyp usually have a low-pitched, hoarse, breathy voice, similar to the voices of people who have vocal nodules.
Contact ulcers are a less common disorder of vocal abuse. They are experienced by people who use too much force when bringing the vocal folds together for speech. This excessive force causes ulcerated sores or a wearing away of tissue on or near the cartilages of the larynx that move to bring the vocal folds together. These ulcers are also found in people who have gastroesophageal reflux. People with this type of voice disorder often complain of their voice tiring easily and may feel pain in the throat, especially while talking.
How are disorders of vocal abuse and misuse diagnosed?
Anyone who experiences vocal change or hoarseness for more than 2 weeks should be examined by Voice Care India an organisation run by Medical Advance Research Foundation, Dr.M.Kumaresan otolaryngologist (surgeon who specializes in diseases of the ears, nose, throat, and head and neck.Siva ENT Hospital,159 Lloyds Road,Royapettah,Chennai.600 014,Cell 98410 55774). While hoarseness is a common symptom of vocal abuse or misuse, it is also one of the first signs of cancer of the larynx. A physician's visit is especially important for people who smoke cigarettes, because smoking is closely associated with laryngeal cancer. The otolaryngologist will examine the individual's vocal folds and determine if a medical condition is causing the voice problem. As part of the voice examination, we will often look directly at the vocal folds. This may be done by inserting a tiny mirror into the mouth to the back of the throat (laryngoscopy). The otolaryngologist may also examine the vocal folds by passing a small camera and light through the mouth or nose and into the throat (fiberoptic laryngoscopy). This method is often preferred because it allows viewing of vocal cord movement during speech.
Following an examination, a team of health professional trained to evaluate and treat people who have voice, speech, language, or swallowing disorders that affect their ability to communicate. The team will evaluate the pitch, loudness, and quality of the person's voice, and will also assess vocal techniques such as breathing and style of voicing. A voice recording is often made, and trial therapy techniques may be used to test their effectiveness at improving the voice.
How are disorders of vocal abuse and misuse treated?
Most disorders of vocal abuse and misuse are reversible. The best treatment is to identify and eliminate the vocal behavior that created the voice disorder. In many cases, a brief period of voice therapy is helpful so that the individual can learn good vocal techniques such as proper breath support for speech or eliminating forceful voicing.
In some instances, eliminating the abuse or misuse and voice therapy are not enough. In these cases, medication to block the production of stomach acid may be helpful. In some cases, an operation may be necessary to remove growths from the vocal folds. Since most disorders of vocal abuse and misuse easily recur following surgery if the vocal misuse continues, another period of voice therapy by our team, after surgery may help prevent recurrence of the problem.
Children with disorders of vocal abuse and misuse are often the most difficult to treat because it is not easy for them to change their vocal behaviors. Fortunately, most children outgrow these disorders by the time they are teenagers. For these reasons, many surgeons do not operate on children who have disorders of vocal abuse or misuse. A period of voice therapy, however, may help the child to learn proper voice behaviors.
What research is being conducted on disorders of vocal abuse and misuse?
Scientists are examining a multitude of issues related to vocal abuse and misuse. They are conducting in-depth studies of the tissues of the vocal folds to determine how various types of stress affect these delicate tissues. Scientists are especially interested in determining why vocal behaviors in some individuals lead to vocal nodules while similar behaviors in other individuals may lead to mild laryngitis, vocal polyps, or little or no voice change. They are also examining the tissue changes necessary for the development of laryngeal growths such as nodules and polyps, as well as laryngeal cancer, and how various treatments reverse those tissue changes. Speech-language pathologists are studying the effectiveness of behavioral techniques including use of machines to help people relearn proper vocal techniques such as good breath support or efficient use of the larynx. Studies that will improve the treatment of hyperfunctional voice disorders in children are also in progress. Of special interest is the long-term impact of various treatments, especially medical and surgical treatments.

திருச்சியில் குரல்வள பாதுகாப்பு பட்டறை

Sep 28th 2008, Anna Science and Technology Centre, Trichy

மூச்சுப்பயிற்சியால் குரல்வளத்தை பாதுகாக்கலாம்: ஆசிரியர்களுக்கு இ.என்.டி., டாக்டர், 'அட்வைஸ்'திருச்சி: ""தமிழ் மருத்துவ புத்தகங்களில் உள்ளது போல் உள்ளங்கால் முதல் உச்சஞ்தலை வரை இழுத்து மூச்சுப்பயிற்சி செய்தால் குரல் வளத்தை பாதுகாக்கலாம்,'' என்று சென்னை சிவா மருத்துவமனை எம்.டி., டாக்டர் குமரேசன் பேசினார். தமிழ்நாடு அறிவியல் மற்றும் தொழில்நுட்ப மையம், திருச்சி அண்ணா கோளரங்கம், சென்னை சிவா இ.என்.டி., மருத்துவமனை மற்றும் காரைக்குடி சித்த மருத்துவ குருகுலம் ஆகியவை இணைந்து, "ஆசிரியர்களுக்கான குரல் வளபாதுகாப்பு' பற்றிய பயிற்சி பட்டறையை நடத்தின. திருச்சி அண்ணா கோளரங்கத்தில் நடந்த பயிற்சி பட்டறையில் மாவட்டம் முழுவதும் இருந்து 101 ஆசிரியர் கலந்து கொண்டனர்.குரல்வள பாதுகாப்பு பயிற்சி பட்டறையை தமிழ்நாடு அறிவியல் மற்றும் தொழில்நுட்ப மைய செயல் இயக்குனர் ஐயம்பெருமாள் துவக்கிவைத்தார். துவக்கவிழாவில் சென்னை சிவா இ.என்.டி., மருத்துவமனையில் எம்.டி., டாக்டர் குமரேசன், மனஅழுத்த நிபுணர் டேவிட், யோகா வல்லுனர் ஆறுமுகம், சித்த மருத்துவர் சொக்கலிங்கம், ஏ.இ.ஓ., ஜெயராமன், திருச்சி அண்ணா கோளரங்கத்தின் திட்ட அலுவலர் அழகிரி சுவாமிராஜ் உள்ளிட்ட பலர் பங்கேற்றனர்.

விழாவில் சென்னை சிவா இ.என்.டி., மருத்துவமனை எம்.டி., டாக்டர் குமரேசன் பேசியதாவது: பொதுவாக குரல் பாதிப்பு என்றால் அது சளித்தொல்லை தான் என்று நினைக்கின்றனர். அது தவறானது. வகுப்பறைகளில் ஆசிரியர்கள் கத்தி பேசினாலோ, உணர்ச்சி வசப்பட்டு பேசினாலோ தான் மாணவர்கள் பயப்படுகின்றனர் என்று நினைப்பதும் தவறு. கத்தி பேசுவதால் குரலுக்கு தான் பாதிப்பு ஏற்படும்.தமிழ் மருத்துவ புத்தகங்களில் குரல்வளத்தை பாதுகாக்க மூச்சுப்பயிற்சி தேவை என்று உள்ளது. ஆங்கில முறைப்படி நுரையீரலில் இருந்து தொண்டை, மூக்கு வரை நன்றாக மூச்சை இழுத்துவிட வேண்டும் என்று சொல்லப்பட்டுள்ளது. இதுதான் தமிழ் மருத்துவ புத்தங்களில் உள்ளங்கால் முதல் உச்சஞ்தலை வரை இழுத்து மூச்சு விடவேண்டும் என்றும், அது குரல்வளத்தை பாதுகாக்கும் என்று சொல்லியுள்ளது. இதுபோன்று உள்ளங்கால் முதல் உச்சஞ்தலை வரை மூச்சு விட முடியுமா என்று சந்தேகம் தோன்றும். தாரளமாக முடியும். அதற்கு மூச்சுவிடும் போது அடிவயிற்றை நன்றாக அசைத்துக் கொடுத்தால் போதும். அடிவயிற்றை அசைவு கொடுத்து மூச்சு விடுவதால் சுவாச பயிற்சி சிறப்பாக அமையும். குரல்வளமும் நன்றாக இருக்கும். புற்றுநோய் மற்ற இடங்களில் வந்தால் சீக்கிரம் தெரியாது.ஆனால் தொண்டையில் ஏற்படும் புற்றுநோய் உடனடியாக தெரிந்துவிடும்.

மேடைப்பேச்சாளர்கள், ஆசிரியர்கள், பாடகர்கள் உள்ளிட்ட குரலை மூலதனமாக வைத்து இருப்பவர்கள் கழுத்தை இறுக்கி நிலையில் பேசக்கூடாது. இலகுவாக கழுத்தை வைத்துக் கொண்டு பேசவேண்டும். அந்தகாலத்தில் பாட்டு கற்றுக் கொள்பவர்கள் கழுத்துவரை தண்ணீரில் நின்று கற்றுக் கொள்வர். அதுவும் ஒருவகை குரல்வள பாதுகாப்பு முறைதான். இப்போது பாடல் கற்றுத்தருபவர்கள் ராகத்தை இழுத்து பாடுவதில் குரல்வள பாதுகாப்பு பயிற்சி இருந்தது. அதையெல்லாம் நாம் இப்போது செய்வது கிடையாது. ஆசிரியர்கள் மாணவர்களுக்கு பாடம் சொல்லித்தரும் போது ராகத்தோடு சொல்லித்தந்தால் குரல் வளம் பாதுகாக்கப்படும். இவ்வாறு அவர் பேசினார்.

voice care india

Our Address
------------
K.Navin Bharath.
Managing Director,
Dr.M.Kumaresan MS,DLO,MIALP[Logopedic and Phoniatrics]
Director ,Voice Care India,Siva ENT Head and Neck Hospital,
159(old no 94) Lloyds Road,Royapettah,Chennai,600 014.
Cell 98410 55774,Ph 28116807,E Mail ,drmkumaresan@yahoo.co.in

voice care india

voice care india

When voice abuse is suspected or observed in a patient with vocal problems, he or she should be referred to the voice care team run by voice care india.
Voice abuse and/or misuse should be suspected particularly in patients who report voice fatigue associated with voice use, in those whose voices are worse at the end of a working day or week, and in those who are chronically hoarse. Technical errors in voice use may be the primary etiology of a voice problem, or the condition may develop secondarily as a result of a patient's efforts to compensate for voice disturbance from another cause.
All these vocal activities can be done safely with proper training; however, most patients (surprisingly, even singers,teachers,actors) have little or no training for their speaking voice. es. In many cases, training the speaking voice will benefit speekersmsingers greatly, not only by improving speech but also by indirectly helping singing technique. Physicians should not hesitate to recommend such training. Many speech-language pathologists who are well trained in speech therapist are not trained in voice therapy for the speaking voice, and virtually none is trained holisticaly to use yoga and meditation for voice therapy.
Conversely, specialized singing training may be helpful to some voice patients who are not singers, and it is invaluable for patients who are singers. Initial singing training teaches relaxation techniques and develops muscle strength, and it should be symbiotic with standard speech therapy.