MENC: The National Association for Music Education

The Relationship between the Physical Aspects of Voice Production and Optimal Vocal
Health
Author(s): Peter R. LaPine
Source: Music Educators Journal, Vol. 94, No. 3 (Jan., 2008), pp. 24-29
Published by: Sage Publications, Inc. on behalf of MENC: The National Association for
Music Education
Stable URL: http://www.jstor.org/stable/4623687
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 The Relationship
between the Physica
Aspects of Voice
Production and
Optimal Vocal Health
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Some texts include resonance as an aspect of

focus issue of Music Educators Journal,
vocal quality.3
vocal health is a particularlyWhile there is disagreement about
meaningful
describing rely
topic. Singers and performers vocal quality,
on it is clear that a
their voices for both their artrelationship
strong and per- exists between poor vocal
sonal fulfillment; they must be
quality andconstantly
physical health. The Vocal Health
aware of how their voices are Report, produced both
functioning, at the 2004 Health
Promotion
in terms of breathing and vocal foldinaction.
Schools of Music Conference at
In studying vocal function, the human
the University of North Texas states,
voice can be analyzed both subjectively and
Effective and pitch,
objectively. Its subjective traits include healthful vocal commu-
Understanding
loudness, and quality, and its objective traits for people of all
nication is important
include frequency, intensity, and ages, amplitude.
and in the vocations and avocations
the physical
Because objective measurement is usually
in which voice is the primary sound
limited to environments that have the neces- source. Given that most U.S. elementary
aspects of vocal sary instrumentation to measure acoustic school children experience music educa-
data, subjective assessment is an absolute tion classes and over 28 million U.S. citi-
production and necessity. zens sing in choirs, music education can
Pitch and loudness are relatively easy to be a primary fountainhead for voice use
the workings of assess. Pitch can be too high or too low for and voice health education.'

age and gender and loudness too loud or too

th e larynx are soft for the environment. Historically, howev- This article focuses on some of the
er, there has been little consensus on judging changes to the voice that are of concer
just the first quality-the clarity of vocal tone-whether vocalists and teachers of vocal music and
among trained or untrained listeners. The drama, with an emphasis on increasing
steps on the terminology frequently associated with vocal awareness about vocal health.
quality has been quite colorful,' yet terms
road to good such as hoarse, strident, breathy, strained, How the Healthy Voice Works
metallic, stuffy, and nasal, while descriptive, To understand what happens to the larynx
vocal hygiene. do not have universally accepted definitions.2 with disease or injury, it is necessary to under-

Peter R. LaPine is a professor in the Department of Communicative Sciences and Disorders a

is director of the Vocal Tract Performance Laboratory at Michigan State University, East
Lansing. He can be reached at lapine@msu.edu.

24 MUSIC EDUCATORS JOURNAL JANUARY 2008

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stand how it functions under normal conditions.
Cyclic vibrations of the vocal folds make
the voice sound. The cycle has three recur-
ring segments: a closed phase, a open phase,
and another closed phase. Air is trapped
below the vocal folds as the vocal folds are
brought together-closed phase-by several
pairs of muscles inside the larynx. The air
pressure that accumulates below the vocal
folds eventually overcomes the elasticity of
the closed vocal folds and blows them away
from each other, thus opening the vocal folds
in the second phase of the cycle. Figure 1
shows the vocal folds in the open phase of
one cycle of vibration.
As air pressure from the lungs decreases,
air pressure flowing between the vocal folds
decreases correspondingly, and the elasticity
of the muscles inside the larynx helps initiate
the last phase of a cycle of vibration, the clos-
ing phase. This cycle repeats itself until the
air pressure is insufficient to start again. The
recurring cycle of vocal fold vibration creates
a fundamental vibratory rate. In the adult
female, for example, this cycle repeats itself
approximately 220 times per second. The Teach your students the importance of healthy, relaxed, easy vocal
more rapid the vibratory rate, the higher theproduction, and encourage them to stay hydrated and get adequate sleep.
pitch that is perceived by the listener; the
lower the rate, the lower the perception ofmovement is altered, as is the quality of voice
vocal pitch. that is produced. A variety of physical
Pitch variation during speech or singing ischanges, including acute illnesses, can also
a dynamic sequence of fine-motor eventsaffect the laryngeal mechanism and alter the
within the face, throat, larynx, and thoracic nature of the vocal tone.
cavity. Vocal pitch is determined by variations Any change in vocal quality that lasts
in the mass, length, and tension of the vocal longer than two weeks requires a medical
fold. Changes in length and tension are deter- practitioner to properly evaluate the physical
mined by the muscles in the larynx. The status of the larynx. This does not apply to
cyclic action of vibrating vocal folds, the vari-variations of vocal pitch and loudness, only
ations in air pressure from the lungs, and theto changes in vocal quality.
verbal or phonetic demands of speech or Qualitative vocal changes are frequently
singing also play a part. associated with vocal misuse (nonvocal activ-
See what the working vocal folds look likeities such as effortful vocal fold closure during
in this online video: www.phonetics.ucla. physical exertion, coughing, and throat-
edu/vowels/chapter2/vibrating%20cords/clearing) or vocal abuse (vocal activities such
vibrating.html. as yelling, shouting, and singing with poor
technique). In either case, the laryngeal
Vocal Abuse and Misuse mechanism is not functioning optimally.
Efficient vocal fold vibration is a dynamic Teachers, professors, drama coaches, choir
blend of proper muscular contraction and
directors, and other people in occupations
balanced respiratory support. When muscu-
that require extended periods of talking can
suffer from vocal abuse or misuse. Other sit-
lar contraction or respiratory support is sys-
temically or actively changed, vocal folduations where vocal abuse or misuse can

WWW. ME NC.ORG 25

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 yet it serves as an excellent preface to
Fg e .irm fh L y
a discussion of various problems that
can affect the larynx.
Vocal Nodules and Polyps. There
Normal vocal folds in the are two kinds of vocal fold lesions that
open phase of one cycle are common pathologies among those
of vibration, looking down who use their voices for extended
the throat (as seen during periods of time: vocal nodules and
an oral video endoscopy) vocal polyps. Both are types of benign
masses that develop most often on a
- Vocal folds
particular segment of the vocal cord.
Although each is different pathologi-
- Glottis
cally, the cause of nodules and polyps
is essentially the same: they are
mechanically induced lesions brought
- Front of body on by excessive force, strain, or
protracted detrimental use of the
vocal folds.

Photo from Boone, Daniel R., Stephen C. McFarlane, & Shelley L.Von Berg, The Voice and Generally, vocal nodules tend to
Voice Therapy (with free DVD), 7th ed. Published by Allyn and Bacon, Boston, MA. occur on both the right and the left
Copyright @ 2005 by Pearson Education. Reprinted by permission of the publisher. vocal folds, while polyps tend to occur
on only one side. Regardless of which
form exists, they have similar, audible
characteristics: low pitch, breathy
occur include singing outside an opti- balancing breathing, voicing, and voice, and a qualitative vocal change.
mal range for extended periods of vocal quality. This dynamic control Vocal nodules have two forms, each
time, projecting the voice in less than must be sustained over a longer dependent on the duration of the
ideal acoustic environments, and period and must include accurate mechanical irritation sustained by the
vocalizing for long periods of time. auditory feedback for simultaneously vocal fold. Singers are predisposed to
For students, even the vocal activities monitoring and modulating laryngeal soft, fleshy, pinkish pliable nodules,
that occur during recess or cheerlead- function and vocal tone. which can reabsorb readily into the
ing practice can lead to qualitative A prolonged sequence similar to vocal fold with conscious attention to
changes in the voice. that just described leads to abrupt voice use via good vocal hygiene and,
This overuse of the voice can pro- contact of the edges of the vocal folds, possibly, some conservative voice rest.
duce temporary changes in the laryn- and the vocal folds can begin to Mature nodules tend to be dense,
geal mechanism that can alter vocal change shape. Changes along the edge callus-like growths that are white or
quality. Very likely, you have experi- further increase vocal fold mass and yellow and less likely to reabsorb into
enced vocal fatigue often enough to contribute to incomplete approxima- the vocal fold without some form of
direct intervention.
be acutely aware of the qualitative tion of both vocal folds-that is, the
changes it causes. vocal folds do not complete the clos- The soft, fleshy forms of vocal cord
ing phase. The incomplete approxima-thickening that occur in professional
The Larynx during Vocal Abuse tion creates conditions where the voice users are commonly called
screamer's nodules, even in children,
It is useful when working with the vocal folds contact only on the thick-
voice to understand what happens in ened portion of each fold, allowingbecause
air they result from brief, short-
the larynx during vocal abuse or mis- to escape through the gaps in term
the voice abuse or misuse. A trained
use. When the vocal folds vibrate con- incompletely approximated portions singer, at least theoretically, should
tinuously in a manner that is excessive of the folds. This air escape resultsnot
in experience long-term voice abuse
in terms of force (velocity) and dura- or misuse.
what is usually described as a breathy
tion, excess fluid begins to accumulate quality. The added vocal fold mass Voice therapy to manage the very
in the folds. The excess fluid increases symptoms that create the nodules can
contributes to the perception of lower
the physical mass of the vocal fold, vocal pitch; ultimately, this added be an effective treatment for mature
leading to slower vibration. Slower mass reduces the ability to raise vocal nodules. However, in cases
pitch,
vibration produces relatively lower and the voice will sound breathy and treatments such as voice thera-
where
pitch; in response to the altered pitch, low, indicative of the common py are not effective or appropriate,
the speaker may put forth greater description that the voice is hoarse. vocal nodules may be removed surgi-
effort to offset this pitch change, cally. The key to managing use-related
which only perpetuates an already Issues That Can Affect lesions like vocal nodules and vocal

unhealthy situation. In skilled singers, the Larynx polyps is identifying and eliminating
these changes are more dynamic and The above anatomic description ofthe behavior that caused the lesion. If
require more refined motor control for vocal fold change is oversimplified,the audible changes in the voice are

26 MUSIC EDUCATORS JOURNAL ---- JANUARY 2008

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properly identified and appropriate limited vocal range. Teachers and per- who can examine the larynx and sug-
treatment begun, with careful atten- formers need to be aware of how diffi- gest treatment alternatives. Ideally that
tion to individual behaviors, the voice cult it can be to detect the onset of professional should be an otolaryngol-
will quickly return to normal. musculoskeletal stress, particularly
ogist. Treating the GERD should allow
Common Illnesses. Many common when there might be performance the voice to return to normal.
illnesses are also associated with vocal anxiety (see the discussion of per- Contaminants. Smoking any sub-
quality disorders. For example, aller-formance anxiety in the article stance
by dries out the laryngeal mucosa
gies may cause a nasal vocal quality.David Sternbach in this issue). and should be avoided. For those who
Allergies can also cause swollen vocal Musculoskeletal tension can dis- perform in smoky environments,
folds because of throat clearing or aplace the larynx, with the ultimate leave the environment periodically for
persistent cough in response to post-effect of changing the balance of aelas-
brief vocal rest. Extra hydration with
nasal drip. The swelling that resultsticity within a laryngeal muscle. water is helpful as well.
from the cough may evolve into a Musculoskeletal tension affects the Postnasal Drip (PND). Postnasal
vocal fold thickening. Using pre-extent to which the extrinsic and
drip often accompanies allergic condi-
scribed or over-the-counter medica- intrinsic laryngeal muscles can tions
regu- or the common cold. PND can
late the length of the vocal folds,
tions may have a drying effect, causing and
lead to a destructive habit of persistent
a sensation of irritation in the larynx
may lead to a muscle tension dyspho-
throat clearing and is associated with a
and increasing the occurrence of nia (MTD). Muscle tension dysphonia
sensation of something stuck in the
results when the voice is adversely
throat clearing or repetitive coughing. throat. Throat clearing causes abrupt,
These medications can also lead to a affected by increased contraction redundant
of glottal attack. The hard
the muscles outside of the larynx,
lack of laryngeal hydration that affects the attack is created when air pres-
glottal
the clarity of the vocal tone. extrinsic laryngeal muscles. sure builds below the vocal folds. This
This
Respiratory Problems. Respiratoryexcessive contraction changes the causes the vocal folds to be
buildup
internal shape of the vocal folds,
problems resulting from asthma, exer- compressed together tightly to with-
cise-induced asthma, or short-term ill-
notably their mass, length, andholdten-
the pressure; then the vocal folds
nesses, including upper respiratory sion. Sound becomes difficult to are
pro-literally blown apart-opened
duce, inducing complaints of vocal
infections, are associated with a repet- forcefully-which is a harsh, detri-
fatigue or tension-fatigue syndromes.
itive cough. Again, recognition of the mental sequence in vocal fold motion.
anatomical changes within the larynx The recurring sequence leads to vocal
Difficulty initiating sound, difficulty
that are associated with repetitive sustaining sound, and inability foldto
swelling, and possibly, to some
coughing is helpful for music educa-reliably produce sound are all effects
changes in vocal production.
of MTD.
tors. During a persistent cough, the This form of vocal attack is associ-
vocal folds are abruptly compressedGastroesophageal Reflux Disorder ated with rapid, forceful onset of voice
with a repetitious, forceful glottal(GERD). Gastroesophageal reflux and leads to vocal fold swelling.
disorder associated with psychosocial Swelling causes vocal folds to become
attack. The compression increases the
fluid that lies over the thin layer of
mucous that covers a healthy vocal
fold and the mass of the vocal fold, It is useful to understand what
leading to powerful, abrupt contact of
the edges of the vocal fold; this force- happens in the larynx during
ful contact leads to edema or swelling.
The edema decreases the vocal fold
vocal abuse or misuse.
vibratory rate, leading to lowered
pitch. A common complaint that stress, personal anxiety, diet, and age- heavier-increased mass-and then
accompanies the repetitive cough is related
a change is increasing in the leads to a decrease in vocal pitch
feeling of something stuck in the United States. Gastroesophageal reflux Hydration can help thin secretion
is associated with stomach secretions
throat, called a globus sensation. The and increase the frequency of swa
sensation tends to produce yet more that escape into the esophagus and lowing as a massage of the larynx
throat clearing, which can further then pool on or near the vocal folds.Using a throat lozenge is acceptable t
injure the vocal fold. The secretion is caustic, causing the help thin secretions, but it is better t
Musculoskeletal Stress. Any dis-vocal folds to become inflamed. The use one that does not contain men-
cussion about music education and inflammation alters the mucosal edges
thol, which can further irritate already
vocal health would probably be of the vocal folds and creates an unde- irritated tissues.

incomplete without mention of mus- sirable vocal change. The primary

culoskeletal stress. The pressure of audible symptom of GERD is glottalSome Suggestions for Optimal
preparing for performance can cause fry, giving the voice a hoarse or raspyVocal Health
nervous energy that transfers from the quality. Stay Hydrated. One of the most
limbs to the body's core, chiefly the Therefore, if you suspect GERD is important things you can do to main-
chest and neck. This transfer can often causing your voice change, you tain vocal health is to drink plenty of
be heard as a tight vocal tone with should see a medical professional, fluids, particularly clear liquids. Water

W W W. MEN C. O RG 27

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is the ideal source of hydration, and
Prevntio Strteges: resevin
you should drink at least sixty-four Vocl eathin heClssoo
fluid ounces per day. However, fruits
and vegetables and liquids such as
low-fat milk also count as fluid intake.
Clear fruit juices are acceptable, but By Karen Salvador, a doctoral student in music education a
individuals with reflux concerns or a University in East Lansing. She can be reached at huberkar
history of reflux should avoid acidic
drinks. Also avoid the dehydrating
Warm Up.Warm up not just the voice, but also the body, t
effects of caffeinated drinks, as well
brain. Each warm-up should include movement to get the
as the agitation that may accompany
stretches to relax tension and align posture, exercises to en
caffeine intake.
and challenges that require students to think about their sin
Rest the Voice When Needed. Rest
tant areas can be combined. For example, you can do a rhyth
the voice after demanding use or sur- warm-up using breath-support hisses, or transpose a famili
gery. There are two basic types of into Lydian mode.
voice rest. Complete voice rest Be an Exemplary Model. Ensure that when you speak and sing
requires absolute cessation of vocal class, you are using excellent posture, engaged breath, and re
fold vibration, which means not tion. Resist the temptation to sing or speak loudly when yo
instruct.
speaking or singing or even coughing
Incorporate Vocal Health into Your Classroom Management Strategy.
or yawning out loud. Recommenda-
Emphasize voice preservation in your classroom routines: use a nonverbal cue
tions for complete voice rest are
for student attention. Require that only one person talk at a time. Don't allow
typically made to assist the healing
gaps in your planning where individual conversations may spring up. Establish
process following some forms of sur- a rule that if students are not directly engaged (e.g., you are working with
gery for the voice. another section), they will silently listen and follow. Choose to demonstrate
In conservative voice rest, some the same good practices by resisting the temptation to shout (even instruc-
voice use is acceptable when oral tions or compliments) over students' singing. It is poor vocal modeling, and the
communication is necessary. Talking singers probably can't hear or understand you anyway. Convey information
quietly in a normal voice is allowed. with your gestures, or wait until students are not singing.
Whispering should not be confused Practice Smarter, Not Harder.Your students do not need to sing full voice
for an entire hour-long rehearsal every day. Experiment with ways to build in
with talking quietly and should actu-
vocal breaks or to lessen the vocal load. Engage the brain, not just the voice!
ally be avoided. Sixty minutes of con-
For example, many groups sight-sing very loudly-try having them read stac-
servative voice rest following a singing
cato on the syllable "dee." Each week, listen to a different recording of a short
or dramatic performance is highly rec-
work (either one you are preparing or a different one) and discuss what you
ommended. Add hydration and oral hear with your students. Or approach a work structurally-identify an impor-
communication as needed. A common
tant theme to be sung while the rest of the parts audiate.
suggestion for voice use during peri-
ods of conservative voice rest is:
"Don't talk to anyone too far away to
touch." This same voice rest recom-
mendation is also a good practice for prevent singers or speakers from
key factor is vocal quality; if it is com-
drama coaches, choir directors, and promised, you need further examina- receiving enough auditory feedback,
others who rehearse in large spaces. tion or analysis of technique. And they it will try to produce a louder voice
Use Good Posture. Appropriate goes without saying: never sing, per-so they can more easily monitor their
form, or project the voice if there isown volume. This is called the
posture makes it easier for the voice to
work. Keep the trachea in line with Lombard Effect. Using a louder vo
evidence of bleeding from the mouth
the larynx, and hold the eyes and chin or nose. will only prolong the use of excessiv
parallel to the floor. Tilting or turning Check Your Voice with the vocal loudness. Again, practicing con
the head can change the configuration "Internal Calibrator." There is an servative voice rest after such a situa-
of the airway and result in a change in
easy method to informally check thetion becomes critical.
vocal effort. For example, elementaryvoice before and after conservative
voice rest. Simply speak the affirma-A Multidisciplinary Approach
teachers should get to a child's eye
tive "uh-huh" with focus on the sec-
level by bending their knees, not by to Vocal Health
bending at the waist. ond syllable ("huh"). This provides a Those who rely on their voices for
Do Not Ignore Painful Phonation.casual estimate of vocal pitch andpersonal expression, lifestyle, occupa-
Don't ignore laryngeal pain. If vocal
quality. The second syllable should, tion, or overall quality of life need to
control remains unaffected, you cangenerally, be a reasonable approxima- be able to use those voices to the
continue to sing. However, acute, tion of proper vocal fold vibration for fullest capacity. Voice issues can be
focused pain associated with anthe voice. simple or complex, physical or
unwanted change in vocal quality Be Aware of the Lombard Effect. behavioral, professional or social.
should not be disregarded. Again, theWhen environmental noise levels Drawing on a number of professions
28 MUSIC EDUCATORS JOURNAL JANUARY 2008

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Be Alert for Signs of Damage. If a student's voice changes significantly in and related disc
range or quality or he or she experiences pain with phonation, these may be a pathway to b
signs of a problem. Students with these symptoms should be allowed to rest management to
their voices-while still fully engaging their brains in the rehearsal. If these option in some
symptoms persist or recur, consultation with a physician trained to examine health requires
the larynx medically, such as an otolaryngologist (ear, nose, and throat doctor), health care pro
may be warranted. physicians who
Encourage Students to Hydrate and Get Adequate Sleep. Hydration and laryngeal fun
sleep are areas where teachers have little control over their students, but rest certified voice teachers and coaches
and hydration are two of the best ways to preserve vocal health.Allow your stu-
who are knowledgeable about voice
dents to have water bottles in choir, and encourage them to get enough sleep.
Educate. Emphasize the importance of healthy, relaxed, easy vocal production at
production and voice use, creden-
every opportunity. This should also improve the intonation, blend, and tone tialed speech-language pathologists
quality of your choir. who can help develop vocal hygiene
Resources for Improving Vocal Health in Your Students plans or assess voice via. objective
* Voice Care Network. A group devoted to research and dissemination of evi- measures, and, conceivably, qualified
dence-based methods to free the voice and make singing healthy and enjoyable. psychologists who can address behav-
Targeted to singers, choral conductors, voice teachers, speech-language pathol- ioral relationships of personality and
ogists, and ear-nose-throat physicians. www.voicecarenetwork.org performance. Using such resources
* Voice Foundation. "The world leader in the care of the professional voice." This
can only improve vocal health.
Web site is targeted more to professionals who treat voice problems. It is also
filled with useful information for teachers who are concerned that they or their
Notes
students may have a vocal injury. www.voicefoundation.org
1. Daniel R. Boone, Stephen C.
* Voice Problem.This site is primarily intended to help people manage their voice
McFarlane, and Shelley L. Von Berg, The
problems. For teachers, it has great information about the anatomy and function
Voice and Voice Therapy, 7th ed. (Boston:
of the vocal apparatus, which will be helpful when you set out to educate your
students about their vocal health. www.voiceproblem.org Allyn and Bacon, 2005); Raymond H.
* Nesheim, Paul, with Weston Noble. Building Beautiful Voices-Director's Edition Colton, Janina K. Casper, and Rebecca
(Dayton, OH: Roger Dean, 2005).This book features pictures that show how to Leonard, Understanding Voice Problems: A
recognize healthy singing (and some common mistakes) in your students and is Physiological Perspective for Diagnosis
filled with ready-to-use ideas for classroom vocal pedagogy.As the title implies, and Treatment, 3rd ed. (Philadelphia:
there is also a student version. Lippincott Williams & Wilkins, 2006).
2. James L. Case, Clinical Management
Books Offering More Complete Information on Vocal Health of Voice Disorders, 4th ed. (Austin, TX:
* Sataloff, Robert Thayer, ed. Vocal Health and Pedagogy: Science and Assessment.Pro-Ed, 2002).
San Diego, CA: Plural Publishing, 2006. 3. Joseph C. Stemple, Leslie E. Glaze,
* Smith, Brenda, and Robert Thayer Sataloff. Choral Pedagogy. San Diego, CA:and Bernice G. Klaben, Clinical Voice
Plural Publishing, 2006. Pathology, 3rd ed. (San Diego, CA:
Singular Publishing, 2000).
4. Health Promotion in Schools of

Music: Vocal Health Report Post-

Conference Response and Recommend-
TIhis is the University of Kansas... ations, www.unt.edu/hpsm/vocal_postconf
_report.htm (accessed February 17,
a great place to be! 2007). U

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Visit KU's Music EducationSCHOOL

and Music OF Therapy websi
http://arts. ku.edu/-sfa/musicdance/memt/
The Universt y ol Ksnsas

for more information!

Department of Music and Dance

WWW. MENC. ORG 29

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