Part 2 of 4: Vocal Health with Dr. Paul Kwak

Welcome to FFB’s 4-Part January Series on Vocal Health with Dr. Paul Kwak! Throughout 2017, FFB will regularly host medical professionals, health gurus, fitness pros, & wellness experts on the blog to share their expert advice on the topics we love most!

A Singer’s Guide
to Vocal Health

You guys, your responses to last week's Part 1 were amazing!! Keep the questions coming! Keep the ideas coming! So grateful it's been such a helpful topic for y'all!

If you're anything like me, you have a tickle in your throat that turns into a little cough and suddenly the downward spiral of negative thoughts is so extreme, most commonly "OMG I will never be able to sing again!!" Singers really are cuckoo birds, myself included but for good reason. The voice is SO special, so valuable, so unique and requires the utmost attention and care. This week, Dr. Paul Kwak is helping us understand when to take action if we aren't feeling our best, vocally. It's great to have some general rules in our back pocket to calm down the crazy-singer-mental-chatter we all experience when little (or big!) changes occur in our voice.  - J. 

Week 2: Hoarseness and Sore Throat

Hello again, everyone! Last week, we started with some basic principles – about having a squad, having a baseline exam, and getting educated. Today, we’re going to start trying to get you educated with a couple of the most common and practical topics in the lives of singers – hoarseness, and sore throat.

These are undoubtedly two of the most common reasons that patients come in to see me, a physician, specifically (as opposed to other members of your squad). There are literally hundreds of reasons that people, especially vocal performers, develop changes to the voice, or pain in the throat; it would be neither helpful nor efficient for me to try to address each one, so let me start with this big-picture observation:

Hoarseness and sore throat are symptoms, not diagnoses

“Hoarseness” is an extremely general term that can refer to widely different things, but fundamentally, most people use it to mean some sort of change in the voice.  I have found that patients use that term to mean any or all of the following:

• A temporary or longer-lasting change in the sound of the speaking voice

• More subtle changes to the mechanics of the singing voice

  • Commonly, singers experience difficulty, a reduction of flexibility in or around the passaggio or the “mix”

  • Diminished range

• Changes to the quality of the singing voice

  • Increased raspiness in the tone

  • Diminished dimension of sound

Vocal performers who come in with these kinds of issues commonly also report some or all of the following:

• Decreased stamina/earlier fatigue

• Discomfort or even pain with singing

• Neck pain or tightness

It is completely within reason to expect that vocal athletes will experience some or all of these issues at some point during their training and careers.  That is why I so encourage you to have a great squad.  Specifically, though, here are some “rules of thumb” for helping you to decide when to come see a physician, as opposed to when things are just normal changes that come with being a vocal athlete.

• Hoarseness that lasts longer than 2 weeks

• Pain (sore throat, neck pain) that lasts beyond 1 week

Common causes of hoarseness in vocal performers

Like I said – there are literally hundreds of reasons that a voice can change.  In busy vocal performers, I would say that the most common reason is a combination of the accumulation of vocal fold edema (swelling) and muscle tension of the larynx. That is vastly oversimplified, but captures the essential truth that in busy vocal performers, your voice can change, tire, or hurt simply because of how much you use it. There are very simple, healthy, and straightforward ways for a physician to help you if that’s the case – but the only way to know for sure is for you to have an exam.

Less commonly – and I suspect that most of you worry about this when things start to change in terms of your mechanics – changes to the voice can be the result of lesions of the vocal folds (polyps, nodules, even cysts), or a vocal fold hemorrhage.

A physician simply cannot help you definitively until they know which of these is at the root of your changes to voice. Of course, the voice changes from day to day, which is why we tell people that 2 weeks is a reasonable period beyond which you shouldn’t wait any longer to come in. I would even suggest that in singers, particularly if you have a show, audition, or other important event coming up within a week, it is wise to come in sooner rather than later to take the guesswork out of your training and preparation, and help you with confidence.

Common causes of soar throat in vocal performers

Similarly, there are many causes of sore throat, but know this: pain is never normal. Naturally, everyone has aches and pains that can come and go, but when it lasts beyond a week, I would say it’s worth getting checked out.

Certainly a throat infection (pharyngitis, tonsillitis) is a common cause for throat pain, and this is easily treated with supportive measures, and sometimes antibiotics.  Additionally, we find that muscle tension – again, that results from extensive vocal demand and use – can itself cause a soreness, tightness, or even pain inside the throat and neck.  The treatment depends on the cause; but when pain lasts beyond a week, it is wise to have a physician evaluate you.

Don’t wait until its too late!

Performers often tough out these kinds of symptoms for any number of reasons – fear of what we’ll discover, cost of the visit, the time it takes to visit a doctor. Sure, depending on what is causing your symptoms, they may go away on their own; but if they do not, and you continue to push and work through an injury, for example, you can exacerbate the injury and make treatment and recovery more difficult and prolonged.  You will start to notice a theme in these posts: having a great squad, and feeling not just comfortable, but excited, about letting your squad help you, will go a long way in preserving your vocal health over the course of a long career.

Here's what a few of our favorite Broadway buddies had to say about keeping in tip top vocal shape to avoid entering the danger zone; hoarseness & a sore throat. - J. 

"HYDRATE! I steam for an hour before bed every night while checking my phone/watching crappy reality TV. I also have a humidifier by my bed that keeps me hydrated all night long, and of course just drinking water 24/7. I’m a huge fan of coconut water and aloe juice as well... Allow yourself quiet time. It is so easy to get caught up in bustling New York City and Broadway life, but it is so important to give your voice a rest. I often take vocal rest days where I won’t speak to anyone (except for my dog) for an entire day leading up to the show. Glinda is very demanding vocally so I need to make sure I’m balancing out my day to day voice usage with how much I need for the show. Taking a whole day of silence is usually just the trick to refill the tank." -Carrie St. Louis 

"The biggest things are sleep and water…ALL the sleep and water. To get good sleep, I learned through whole30 that I have to limit my sugar intake. Sugar really messes with your sleep. I also am kind of a hermit when doing something this taxing, it stinks because I miss my friends, but I know there’s a light at the end of the tunnel. You do build up endurance, but it’s still a challenge. Lastly, warming up my entire body and then my voice is my pre-show routine." -Analisa Leaming

"SLEEP – 9 or more hours is golden for me… (cc: blackout curtain).  I also find that I get better sleep when I fall asleep happy and smiling. So I usually watch a light/funny episode on Netflix to unwind after a show.  Friends, New Girl, Modern Family, Mindy Project, etc. // STEAM – I use the MyPurmist steamers and have one at my apartment as well as at the theatre.  I steam as soon as I wake up, before every show, and when I get home from the show.  It’s just the best way to hydrate the vocal cords which is the best thing for my cords when they are tired, swollen, dry, or flemmy. // SILENCE – This is a personal challenge for me because I love being around people so much… and when I’m around people, I am constantly laughing and chatting. I learned quickly though, that our vocal cords are truly muscles that can only take so much.  If I stay out late, or talk all throughout the day, or don’t pace myself vocally onstage…overtime, I won’t be able to get through the entirety of the week.  I think it’s still important to still have a social life: relax, have fun, do other projects, get brunch with friends, go to that birthday shindig, have that Sunday night martini, etc., but I’ve also learned there’s nothing wrong with the “hermit” lifestyle.  And I may or may not be a proud homebody these days." -Ashley Park

"I’m a bit crazy when it comes to vocal health and I proudly admit that. Staying in the gym is so important. You vocal health is tied to every nerve and muscle in your body so staying in shape is crucial. For the past couple of years I’ve decided to be sober while performing. Alcohol is extremely drying. Keeping an eye on the rest of my diet is important as well. I usually cut out dairy if I have to sing. All of these things will help keep my voice from deteriorating more in the future." - Matt Doyle

Stay tuned in the coming weeks for more helpful tips, and again, don’t hesitate to reach out to me at paul.kwak@nyumc.org, or to find more information at nyuvoicecenter.org.  Next week, we’ll tackle the common cold – it’s been a brutal cold season, so we’ll give you some tips for surviving the rest of it!

One of my favorites, Adam Jepsen, sporting "I'm On Vocal Rest" from FITFORBROADWAYAPPAREL.COM

photo by Lumberjackstudios