Owning Your Vocal Health

In the height of my career, I came down with a terrible cough. I had just finished my last round of New York auditions and was headed to Italy for a few months of language training, so I wasn’t concerned. The swelling subsided in a few weeks, and I started coaching with the regional maestro in Perugia. Everything felt different. I chalked it up to being out of practice, late nights out with friends, and my new environment in the chilly hills of Umbria. 

Three days after landing in the States, I auditioned for Lyric Opera of Chicago. I had been invited to the finals the year prior, so I was excited for my reaudition. My rejection letter beat me home. Blaming jetlag, I headed out for my first mainstage role with San Diego Opera. Only then did I begin to panic. I had no low range, no consistency, everything felt swollen and forced, and it wasn’t getting better. 

As soon as I returned home, I sought out a doctor. Amazingly, even as a professional singer with a full load of upcoming gigs, I didn’t have a regular ear, nose, and throat doctor (ENT). I had never needed one. I thought myself well versed in vocal health, but I realized I knew very little about the mechanics of my voice. But I knew something was terribly wrong. 

Fortunately, I found an amazing team of professionals who guided me through my vocal pathology. I had hemorrhaged a vocal fold months earlier with that terrible coughing and it had hardened into a polyp—a bump on one vocal fold edge that prohibits proper closure of the vocal folds and keeps a constant open space in the closure. Still actively singing, my body had been compensating by squeezing my folds together to limit all the extra air that was escaping. 

 

A week after my diagnosis, I started my summer gig with Lake George Opera. I kept silent about my vocal problems while valiantly trying to negotiate concerts, auditions, and Gilda! I feared that vocal pathology would blacklist me forever. 

My amazing speech therapist, Joseph Stemple, had given me vocal function exercises, strengthening exercises he created, to help me get through the summer and hopefully rehabilitate my voice. It worked with the former but not with the latter. The polyp was too hard by the time we caught it and could only be removed surgically.

When you say the word surgery to a singer, there is an instant panic. Initially I refused, but later realized I couldn’t continue my career without this procedure. I was sent to a fantastic surgeon in Cincinnati, rehabilitated with Stemple and my voice teacher Robin Rice, and was singing high E-flats in San Diego six weeks later. I jumped right back into my career, but mentally it took me years to get over the fear. 

What had happened? I thought I was so attuned to my body. How did I miss it? And how could I have avoided it? I could no longer stay ignorant of my voice. I wanted a fuller understanding of singing health to better avoid problems in the future and to help advocate for others. 

Health must be the primary goal for every singer. All the coaching sessions, language lessons, and technical and artistic work you do is negated if you cancel due to health. Only you can cultivate healthy sensations of singing, recognize the difference between overdoing it occasionally vs. a chronic hoarseness or strain, and admit when something just isn’t right. Stay alert and learn to advocate for yourself. Move beyond the youthful mantra that you’re young and you’ll bounce back! 

Start and stick to healthy habits. This is far more difficult than it sounds. Every time I yell up to my kids because it’s faster than running upstairs to get them, I remind myself of the daily ways I subconsciously tax my voice. We practice when we’re tired, socialize in loud places, teach for long hours at a time, pitch our voices too low, travel a lot, sleep little, and stress too much. 

I was so good for years after my surgery, and then life just crept back in and I felt invincible again. But we can’t just be good when we’re scared—it must become a reinforced lifestyle choice. Here are a few ways to start. 


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Hydration 

An easy way to improve both your singing and your health, hydration is a long-term process. It is more effective to hydrate your system daily rather than tanking up before singing. Prolonged dehydration can cause irreversible damage to your vocal cords. 

 

Speaking Voice 

Many singers are diligent about vocal health while singing but have poor speaking habits, often speaking too much or at inappropriate volumes, which can damage the voice. Do not push your voice over loud noises or in crowded areas and be sure that you are always speaking with a healthy, supported production. 

Vocal Rest 

Know when your voice needs a break. If you’ve been singing for a great length of time or have been working on new or heavy repertoire, be cognizant of how much you use your voice after you stop singing. Make it a habit to warm down after practice sessions and then silently give your body a chance to repair. 

 

Singing Appropriate Repertoire 

One common way to misuse your vocal folds is to sing in the wrong Fach. Singing inappropriately heavy, light, high, or low repertoire can tax the muscles and create bad habits in order to achieve a desired sound. Be honest and discerning when choosing repertoire and resist the temptation to accept roles that are bigger than you can sing healthily. 

 

Singing Sick 

When possible, it is best to wait until you are healthy to resume singing. When you sing sick, your body is constantly modifying your technique in order to compensate, which can retrain your muscle memory. Pushing through a sickness also carries the risk of causing a vocal pathology. 

 

Canceling When Sick 

Sing only if you feel you can accurately represent yourself and not do additional damage. Anytime you have pain when you are singing, or if you have felt a sudden pain and change of vocal technique, immediately stop singing until you can be evaluated by an ENT. 

 

Medication 

Pay attention to side effects from prescriptions, over-the-counter meds, vitamins, and supplements. All medications can affect the voice, and it varies from person to person. Do your research and experiment as to what gives you the best relief with minimal drawback. A trusted doctor can help guide you. 

 

Reflux 

Gastroesophageal reflux disease (GERD), commonly known as heartburn, occurs when stomach acid travels back up the esophagus, irritating the lining. Laryngopharyngeal reflux (LPR) is when those same acids travel far enough up the esophageal tube to wash into the vocal tract and larynx, causing irritation, excessive mucus, and swelling. Untreated reflux can become a serious health condition. 

 

Diet/Exercise/Sleep 

Be disciplined about your health. Poor eating habits and excessive weight can lead to reflux and an overall lack of energy and can even impede your breathing. Lack of exercise can leave you unprepared for stage demands and lead to health problems down the road. The goal is not to be thin; the goal is to be healthy. Poor sleeping habits leave you vulnerable to a weakened immune system and make you more likely to get sick. 

 

Stress 

Dealing with rejection, working away from home and loved ones, singing in high-pressure situations, and constantly dealing with criticism can add intense levels of stress to a singer. It is important to find ways to cope: trusted friends or therapists, outside interests that give your life balance, breaks when you need it, and a healthy perspective on dealing with rejection. 

 

Knowing Your Voice 

Empower yourself by having basic knowledge of your own voice. Ask questions, seek out information, and speak intelligently with your doctor. Be able to give doctors as much information as possible and follow their directions implicitly. If you don’t trust or agree with the advice given to you by your doctor, find one you do trust or at least get a second opinion. 

 

Finding Your Team 

You need a team of professionals that you trust. If possible, find an ENT who is a laryngologist or otolaryngologist and get a baseline videostroboscopy (a video of your vocal folds). A healthy scope of your vocal folds is important for comparison when you are unhealthy. Speech-language pathologists help with therapies and follow-up care and sometimes assist an ENT. Voice teachers and coaches are important outside ears and they can assist in addressing vocal problems as well as help with rehabilitation. 

 

A few years ago, I realized I wanted more than just a basic knowledge of the voice. Prior to getting sick, my only goal was to perform, but I suddenly felt drawn to something extra. I wanted to be part of that team of professionals diagnosing, rehabilitating, and teaching others to get back on track. 

But I was a singer, not a doctor. I had amassed a great deal of information and interest in vocal health, but that didn’t leave me qualified to do anything. And then I found the singing health specialization (SHS) at the Ohio State University. 

When searching out schools for my DMA, this unique program caught my attention. The first of its kind in academia, the SHS combines music, speech and hearing science, and laryngology in an interdisciplinary specialization. I was given hands-on training in voice disorders and rehabilitation, observed rotations in the operating rooms and voice clinic of Ohio State’s medical facilities, and attended seminars by top faculty and medical professionals in the field. This program met me where I was as a singer and trained me to become a singing health specialist. 

Wherever your career path takes you, make awareness of your vocal health a priority. Your knowledge will put you on the path to longevity and help you with bumps along the way. Here’s to becoming your healthiest self! 

Laura Portune

Soprano Laura Portune is a singer, teacher, stage director, writer, and mom. She has performed regionally and internationally in over 60 opera and concert productions, including world premieres in the Czech Republic, Italy, and San Diego. A frequent guest clinician and stage director, Portune is a Senior Lecturer of Voice at The Ohio State University School of Music. For more, go to www.lauraportune.com.