Irritable Larynx Syndrome was presented in 1999 as a clinical phenomenon that refers to hypersensitivity symptoms in the larynx (Morrison, Rammage & Emami, 1999). The theoretical pathophysiology that was proposed has since been refined to reflect the supposition that ILS represents a central sensitivity syndrome (CSS), and data was presented that demonstrates a high co-occurrence of ILS with other CSS (Morrison & Rammage, 2010). The ILS theoretical framework resonates well with that proposed for other CSS (Yunus, 2000-2008). Vocal performers are more highly represented in clinical populations than the general census population would predict, when compared with individuals from “less vocal” professions (Titze et al, 1997; PVCRP, unpublished statistics).
We will review ILS theories, symptoms, and treatment. ILS patient databases will be examined for symptom patterns and personal demographics to determine if vocal performers are reflected in the ILS caseload. Possible ILS susceptibility and “immunity” factors for vocal performers will be discussed.
REFERENCES:
Morrison, M. D., Rammage, L. A., & Emami, A. J. (1999). The irritable larynx syndrome. Journal of Voice, 13(3), 447-455.
Morrison, M.D. & Rammage, L.A. (2010) The Irritable Larynx syndrome as a central sensitivity yndrome. CJASLPA-RCOA, 34(4), 282-289.
Titze, I. R., Lemke, J. & Montequin, D. (1997). Populations in the U.S. workforce who rely on voice as a primary tool of trade: A preliminary report. Journal of Voice, 11, 254-259
Yunus, M. B. (2000). Central sensitivity syndromes: a unified concept for fibromyalgia, and other similar maladies. Journal of Indian Rheumatology Association,8, 27-33.
Yunus, M. B. (2005). The concept of central sensitivity syndromes. In: Wallace D. J., & Clauw, D. J., eds. Fibromyalgia and other central syndromes. Philadelphia: Lippincott Williams & Wilkins, p.29-44.
Hydration is believed to be a critical aspect of healthy voice production. Professional voice users are particularly concerned with maintaining adequate vocal fold hydration to ensure optimal vocal performance, minimize vocal strain and fatigue, and prevent the onset and progression of voice disorders. However, little is understood regarding the precise mechanisms responsible for maintaining vocal fold hydration during vocal performance. Historically there have been a substantial number of studies aiming at clarifying the effects of systemic, environmental, and direct vocal fold epithelial cell dryness. Collectively these studies have demonstrated mixed results related to the independent effects of individual hydration variables on voice function. Additionally, a number of remedies have been developed in an attempt to prevent or offset the negative effects of vocal fold dryness. In this presentation, physiologic mechanisms that influence vocal fold hydration will be presented. The levels of evidence for several popular vocal fold hydration remedies will be reviewed. Novel treatments that directly target vocal fold hydration will be discussed, including studies demonstrating voice improvement in professional voice users.
The source-filter theory of vowel production is relatively well-known and understood among voice researchers and singers alike. According to this theory, the glottis produces a “source” sound consisting of many harmonic frequencies and the vocal tract “filters” some of those frequencies to be amplified and some to be attenuated. If the source-filter interaction is a purely linear relationship (i.e. the filter has no effect on the source), then harmonic intensity could be easily predicted given the location of any harmonic in relation to a formant and stability of the glottal vibration would not be influenced by changes in the vocal tract geometry. Using such a linear explanation then, an ascending pitch glide with a steady vowel shape would result in relatively stable phonation with amplifications and attenuations of individual harmonics as they pass through stationary formant bandwidths.
A purely linear description, however, does not adequately explain fundamental frequency and vibratory instabilities that appear to coincide with formant/harmonic interactions. The present study being conducted at the National Center for Voice and Speech seeks to apply a non-linear dynamic theory of source/filter interactions to describe how the vocal tract filter may be affecting the stability of the vocal fold oscillations. Acoustic and glottal contact analyses are employed to illuminate how varying acoustic pressures within the vocal tract may influence the stability and reliability of a voice as it passes through certain fo ranges.
People who use their voices to speak and communicate in their everyday lives can benefit from vocal techniques used by high level vocal performers. Many of the goals of voice training (to improve voice quality, vocal resiliency and to maintain laryngeal health) can be met in a group treatment, where singing is used as vigorous vocal exercise to condition the vocal mechanism. The choral setting allows for anonymity, loud or quiet voice production without penalty, socialization and contribution at various levels of musical and vocal skill. The helpful benefits of the choral and Lombard effects also come into play in a group setting.
Anyone who has voice training skills can lead such a group (SLP or voice teacher) with musical support (good pianist). Screening by an ENT and SLP is needed since vocal strengthening is not appropriate for all voice complaints.
A variety of vocal disorders may benefit including prespyphonia (aging), hypophonia (Parkinson’s disease), many dysarthrias (stroke, brain injury, neurological disease) and general respiratory and vocal deconditioning.
Research is growing is this area and shows multiple benefits to participants in vocal QOL and in vocal skill improvement. Informal interviews reveal that participants report reduced coughing and swallowing problems. Recent research at the University of Alberta and the Glenrose Rehabilitation Hospital will be presented.
Hearing a voice disorder is the most valuable tool available to the voice teacher, voice pathologist and laryngologist and yet remains the most underutilized exam in laryngology. Understanding how to use vocal capabilities pattern matching before visually examining the larynx will improve the accuracy of laryngeal diagnosis.
Vocal capabilities pattern matching consists of identifying the comfortable speaking pitch, maximum phonation time, highest and lowest pitch while noting the quality of voice production. Loud and soft voice production at low pitch and repeating loud and soft at high pitch will elicit audible vocal cues revealing (sometimes hidden) vocal cord vibratory impairment. Wherever vocal capability testing suggests the maximal impairment during this audio portion of the exam will then suggest the pitch and volume at which to record the stroboscopic examination.
For example, weakness of the vocal cords will be exacerbated at low pitch and low-volume sound production. Meanwhile, vocal cord swellings such as nodules, polyps and hemorrhage will most significantly impair vocal cord vibration at high pitch and low-volume. Additionally, the impairment has a very specific character. Each type of vocal cord vibratory impairment generates a specific pattern on this type of vocal capabilities pattern matching elicitation.
By the end of the session, the participant should be forming a more accurate differential diagnosis after listening to an impaired voice.
Go to this link for the "handouts" for this presentation:
http://voicedoctor.net/blog/examination/optimal-exam/vocal-capabilities/vocal-capabilities-pattern-matching
Most training in speech language pathology and medicine does not incorporate vocal pedagogic opinion. Yet in the world of postacademic practice we find there is an important need and benefit to integrate voice pathologylaryngologyvoice science tenets with the methodology of highly evolving vocal pedagogy.
Singing expertise can yield vital information and strategy within voice intervention, including increased diagnostic perceptivity in behavioral or endoscopic assessments as well as optimized treatment of organic and/or functional voice disorders.
The author will present several specific techniques crystallized from singing (and theatrical) pedagogy which are well matched with the needs of comprehensively modern medical intervention. The tools are seemingly simple; pitch and intensity. Pitch may stabilize or destabilize optimal quality, stimulate registration, and focus attention on muscular equilibriums. Intensity provides a nestling boundary for loudness levels and challenges sustained physiologic engagement.
The therapy techniques would be supported with anatomicalphysiologic validation and are applicable to:
“The Wealth of Nations and the well-being of individuals now depend upon having artists in the room.” So wrote Daniel Pink in A Whole New Mind: Why Right-Brainers Will Rule the Future. Pink’s optimistic projection for the future of art may be premature. For more than a century, the Western cultural milieu in which we live and work has valued rational thought and the scientific method more highly than it has valued creative thought and the output of its artists. A case in point is the current craze for cognitive neuroscience, which has fueled new brain research on practically everything, including the cognitive neuroscience of music. Yet most of this research is slanted one-way, toward how listening to music affects the brain, not how making music enhances thought and the human condition.
Both the scientist and the artist are stimulated by mystery; both seek to know. Science pursues knowledge for its own sake, but art illuminates that knowledge with meaning. Yet while science seeks definitive answers via the scientific method, as measured by quantitative data, art raises issues and thrives in the unanswered questions. Ultimately, the scientific method does not always lead to the measureable, and art prompts us to realize that we wish some things to remain unknowable. A culture’s vocal artists (singers, actors, poets) literally give voice to these collective mysteries – those chimeras just outside our immediate awareness, beyond the definitive reach of science.
As cognitive neuroscience rapidly dissolves the arbitrary boundary between body and mind to posit a unified whole, so must the border between science and art disintegrate.
This paper presentation will focus on the issue of guiding male students successfully in registration negotiation from the female voice teacher perspective. Learning how to correctly communicate the process of male registration negotiation via specific instructional language and knowledge of physiology is paramount for a female voice teacher since a female cannot either experience or accurately demonstrate for a male how properly to negotiate their passaggio due to physiological and structural difference between the sexes. Literature written on the subject is very clear in the usage of breath management and vowel modification as the primary tools for negotiating the male passaggio. However, preliminary research and experience in the field has shown that, in practice, female teachers could benefit from more clarification and hands-on experience in this important area of instruction. The objective will be to identify the issues female voice teachers face traditionally in this area and to then provide information on how to identify, diagnose and correct issues in negotiating the male passaggio using specific language and methodology.
The use of extended vocal techniques (non traditional methods of vocal production) is rather pervasive in post-1900 art music. Composers commonly associated with extended vocal techniques include Arnold Schoenberg, Alban Berg, George Crumb, John Cage, Georges Aperghis, and many contemporary living composers. Though the demands on singers have become increasingly diverse and challenging, literature and pedagogical resources are somewhat scarce. In my paper, I will discuss some of the most commonly required extended vocal techniques, such as ingressive phonation, sprechstimme, yelling, and vocal fry (and even combinations such as ingressive vocal fry). I will discuss their artistic uses, including how and why composers utilize these techniques, as well as the differences between traditional classical vocal technique and extended vocal techniques. I will also discuss physiological challenges facing singers who perform this repertoire (dehydration, increased vocal fatigue, etc.) and offer solutions where applicable.
This is an important topic for singers who wish to perform contemporary art music. The body of music utilizing extended vocal techniques is considerable and important to our field, but the available resources and information are inconsistent and difficult to find. As a teacher and a singer who has performed this music professionally, this topic is not only fascinating to me—it is an increasingly necessary area of conversation and study for anyone who regularly works with singers.
The profession of voice pedagogy continues to evolve. For centuries, the art of teaching singing was dominated by the tradition of imagery based technique passed from generation to generation. For the elite singer, this tradition has been sufficient. However, for the majority of singers, both professional and avocational, a more functional approach provides a better technical foundation, especially with the added need for mastering a variety of singing styles.
This session will provide a systematic approach to teaching functional pedagogy. By understanding anatomy, physiology and acoustics of the 5-systems of the voice, respiration, phonation, registration, resonation, and articulation one can more readily diagnose technical vocal faults. The teacher can then provide concrete structure for helping the singer coordinate a functional singing technique.
Dr. Ragan will combine slides with live demonstration with singers in order to facilitate a dynamic process for observing, diagnosing and habilitating the singing voice.
