Home Health Care 6 Vocal Myths: Practical Therapy Applications

6 Vocal Myths: Practical Therapy Applications

by Kristie Knickerbocker
boy eating pizza

We all have a tree of knowledge that represents the intricate experiences that make each of us different and wonderful. Our branches stretch, flower and die only to grow into a more complex labyrinth of information. Once this tree is rooted in ideals, it is difficult to pull out any of the roots, especially if they have been supporting a perfectly healthy tree for many years.

I like science. I find a certain solace in knowing that a randomized control trial was completed in order to prove that I’m not just making you hum through a straw for fun. On the other hand, I completely give merit to the occurrences you can’t explain or rationalize. Some very important moments in my life, especially in my speech-language pathology career, cannot be measured and explained scientifically.

When I was younger, I was petrified that eating before a performance would screw it all up. I can remember vividly, sitting at a Texas Music Educators Association competition as a kid near me consumed an entire slice of pepperoni pizza before disappearing into his audition room. He leaned over and smiled, “It’s always good luck for me.” I was aghast, and I hope my face did not reflect what was going on in my head. Food? I thought. Before singing? NEVER! But, why did I believe so strongly that the voice gods would shun me if I ate a bite of anything? Should superstitions be revered? Is it really all in my head?

I posed that question to a few forums I belong to, both vocal pedagogy and vocal pathology. Along with comments and emails that flooded my inbox, the University of Minnesota and Truman State University brought me a study by Julia Edgar and Deirdre Michael that surveyed almost 400 singers about their beliefs in vocal health. The only thing everyone could really agree on? A whopping 97 percent believed that warming up before performing benefits the voice. That’s it. The rest of the answers were as scattered as an Admission, Review, and Dismissal team after the final meeting before summer break.

I pulled together the most interesting beliefs and did my best to find scientific evidence to aid in proving or refuting. I have questions from the professional singers I treat about many of these subjects, so what better way to debunk the myths? What I found was that many people hold their beliefs dear and are not willing to lend an ear to anything that might refute what gets them through a gig. So, what are we as SLPs to do? Do we believe in Grandma Sue’s recipes? Do we believe in science? Do we believe in experience? Do we believe in life after love? Sorry, Cher kind of snuck in there.

  1. Smoking marijuana and vaping is not damaging to the vocal folds like cigarettes are Reinke’s Edema, tissue damage in the form of gelatinous goo just below the top layer of the vocal folds, commonly occurs from smoking.  A study here discusses the effects of cigarette smoke on the delicate tissues of the vocal folds. Even the vocal folds of rats changed after passive inhalation of smoke. So that sets you straight…right? Not quite. A student told me that an alarmingly high number of voice performance students at her school claimed smoking marijuana and vapor cigarettes will not damage the vocal folds. Although there are not yet any published studies specifically about the effects of vaping on the vocal cords, a study here found that electronic cigarettes contain less carcinogenic ingredients than their tobacco counterparts, however less does not mean none. There is also concern that propylene glycol irritates the respiratory tract. (PG is just a fancy word for stage smoke.) Despite more than 1,000 studies on electronic cigarettes, conclusions cannot be made on their safety or danger because of contradictions and inconsistencies in methodology. Get it together people…I think people are learning this and deciding ECs are safe to smoke because of the lack of evidence. Perhaps they are fishing for an excuse. Perhaps they are avid consumers of research. In my clinical opinion, you are still inhaling something that is manufactured and exposing your most delicate tissues to foreign materials that may or may not be toxic. An article in the Guardian states that those who smoke ECs think the water vapor is safe, they brush off the PG as an irritant, and smoke them anyway. As for the marijuana, aside from altering perception and most likely performance, it is heated just like cigarette smoke and any smoke will irritate your tissue.

Bottom Line: Smoke can change the composition of your tissue. If you don’t inhale foreign material, your vocal folds will likely maintain their health.

  1. Throat Coat Tea and Entertainer’s Secret are a sore throat cure-allA 2004 study on the effects of laryngeal lubricants, like Entertainer’s Secret, revealed that even if a spray affects the vocal fold vibratory pressure, after 20 minutes it is like you never used it. Throat Coat tea contains slippery elm bark, a demulcent that soothes irritated tissue, and is not FDA approved to cure anything. There are no studies on how it directly affects the voice, but the steam from a hot beverage most likely will topically hydrate your vocal folds as you inhale, so that’s a plus. A hydrating beverage will provide you with internal hydration to lubricate the vocal folds from within the body. Like any pain, though, if your throat is hurting, don’t mask the problem by using numbing spray or another band-aid.  Your body is trying to tell you something and if you silence it, you could injure yourself further. Know your body.  I’m all for throat coat tea, ginger tea, lemon water, whatever–If you say it helps you feel better. I am against using any of that to hide pain so you can perform. If you are not giving your body time to heal, you’ll end up with a bigger problem.

Bottom Line: Using any crutch will usually get you through a performance, but “getting through” something may backfire on you. Instead, try to maintain a balance by keeping your body healthy, listening to it, and caring for your vocal folds even more fervently because you can’t see them.

  1. Whispering is a good idea to save your voice when on vocal rest. I was informed when I received voice therapy myself that I was not allowed to talk or whisper for a week following my surgery. Some people say the real myth is that whispering is as bad as shouting. Is it? For her own voice issues, an SLP who received treatment like me, was told that whispering would save the voice, but she found it to increase fatigue and pain for her. Go figure. Shouting and whispering differ in placement and technique, but whispering can sometimes turn into a hyperfunctional breathy voice where vocal production is made with an incomplete vocal fold closure. Ah, there’s the danger. A study in 2006 examined 100 patients with a fiberoptic camera. Only 70 percent of the patients showed supraglottic hyperfunction while whispering, meaning some of them had no hyperfunction at all. Other muscles are involved in whispering, and people whisper differently, so some studies suggest that whispering, when low in effort, can be considered for post-op patients.

Bottom Line: Whispering could turn into a poor vocal production habit in the majority of patients, so better to avoid it or monitor it closely on a case-by-case basis. If you were to whisper with a completely relaxed larynx, it’s hard to get adequate volume anyway. Tell them to text. Don’t we all have smart phones glued to our thumbs?

  1. Dairy products thicken my mucus. Recent publications have demonstrated that dairy products do nothing to chemically increase mucus production or viscosity, but why does the myth remain? A group of investigators from New York examined 21 individuals, half with asthma and half without, to see if milk increased mucus. It suggested that airway resistance was not altered by milk consumption, so no thicker mucus here. Perhaps if there is a milk allergy, the body will have a reaction to it? That might explain the widely-held belief that mucus will “gunk up vocal cords” and should be avoided. Unfortunately, I could not find any research studies about mucus thickening after eating or drinking dairy. Another study states that some people with asthma may see an improvement after eliminating dairy from their diets, however, it does not definitively prove that mucus production increases because of dairy products.

Bottom Line: You can throw science at your patients, but they may remain convinced that milk will gunk things up. You might be fighting a losing battle, but hey, at least calcium comes from other sources.

  1. Eating or drinking certain foods (or abstaining from them) will improve your performance. Okay, here we are with pizza singing boy again. He obviously thought that the pizza was his golden ticket for the American Idol of Texas choir competitions. Some performers believe licorice before a gig helps improve vocal range. One singer would consume an entire bag of licorice prior to a performance. Is this a placebo? After discussing, he stopped and the range remained the same. Hmm…. What about those singers that tell you eating Lays potato chips will lubricate their throats? Is this only in Nashville? What you eat and drink will not touch your vocal folds, it only touches the tongue, soft palate, throat walls and esophagus. If it is touching your vocal folds, you are aspirating! A recent post on a professional voice teaching thread inquired about what teachers advised singers to drink to lubricate their cords. Home remedies included vinegar, garlic, ginger, olive oil, sugar, and even aloe vera. None of these have scientific evidence that they are harmful to the voice, so if you think it helps, then by all means. Nothing really lubricates the cords from the outside, but drinking hydrating beverages lubricates from the inside, so this is kind of true…kind of…Just make sure you don’t become a yummy snack for your speech therapist if you come in smelling like an Italian dish.

Bottom Line: Hydration, Hydration, Hydration. There is no scientific evidence that certain foods or beverages will improve or hinder your performance. Water will always benefit the friction and heat created by your vocal folds by lubricating them on a cellular level. See also, my previous blog on beta-blockers and performance if your patient is considering anti-anxiety meds along with the olive-oil rub.

  1. Cold beverages, caffeine and alcohol are bad for your voice. A student at one of my lectures saw me drinking ice cold water in my handy Tervis cup. Those things are indestructible and I have one for every day of the week. Obsessed? Maybe. There is no evidence to suggest that cold water is bad for your vocal cords, I told him. Beer actually counts toward hydration, interestingly enough. These researchers found that when you are dehydrated, drinking beer will not only get you drunk, but hydrate you as well. Caffeine was found to usually not impact vocal acoustics if consumed conservatively (100mg), and this study showed that caffeine did not adversely affect voice production at all. Also, not related to voice specifically, this study suggested that coffee even hydrated similarly to water.

Bottom Line: Cold or hot, it’s your choice. And when there’s a choice, go with water over alcohol. Caffeine consumption should be examined along with other factors when recommending cessation in the therapy room. When I look at this, I think, Starbucks? Why not.

We have to be careful when presenting new information. Try hard not to claim information already known to be erroneous. Many established teaching professionals have been molding and creating performers for years, and trying to reveal a “new” truth might be unwelcome. Can we not bridge this gap between pedagogy and therapy? Between art and science? After all, the voice is both, isn’t it? Many SLPs told me they are afraid to challenge any voice teacher because they might get brushed off. I want to change this “challenge” to “suggest.”

If we are cognizant of the training and education of others, we can present information in a way that is not patronizing. And if we are open to new ideas from different sources, (I am so guilty of this too) then we might find that it works in our studios and clinics. One contributor had the most poignant response. “People become defensive sometimes when they are confronted by their own knowledge gaps, but hopefully they’ll internalize the information and emerge the better for having heard it.”

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

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12 comments

Alida January 22, 2015 - 1:24 pm

Thanks, this is really helpful. Can’t wait to share with everyone. Alida

Kristie Knickerbocker February 3, 2015 - 7:50 pm

Great. Glad you enjoyed it Alida.

Laura Kalajdzic January 22, 2015 - 7:24 pm

Great article! Regarding #5 and #4 I would like to point out that dairy, pizza, and potato chips can cause reflux and therefore stringy and or acidic mucous in the pharrynx which can easily irritate the VFs when microaspirated via Laryngopharyngeal reflux! True you may not directly aspirate these foods but they sure have a sneaky way of resurfacing. Plus, up to half of people with LPR don’t even know they have it.

Kristie Knickerbocker February 3, 2015 - 7:52 pm

Very true. It is looking like reflux will be the subject of a blog in the future.

annalyman January 22, 2015 - 10:34 pm

Every new voice student that walks into my vocal studio arrives already dehydrated unless I specifically ask them to bring water. They are all dehydrated – they need to drink
water an hour before they arrive!

Kristie Knickerbocker February 3, 2015 - 7:53 pm

I seem to remember always being dehydrated at college voice lessons…

Pamela Rowe, MA, CCC-SLP January 23, 2015 - 8:35 am

Thank you for this article. As a SLP specializing in voice therapy, I would suggest that we do keep in mind GERD restrictions for voice hygiene as many voice Pts have GERD as well. I do recommend that my Pts try to decrease alcohol, caffeine, citrus, mint/menthol, spicy, tomato-based foods.
Thank you for mentioning marijuana’s impact on vocal fold tissue health. (Not to mention vocal abuse from excessive coughing…)

Kristie Knickerbocker February 3, 2015 - 7:55 pm

Agreed. GERD and LPR are many times co-occurring with voice disorders. Stay tuned for reflux and the voice in a future blog.

Full Spectrum Mama January 23, 2015 - 3:19 pm

Loved how you made what really is a very well-researched and seriously useful article soooo funny. Thanks!

Kristie Knickerbocker February 3, 2015 - 7:57 pm

Thank you very much. I employ just as much humor during my sessions. 🙂

Rebecca January 23, 2015 - 6:40 pm

I have a question- I don’t like to drink ice water beforw I sing not because I think it has any effect on my vocal folds themselves, but because I feel muscles on my throat tense up from the shock of the temperature. Is there research that contradicts that aspect? I feel like reliance on some of these other behaviours has more to do with your general physical condition when singing than with whether or not they effect your vocal folds- i also avoid certain foods before I sing because some things just make engaging lower abdominal support uncomfortable.

Kristie Knickerbocker February 3, 2015 - 11:07 pm

Not that I’ve seen when looking through pubmed and sciencedirect. Muscle tension is very real and can affect the entire vocal mechanism. There are no studies that suggest cold water is bad for the vocal folds. There are studies to suggest water is good. I would say that if you have a reaction to cold water, and prefer warm or room temperature water, then you know you body best. Even though there is no real harm in the cold water, I would do what is best for your whole instrument. I didn’t even think about those foods causing gas. I guess I chose to focus more directly on the tiny instruments (vocal folds) and not the whole instrument. Good point.

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