aS References ‘CASS, L. (1974). "The Passaggio In the Male Voice: An Analysis Based on the Subjective Sensations ‘of Acknowledged Professional Male Singers "Ph. O. Thesis University of Pittsburgh DIDAY and Pétrequin (1840. "Memories sur une nouvelle @spece de volx chantée," Gaz med. Pars 8 Pp. 905:314 GARCIA, M, (1840). Ecole de Garcl du chant. Troupenas et Cie Traite complet de art LARGE, J. (1972). "Towards an Integrated Physiologic: “Acoustio Theory of Vocal Registers." The NATS. Butletin, FetsMar, pp. 18-25, 3036, LARGE, J. (1973). “Acoustic Study of Register Equalization In Singing," Fola Proniarnce, 25, pp. 3083 LARGE, J. (ed. (1973). Voca’ Registers in Singing. ‘The Hague: Mouton et Cle LARGE, J. Iwata, S. and von Leden, H. (1972). "The Male ‘Oparatic Head Rogister versus Falsetto,” Folia Phoniatice, 24, pp. 1929, RUSSO. V. and Large, J. (1978) “Payehoacoustc Study of the Bel Canto bodel for Register Equalization: Malo Ghost and Falsetto," Journal of Research in Singing 13, pp. 125. SUNDBERG, J. and Nordstrom, P. (1976). “Raised and Lowered Laryne The Effect on Vowel Formant Fre ‘uencies," STLOPSR 23, 9p. 35:38 Dr. John Large, Schoo! of Music, North Texas State Univer sly, Denton, Tx. 76203, VOCAL HYGIENE: THE OPTIMAL USE OF THE LARYNX* D. Boone The professional user of voice, such as the singer or the palticlan, must use the laryngeal mechanism optimally it he orshe isto avoid unnecessary problems of voice. A vocal hygiene program will often prevent excessive laryageal abuses and misuses, Frocschels. Tit used the phrase hygiene of the voice” In 1043 to develop alist of behaviors uinieh were designed to provige the heavy user ofvolce with Some voeal guidelines for achieving efficiency of laryngeal function. Dictionary definitions of the word “hygiene” In Clude such meanings as a "science of the establishment land maintenance ot health "oF “conditions or practices con- Sucve to health." Vocal hygiene then ts a series of cond tions or practices that when followed give the speaker tne best "vocal health,” producing goed voice toe of any negative symptoms. ‘Many writers (Boone, 1977; Cooper, 1977; Wilson, 1979) have developed rules of good vole practice for pationts ‘nth vocal pathologies which enable the patient to use the Vocal mechanisms with greater ease, avoiding laryngeal Strain and excessive effort in vocalization. Central to such ‘ocal hygiene management isthe identification of laryngeal ‘abuse (auch as from excessive thvoat clearing) and voice misuse (such as from speaking inappropriately loud), followed by remediation efforts fo eliminate of reduce the Identified abuses and misuses. Many of the tenets of & ‘vocal hygiene. program have been dovoloped for patients with various problems of vocal Ryperfunction by thei cil: Clans in an attempt to prevent or reduce vocal fold pathology. Most of the negative behaviors describes below have been found tobe iritating to the larynx In clinical pa lients. For example, a typical young adult with. vocal odules may provide @ history of excessive throat clearing with a speaking behavior characterized by hard glotal at lack accompanied by a tight, closed mandible. Voice cin Clans observe these stained benavlors in voice patient after Voice patlent. Reducing these unnecessary vocal efforts is Often the focus of volce therapy. A vocal hygiene program thon becomes a postive program of voice tization follow: Presented at the 1980 NATS Symposium on Vocal Abuse.ing the common sense vocal behaviors used by singers and speakers who not only Rave. normal voices. but often Ueautiful, exceptional voices. Voices. produced with the least amount of unnecessary effort are often percelved as ‘Good sounding voices; to Rave @ good voice. the singer oF ‘Seaker must avoid environmental and laryngeal excesses, "The vocal hygiene program developed here comes from the practical appilcaion of cinial and teaching observa. lions over time. The ‘clinician and teacher must take ‘pragmatic approach in applying the twelve steps of the ocal hygiene program to the individual patient or student, Some individuals may profit trom following all twelve sug: Gestions, but nly'a few of the guidelines may apply to the typical voice patient or voice student. For any user of vice, owever, wha s experiencing some vocal symptoms or who wishes to develop optimal voice usage over tim Steps of ine program below provide a ready checi {ain conditions which may influence the sound of the voce, ‘A Voea pies Progam. i ne st ng sp 2 Develop an easy glottal attack. eae PTR RNs aoe mo moe 1 Spee Sea eee tcteermo ere Series em ieee, aS 11 Ad osc wit our sis, sha iting anges, ty 12"Tetp the membranes of our mouth and thost a molt a poss Each step of the vocal hygiene program will be et described Si en 1 Identity vocal abuse and misuse Probably the most important sep for developing optim use of the tary is to identity any laryngeal abuses. The lary as the protector ofthe atway i ften volved i ar way maintenance ctvites such as coughing or throat learing. Such normal away protection behaviors are nor Boones? ‘mal behaviors inthe typical person. They become aversive te laryngeal health when they become excessive often part of a habit. Excessive laughing or crying, producing odd noise perhaps in imitation of animals or engines, producing xtreme yes and shouts are all examples of possibie vocal fbusee, While an oceasional vocal abuse may be observed in enyone, excessive amounts of such abuses should be avoided. Typical laryngoscopic: findings after prolonged Yeling wilPshow an edematous swelling along the glottal margin of the vocal folds. Such edematous. folds. then Vibrate In an asynchronous manner, producing a dsypnonia which may include breathy, low ptchod and hoarse phon. tion. Misuse ofthe voice may include singing or speaking at excessive intensity levels, excessive frequency loves, us: Ing excessively abrupt giotal attack, or using an nap. Dropriate register. Serious users. af voice simply cannot fallow themselves the luxury of abusing or misusing the larynx. An albout effort should be made to identity these abusee-misuses. 2. Reduce or eliminate the identified abuse and misuse Perhaps the most important part of the vocal hygiene pro ram isto reduced the occurrence ofthe identiieg abso land misuses. While foal elimination of the abuse Ike ox essive throat clearing is a desireable goal n developing {900d voice habits, most voice patients have to sate for on ya reduction of such activity. Howover, most voice cn. ans fee! that some reduction of vocal abuse-misuse is an {solute prelude to alfecting any kind of voice improvement through volee therapy. Boone (1877) developed speciic pro cedures for reducing abuse such as keeping a tally cart on fbuse occurrence, tallying each day the Total number of buses the patient was abi to count fr that particular day. ‘The abuse tales were then pleted on an abuse chart which was subsequently reviewed In voice therapy sessions. “3. Develop an easy glottal attack Many speakers use an excessive phonstory attack as they speak, biting out each phonation as a distinct ently Spectrograghic analyses of speakers wit hara atfack snow {an abrupt phonation onset. This appears tobe produces by ‘sudden slamming together of the vocal folds and thet Posterior vocal processes followed by a sudden initiation of fir stream and phonation. This isn direct opposition tothe breathy voice which is produced by Initiation of alr flow before the vocal folds are completely adducted in approxImation. The Bette Davis voice (hard glotal attack) is in sharp contrast to the easy phonatory altack of @ Southern Speaker ike Jimmy Carter Speaking with hard glottal at tack is usualy but part ofan individva's overall hyper state ‘of communication. The unnecessary elfor of hard giotal at. {ack takes a toll on the pationt’s speaking efforts. The pa tients volce may tite easly and he or she will experience a myriad of vocerrelated symptoms such as pain inthe hyold ‘tea, throat dryness, or change of voice quality. This author Innis early teaching days used abrupt glottal attack as part ‘of a “voice of authori,” paying the penalty after long lec: Ture with deteriorating voice quallty and related somatic Symptoms. Hard glttal attack requis too much vocal et fort the typieal patient can communicate just as well with less efor’ and easy glottal attack. Once voice patients have eliminates hard glottal attack, has been my experiance {hat they tind it aimost Impossibie to return to 11 we oliberately attempt hard attack in negative practice, Le using hard glottal attack on purpose, the patient who now ‘omploys easy attack ean not reven back to efforttl phon tion. Most voice therapy textbooks offer procedures. for helping the speaker o singer dovelop an easy glottal attack. "f Use a. speaking voce! Trequency that Is where you ‘should be. Avoid singing at extreme pic levels. ‘Occasional speakers speak af to0 high or too low a pitch. Most speakers will get the most “mileage” out of thelr volees if thelr habitual pitch the pitch they generally use In) Conversation Is located about one-third Irom the bottom of thei total pitch range exclusive of falsetto (Boone, 197) One's habitual piteh feel is in no way a fixed or absolute pitch level. n the measurement of voice frequency range, Setermination is made of one's lowest ang highest trequen, ty. These measures may then be converted to musical pitch levels: For example lan adult male's lowest pitch is an F? and his highest note isa C4, ha would have apiten range of TBnotes F2, G, A.B, CF, E,F, G, A,B, C2). Using the for mula of one-third from the botiom of the total range, we ‘Would say that four notes from the bottom (BE) would give fim his best speaking voice (optimum pitch and hopefully become his habitual pitch). The best voice pitch seems 10 ‘be several full nates about the lowest note one can produce Habitual pitch ie never at a constant frequency level but fluctuates Up and down a note or two depending on the In flectional pattems used. Singing Tor prolonged periods of Boones9 time at the very bottom or top of our singing range is also reported by singers to produce symptoms of vocal fatigue {reduction in range, somatic discomfort, reduction of qual {yi ithas been my observation that some of my singer pa tents profit from avoiding singing their absolute lows ar highs in rehearsal, saving such a production for oniy occa 'D. Keep your speaking voice at the lower end of you loudness range. it we had an imaginary intensity scale to apply to the in tensity of the speaking voice, let us say it has 10 intorval points The T value is for a sot whisper and the 10s or 2 ‘maximum yell, Using this tensity imagery kee the speak ing voice at 9 or lower as much as possible. Let one's listeners hear voice loudness a the lower end ofthe inten ty range. A louder voice should only be used n environmen: talor performance situations that require aloud production ‘Many volee patients have Tound in voice therapy that they had previously talked fat louder than they needed 10 do. One tan often extend the utilization of the voice for longer periods of time i voice intensity levels aro reduced Take an easy, rolaxed breath while speahing Most conversational speaking situations do not require any special effort in breathing, Only in some situations such fa acting or singing is forced expiration required. needing a bigger inhalation and a controlled, sustained expiration Many speakers In conversation work too hard at ureathing {The typical speaker seems to match his inspiration and ox piratory contol to meet the verbal passage he wishes to Say, There appears innormal speakers to be an amazing cor. eepondence of the timed or temporal aspects of respiration to the actual number of words spoken. Otten the best breathing etfor for conversational speech Is the breath of ‘well-being this i the kind of easy Inhalation-oxpiation one ‘might use when saying an easy exclamation (perhaps while Tooking ata sunset witha sky lacod with volcanic ash), "Oh mmy God, how Beautiful” Most speaking attempts oniy ro ‘ure an easy. relaxed breath. The occasional speaker ot Singer who is working {00 hard on his breathing (such as fnth shoulder elevation, aucibie inspiration, lack of ym “hony between atdomen and thorax) might wall profit from Some formal respiration taining, designed to utlize the Sutgoing air stream with relative ease and elficioncyouRs 7. Reduce vocal demand as much as possible. Speak or sing oss. Some voles are destoyed trom overwork. Frequently the performer gets ina situation where acting or singing rehear Sals become prolonged. demanding full voles in all the dimensions of frequency, intensity, and. quality. “This Clinician has had occasional portormer patients hg had fo follow an all day rehearsal with a performance that night experiencing from the prottacted effort a voice breakdown Many speakers or singers vocalize unnecessarily, talking or singing far more tan they have todo. Serious users of voice should make an attempt to reduce thelr vocalization. Occ Sional clinical patients have profited vocally from restric. ting their vocal eutput to reduced hours: for example, are. ent night club singer avoided conversation with anyone all day before she sang. As she trained her speaking voice In voice therapy, she was then able to resume conversation for ‘most of the day before the performance. Many performers, however, have gregarious personalities, andi not ust the amount of vocalization they do but the type of vocalization they do (laughing, contoling their listeners by thei inces ‘sant chatter,etc): Heavy usoregf voice should explore ways {o reduce their vocalization. The vocal pertormer like the Physical athlete must avold performance oxcessaa, par. Hicularly ihe or she ls experiencing symptoms of vocal fatigue orf one wishes fo extend performance ove longer Period of time, ' While listening, keep your teeth separated witha slight ip opening. ‘Many patients with vocal hyparfunction exhibit tightly closed mouths with excessive mandibular restriction. Etec live therapy for these patients often utiles. specific Taclitting therapy approaches. suchas chewing, open mouth, ‘and yawrrsigh. Most anyone can" profit trom Goveloping more oral’ opaness with less. mouthjaw tightness. A gentle opening a less than one finger wide bet. ween the central incisors Keeps the teeth apart and general ly fosters a relaxed ral posture. This s directly opposite 10, the grinding of one's molars, a common phenomenon reported in dental literature, which may will be symptomatic Of overall tension. Developing an awareness of oral opening Versus oral tightening both In onesel! and others Is often = Needed beginning for developing greater oral relaxation. A frequent user of voice can often profit tom employing & Boonaltt slight mouth opening while not actively speaking or singing Good production of voice requires an active movermant of jaw and opening of mouth as most actors and singers have been taught. However, many performers forget the impor {ance of continuing to open their mouths during conversa tion: a good conversational voice also requites some mouth ‘opening for production of adequate voice resonance. Many ‘900d singers may be poor speakers because they simply do ‘Rot open their mouths enough when they speak 9. Avold talking n loud settings (aisco, efplanes, cas, oats, et) ‘One may havea dificult time monitoring both the efor in speaking and the loudness of the voice in noisy eetings. ‘The backgound nolee Ina discotheque may be 80 intense that ane cannot hear or monitor his own voice. After pro longed voicing in such a setting, one may begin to feel the ‘symptoms of vocal fatigue, Lea deterioration of volee and ualty and an experience of somatic. symptoms. While iso seltings are well recognized for thelr Intense sound fevels, loss obvious are other noisy situations like a car on a ong tip, power boats, alplanes, power motors, eto. One reeds to become aware of te difficulty talking in noisy set. {ings oF around notsy equipment. Prolonged vocalization In ‘uch environments should be avoided, 10. Avold smoking and excessive use of alcohol. ‘There Is ample evidence that smoking and heavy use of alcohol should be avoided by serious users of voice. Smok ing is a known irtant to tne membranes of the airway. Pa tents with voice disorders related to laryngeal pathologies such a8 nodules or polypoid degeneration are usually asked to quit smoking asthe first step in vocal rehabilitation. This, Clinician no longer will provide voice therapy for patients Wwith voice. disorders. who smoke. since. experience has taught me the hard tosson thal smoking patients make ite or no volee recovery. Heavy use of alcohol should also be {avoided as the Increased vascularization ofthe vocal folds produces more vocal fold iitation and increase in mass, Feading to more dysphonia. Wile absolutely no smoking should be allowed, mild and occasional use of alconol Seems to have no negative effect. "I. Avoid oda sounds with your voice, such as imitating engines, Funny volces, ete ‘A professional speaker, actor, oF singer should avoid vocal extremes that one might experience imitating loudand strange sounds. There are a suprising number of peo: {empting fo mimic the sound of an engine, an animal sound. fra strange voice, We discovered a recent femate patient sino frequently lmitated for er friends and family the gravel volee of Louls Aimstvong; this was subsequently found In Uenaviors. Vaca! imitations. often. tax the physiological limits of one's larynx and ‘can result in damage 10 the laryngeal mechanism & professional colleague of mine pro duced bilateral contact vleers by Imitating hard glottal at tack over a prolonged period of time, actualy producing membraneous breakdown and ulceration whila being Fimed with a high speed camera. Pushing the. laryngeal Mechanism into strained, nyperfunetional_ utterances as {2p occasional imitation of fun voice may be counter Broductve for the speaker who wants his voloe "to last 72.‘Keep the membranes of Your mouln and throat as moist as possiote Excessive dryness is hard on the laryngeal membrane. Performers who live and perform in low humisity climates or In settings requiring either excessive air-conditioning oF heating which take away raom moisture may need. some kind of Rumiificetion it was stated many times in the Transcripts of ihe Seventh Symposium Care of he Profes: ional Voice (1979) now Important moisture te fr the eff lent function of the larynx. Excessive dryness gies the mucous" membrane covering. the folds. which causes ‘edness and adema of thamembrane, resulting in'a marked ‘hanged of voice quality. Sometimes the simple addition of ‘room vaporizer or home humidilier may make a postivie “iference i the sound ofthe voles. A serious user of voice Should cheek out both his home and performing arena (ot flee, heater, school fo determine the relative humidity. I leveis are below 30%. efforts should be made to aad some room moisture by using @ vaporieer or humidifier. Medica tions whieh have drying effects on the secretions In the nose, foal, and mouth, such as antihistamines, should be Svoided as much as possible. The professional user ot voice Should also watch hie overall state of body hydration, ma {ang an adequate balance of body fluids despite the on. vironment of work requirement. Good voice overtime re ‘ires moist membranes in the vocal tract. We should perhaps think of pharyngeal and laryngeal mucous more as Brien than as an enemy. Boonelaa Summary The professional user of volee may profit from a vocal hygiene program. Deriving many of the hygiene principles from a clinical voice population, twelve suggestions. are presented for the singer or speaker fo follow in an attempt forget the most "mileage" out af volce. References BOONE, D., The Voice and Voice Therapy. Englewood Gilfé, Ns: Prentice Hall, 1077 COOPER, M., Modern Techniques of Vocal Rehabilitation. ‘Springtels, I: Charles C. Thomas, 1977 FROESCHELS, E, "Hygiene of the Voics Arch. of Otoleryn ‘90!09y, 37,1848, pp.122-100 LAWRENCE, V., (Elton, T Transcripts of the Seventh Sym ‘pasium Care ofthe Professional Voice, Par Il: Med: featiSurgioal Therapy. New York: The Voice Founda- tion, 1978 WILSON, ©., Voice Problems of Chilaren. Baltimore: The Willams and Witkin ©. 1979. 1. Danie! Boone, Dept. of Speech and Hearing Sciences, University of Arizona, Tucson, Az. 65721 USA.