Vocal Abuse and the Results of Surgery, a True Story

Person undergoing surgery on the vocal folds

About 20 years ago, I taught voice lessons to a talented singer who studied with me from sixth grade until the summer before she entered music school. This young woman went on to earn her Bachelor of Music and Master of Music degrees at two renowned conservatories. Her mezzo-soprano voice was exceptional, and she aspired to perform at the Metropolitan Opera in New York.

To prepare for auditions and cover travel expenses to New York or other major cities, she needed to earn money. She began teaching middle school chorus and general music classes at our local high school. Using her voice all day, she didn't realize the additional strain she was putting on her vocal cords by also teaching private lessons in the evenings and on weekends. Adding to her vocal stress, she sang in a rock band on Friday and Saturday nights. Eventually, her voice endured too much strain with insufficient vocal rest, leading to damage and the formation of large nodules (bilateral, benign masses that form at the midpoint of the vocal folds). This young woman did not respond well to voice therapy, as her nodules were too large, preventing her from speaking normally or singing at all. She underwent vocal cord surgery at a renowned hospital in Boston. Complications from the surgery forced her to end her vocal career. She returned to school for a doctorate in school administration and is now a middle school principal in Rhode Island, unable to use her beautiful mezzo-soprano voice!

 Phonotrauma and Dysphonia

What happened to this young woman is known as phonotrauma. The word 'phono' comes from the Greek root for sound or voice, and we all understand what trauma means. This type of severe damage often begins with dysphonia. Dysphonia refers to an abnormal sound of the voice, such as hoarseness, raspiness, or sounding strained, weak, breathy, or gravelly. Everyone experiences hoarseness during laryngitis or pharyngitis due to temporary vocal fold swelling. Dysphonia is a chronic vocal issue that must be treated to prevent serious voice damage, such as vocal edema, ulcers, nodules, or polyps.

How the vocal folds work

The voice involves many components. We use the vocal folds, lungs, and diaphragm. When air is pushed out of the lungs by the diaphragm, it causes the vocal folds to vibrate against each other. The vocal folds are V-shaped. To sing higher notes, the vocal folds increase in length and tension, vibrating faster. Lower pitches result from shortening the vocal folds and decreasing tension. People often don't realize how fast the vocal folds can move; when a band or orchestra tunes their instruments, they tune to the pitch of A 440, meaning the strings vibrate 440 times a second. That may not seem like much until you compare it to hummingbirds, which flap their wings 50 to 200 times per second. Sopranos can sing the note C6, which has a frequency of 1046.502 Hz, meaning their vocal folds vibrate 1046 times per second! That is two octaves above middle C. If you sing day after day, causing those vocal folds to come together at frequencies between 200 Hz and 1046.502 Hz, your vocal cords or folds are colliding millions of times each day. It's no wonder singers suffer from vocal abuse and trauma!

How to prevent vocal abuse

Preventing vocal abuse is crucial for maintaining a healthy voice. Singers need to stay well-hydrated, eat healthily, and get enough sleep. Additionally, singers should consider the number of hours they sing each day and try to adjust their practice time and strategies, as well as make changes to their speaking voice to help prevent further abuse. For these changes, you may need assistance from a qualified vocologist like myself. Vocologists will address changes to your optimal speech pitch, timbre (the quality of your sound), and resonance (the amplification of your sound).

By preventing phonotrauma or vocal abuse, you can use your voice efficiently for performing, speaking, or teaching. If you need help with your voice, please contact me or another professionally trained vocologist.

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