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Laryngeal Reflux
Reflujo en la laringe
Diseases of the Larynx





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Advice For Care Of The Voice

The following are some helpful hints for the care of the voice.

I. Hydration

The vocal folds need to be lubricated with a thin layer of mucus in order to vibrate efficiently. The best lubrication can be achieved by drinking plenty of water. A good rule of thumb (if you have normal kidneys and heart function) is to drink at least two quarts of water daily. Dr. Van Lawrence, world renowned Laryngologist, often said, �Drink until you pee pale.�

Caffeine and alcohol pull water out of your system and deplete the vocal folds of needed lubrication. Caffeinated drinks include coffee, tea, and soft drinks. Small amounts of these beverages are acceptable but must be counterbalanced by drinking more water.

Another factor that can affect lubrication is a dry air environment. The cause can be from gas furnaces, air conditioners, and climates with a low amount of moisture in the air. Using a humidifier at night can compensate for the dryness.

The air in airplanes is extremely dry. It is recommended that you avoid alcoholic, caffeinated beverages and drink at least 8 ounces of water per hour while flying.

Dr. Lawrence often recommended a favorite gargle recipe: 1/2 tsp. of salt, 1/2 tsp. of baking soda, 1/2 tsp. of clear corn syrup, and 6 oz. of warmed, distilled water. Gargle quietly and gently for two long, boring minutes. Do not rinse and use as often as necessary to help your dry, irritated throat.

In addition, Entertainer�s Secret® (800 308-7452) throat spray is an effective way to help moisturize the vocal folds (follow the directions on the label).

II. Throat Clearing & Harsh Coughing

Throat clearing and harsh coughing are traumatic to the vocal cords and should be reduced as much as possible. One of the most frequent causes for throat clearing and coughing is thick mucus (due to dry vocal folds) or too much mucus (as with a cold) on or below the vocal folds. The safest and most efficient way to clear mucus is by using a gentle, breathy productive cough where there is high airflow with little sound. This can be achieved by using the following strategy: take in as deep a breath as possible, momentarily hold your breath, and produce a sharp, silent �H� sound while you expel the air.

III. Drugs

Antihistamines: Antihistamines are sometimes prescribed to treat allergies and are present in some over-the-counter cold medications. Antihistamines should rarely be used because they tend to cause dryness. Prescription nasal steroid sprays such as Nasacort® (Phone-Poulenc Rorer), Nasonex® (Schering), Flonase® (Allen & Hansburys), etc. will often relieve the symptoms of nasal allergy without the drying side effects of antihistamines.

Analgesics: Aspirin products and non-steroidal anti-inflammatory drugs (ibuprofen) should be used with caution as they cause platelet dysfunction and this may predispose to bleeding. Tylenol® (McNeil Consumer Products) is the best substitute for pain relief.

Mucolytic Agents: The most common expectorant is a preparation of long-acting guaifenesin to help liquefy viscous mucus and increase the output of thin respiratory tract secretions. Drugs, such as Mucinex®, may be helpful for singers who complain of thick secretions, frequent throat clearing, or postnasal drip. Awareness of postnasal drip is often caused by secretions that are too thick rather than too plentiful. Mucolytic agents need to be used with a lot of water through the day, to be effective.

Local Anesthetics: Avoid the use of over-the-counter local anesthetic preparations for the throat. Singing under their influence is like trying to play the piano with gloves on.

Progesterone: Question the use of progesterone-dominant birth control pills. They may cause virilization of the female larynx and a loss in the upper vocal range. There may be no other alternative for your individual situation, however, so consult your gynecologist.

IV. Laryngopharyngeal Reflux Disease and Recommendations to Prevent Acid Reflux

What is Reflux?

When we eat something, the food reaches the stomach by traveling down a muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) to help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). The term REFLUX means �a backward or return flow,� and refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.

What are GERD and LPRD?

Some people have an abnormal amount of reflux of stomach acid that goes up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, vocal folds and the lungs) are extremely sensitive to stomach acid, so smaller amounts of reflux into these areas can result in much more damage.

Why Don�t I have Heartburn or Stomach Problems?

This is a question that is often asked by patients with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus become irritated. Most of the reflux events that can damage the throat happen without the patient ever knowing that they are occurring.

Common Symptoms of LPRD:
Hoarseness, chronic (ongoing) cough, frequent throat clearing, pain or sensation in throat, feeling of lump in throat, problems while swallowing, bad/bitter taste in mouth (especially in the morning), asthma-like symptoms, referred ear pain, post-nasal drip, singing difficulties (especially with high notes).

Medications for LPRD:
The most effective treatment for LPRD may be drugs in the class known as proton pump inhibitors. Included in this group are Prilosec®, Prevacid®, Protonix®, Aciphex®, or the new medication known as Nexium®. Ask your physician which may be appropriate for you.

V. Self-Destructive Behaviors

Avoid smoking cigarettes. They are bad for the heart, lungs, and vocal tract. Also, avoid other irritant inhalant substances and mind-altering drugs. Tobacco and marijuana are irritants to the vocal tract. When you sing you must be in control of all body systems: physical, spiritual, and mental. Smoking is disastrous for the speaking and singing voice.

VI. Requirements For A Healthy Voice

� Try your best to maintain good general health. Get adequate rest to minimize fatigue. If you do become ill, avoid "talking over your laryngitisee" - see your physician and rest your voice.

� Exercise regularly.

� Eat a balanced diet, including vegetables, fruit and whole grains.

� Maintain body hydration; drink two quarts of water daily.

� Avoid dry, artificial interior climates and breathing smoggy, polluted air.

� Limit the use of your voice in high-ceilinged restaurants, noisy parties, cars and planes.

� Avoid throat clearing and voiced coughing.

� Stop yelling � avoid calling from room to room.

� Avoid hard vocal attacks on initial vowel words.

� Use the pitch level in the same range where you say, "Umm-hmm?"

� Speak in phrases rather than in paragraphs, and breath slightly before each phrase.

� Reduce demands on your voice � don�t do all the talking!

� Learn to breathe silently to activate your breath support muscles and reduce neck tension.

� Take full advantage of the two free elements of vocal fold healing: water and air.

� Vocal athletes must treat their musculoskeletal system as do other types of athletes; therefore, vocal warm-ups should always be used prior to singing. Vocal cool-downs are also essential to keep the singing voice healthy.

Some additional suggestions for good vocal care are:

� If you need to get someone�s attention, use non-vocal sounds such as clapping, bells or whistling.

� Move closer to those with whom you are speaking.

� Face the person(s) with whom you are speaking.

� Use amplification, as needed, if possible.

� Reduce your speaking time in noisy environments, such as in automobiles and airplanes.

Optimal Speaking Techniques:

� Use good abdominal/diaphragmatic breathing and support.

� Learn to use your voice with as little unnecessary effort and tension as possible.

� Take frequent breaths when speaking long sentences.

� Maintain a smooth legato speech pattern with clear articulation.

� Allow the neck, jaw, and face to be relaxed.

� �Place� or �Focus� the voice appropriately.

� Speak at a normal rate of speed.

� Use good vocal inflection.

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Houston, Texas 77030
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