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Understanding Your Voice: Disorder Prevention
Dr. Kimberly Steinhauer
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Editor's Note: This volume of Voices offers important information on the care and maintenance of your most important tool — your voice. We’ve invited expert physicians from the field — doctors recommended to us and used by our OPERA America member companies — to share their knowledge with you. In the following article, vocal health experts Clark A. Rosen, M.D., and Kimberly Steinhauer, Ph.D., both of the University of Pittsburgh Voice Center, along with members of the Watergate Voice Consortium, give instruction and advice on protecting your voice from damage and maximizing its potential.

Advisory Note Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.
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Value Your Voice Through Healthy Diet and Lifestyle

Voice health follows overall health. Prevention of voice disorders requires individuals to value all aspects of their voices. Voice health follows the overall health of your body — things that help you stay healthy in general also preserve the quality and function of your voice. Additionally, healthy living can enable improved recovery in the event of a voice disorder.

A healthy voice requires specialized care and maintenance of all parts of the voice system: posture, breathing, vocalizing, and projecting. As in physical fitness, vocal fitness is reflected in diet and lifestyle.

A Healthy Diet for Voice
Each person’s voice may react differently to any number of common foods and beverages. Individuals should be aware of their voices and determine whether any voice complaints are associated with a particular food or drink. For example, some people report that drinking milk before speaking or singing causes an increase in phlegm or laryngeal mucous, making the voice unclear. These people should avoid or reduce exposure to these foods or drinks when possible. Certain types of food and beverages can complicate voice production.
  • Chocolates, spicy foods, caffeine, and alcohol can increase the stomach’s production of stomach acid. This increases the risk of backflow of stomach fluids, which can cause reflux laryngitis.
  • Caffeine and alcohol can have adverse effects on the nervous system, which can contribute to decreased voice quality. Caffeine is a nervous system stimulant that can cause hyperactivity and tremor, both of which can affect the voice negatively. Alcohol is a nervous system depressant that can impair coordination of speech and voice. Caffeine and alcohol have also been associated with the “drying out” of vocal folds, which can contribute to voice problems.

  • The Role of Water
    Proper hydration is key to the optimal function of vocal folds. When the body is even slightly dehydrated, the mucous made by the throat to lubricate the vocal folds becomes thicker. This thicker mucous can interfere with vocal fold vibration. The nutritional recommendation is to drink 6-8 glasses of water per day. Professional voice users and performing artists may require even more water.

    A Healthy Lifestyle for Voice While the prevention of voice disorders begins with a healthy diet, leading a healthy lifestyle is equally significant. Individuals who smoke, consume excessive amounts of alcohol, and/or use illicit drugs are at increased risk for voice disorders. Excessive use may lead to chronic swelling and irritation of the vocal folds, which can lead to voice disorders such as Reinke’s edema, laryngeal atypia, cancer, and vocal scarring.

    The Role of Voice Rest
    A frequently overlooked component of lifestyle that contributes to a healthy voice is voice rest. Programming short periods of voice rest into the day’s routine can rejuvenate the voice and possibly make it stronger — especially for individuals who use their voice frequently in their job.

    For example, by taking a quiet coffee break, not shrieking with the radio on the way home, and controlling cheers at a sporting event, one can “save” the voice and keep it prepared for times when it is needed most. The bottom line is that valuing voice by following a nourishing diet and healthy lifestyle is a great first step in preventing voice problems.

    Optimize Voice Readiness Through Exercise

    Regardless of how frequently an individual uses their voice during the day, voice disorders can be prevented by voice warm-up exercises that get the voice ready for optimal function. It is also important to “cool down” the voice at the end of the day.

    Just as body conditioning and warm-ups are important to athletes, voice conditioning through voice exercises can improve strength, endurance, range, and flexibility of the voice.

    Typically, voice exercise programs address four key aspects of sound production: proper posture, appropriate breath support, healthy sound, and adequate resonance.

    Warm-up for Proper Posture
    Posture is important to voice production since the body serves as the frame for voice support. Sample Posture Exercise: Stand with one foot slightly in front of the other at shoulder width to provide a firm base for the wellaligned head, neck, and torso (upper body). While standing, bend at the waist like a “rag doll” and gradually “roll up,” so that the head, neck, and body are in line. While standing, raise both arms to the sky, inhale and hold your breath,

    With your body well aligned as described above:

    Relax the facial muscles by massaging them with your hands. Relax the jaw muscles by chewing an imaginary piece of gum. Warm-up the neck muscles by: looking right, then center, looking left, then center, looking up, then center, looking down, then center. Warm-up for Voice Power (“Breath Support”), a Healthy Sound, and Adequate Resonance The consensus among voice care professionals is that exercises can help improve breath support, a healthy sound, and adequate resonance.

    For examples of healthy exercises for support, sound, and resonance, talk to your voice teacher or see exercises provided at

    Invest in Proper Voice Technique, Training, and Consultation

    Practice can help prepare the voice for almost any situation. As with all tasks, practicing good vocal habits is a key step in preventive voice care, and can improve voice function.

    Invest in voice training provided by qualified voice teachers in order to increase vocal range and repertoire. Advice from accomplished local actors and singers is a great first step in finding such a professional.

    Invest in medical consultation by seeking care from qualified voice care professionals when voice problems persist for two or more weeks beyond the end of cold and flu symptoms, especially if risk factors, such as smoking and reflux, exist. Timely evaluation of voice disorders by an ear, nose, and throat physician (ENT or otolaryngologist) or ENT-voice specialist (laryngologist) is important.

    Cherish Your Voice

    Voice is a reflection of an individual’s persona and physical well-being. Preventing voice disorders requires that one cherish all that goes into communicating that message. A person’s voice can reflect his or her psychological state. Singers have known for years that the voice reflects both mental and physical health. Cherishing and respecting your voice will ensure its vibrancy for years to come. Restraint

    Cherishing one’s voice implies using restraint during potentially vocally abusive situations such as sporting events, loud concerts, noisy parties, and crowded nightclubs.

    Almost everyone has experienced a phenomenon called the “Lombard effect,” which refers to raising the volume of the voice in the presence of competing background sound or noise. For example, suppose you are talking to your friends at a noisy party and the background music suddenly stops; when this happens, you end up surprised that you have been talking so loudly. In addition, you may also notice hoarseness or scratchiness in your voice the next morning — symptoms of inflamed or irritated vocal folds from yelling the night before.

    Though voice disorders typically result after years of constant abuse, it is good to get into the habit of using your voice sparingly in noisy environments. Also, try to maintain an awareness of the background noise at each location so you continue to speak in a normal volume.

    You may choose to move to a quieter part of the party t
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    About the Author: Kimberly Steinhauer, Ph.D., is a singing-voice specialist and received her doctorate in Communication Science and Disorders from the University of Pittsburgh. She earned her Bachelor of Science in Music Education from Indiana University of Pennsylvania and a Master of Arts in Speech Communication from The Pennsylvania State University. She has taught vocal music in the elementary through high school grade levels, and has performed extensively in community and professional venues. As a singer highly committed to voice education, Dr. Steinhauer focuses her research on the relationship between teaching techniques and vocal skill learning. Dr. Steinhauer works collaboratively with Clark Rosen, M.D., to tailor vocal exercises and repertoire specifically for singers who have experienced vocal injury.

    This article was written by Dr. Steinhauer in collaboration with the principals of the Watergate Voice Consortium: Charles N. Ford, M.D., F.A.C.S., Jamie A. Koufman, M.D., Clark Rosen, M.D., Robert Sataloff, M.D., D.M.A., Peak Woo, M.D., and Steven M. Zeitles, M.D., F.A.C.S.. This group of doctors serve as the board of editors for the Web site ( The Voice Problem Web site is a nonprofit educational Web site funded through the Watergate Voice Foundation. The Web site’s entire purpose is to support patients with voice disorders as they seek healing for more complex, more intractable voice problems.
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