Declan Costello

Professional voice users are those patients who rely on their voices for their livelihoods. This group therefore includes actors, singers, lecturers, teachers, clergy, and lawyers. However, in an increasingly communication-driven world, it also includes call center workers, sales representatives, and other professionals who have to communicate to any significant extent.

This chapter will focus largely on vocal performers and the specific considerations that must be borne in mind in this group.

History

Vocal performers are often exquisitely sensitive about subtle changes in their voices and will be able to pinpoint very precisely the nature of their problem. The consultation should start with an open question allowing the patient to explain their difficulties.

A “standard” history in the voice clinic is covered elsewhere in this volume and will not be rehearsed here. Particularly in singers, the presenting complaint may often be a very subtle problem relating to parts of their range, certain dynamics, or certain vowels.

The singing style can have a profound effect on the ability of a performer to sustain their vocal instrument—singing in the musical theater style, for example, has a tendency to be very vocally demanding, with a high “closed quotient” (the vocal folds being closed for a large proportion of the vibratory cycle). The same can be said of many styles of rock and pop singing. In addition, a change in repertoire can have a great impact: it is not unusual, for example, for singing students to be required to change their repertoire from one college term to the next. A change of repertoire requires a change in the setup of the laryngeal musculature, and it can lead to vocal problems.

The extent of vocal training is an important factor: it is surprising how many young performers have relatively little training and are thrown into rehearsal and performance schedules without adequate preparation. This is particularly true for amateur and semiprofessional performers.

A performer’s schedule of rehearsals and performances is important: is it not unusual, for example, for a musical theater production to have up to two performances a day for 5 days per week. On the contrary, an opera singer will often perform just on alternate nights. Rehearsal schedules can be very intensive and it is important for the performer to realize that sufficient breaks should be incorporated into their schedule. Rehearsal schedules that are organized by institutions (opera houses, West End shows, etc.) will, on the whole, incorporate sufficient breaks and rests. However, it is often the case that amateur or semiprofessional bands, who have to fit in their rehearsals around other occupations, will have long rehearsals with few breaks.

Some performing roles require specific vocal demands. This might include foreign accents, shouting, or other vocal effects. If these gestures are unfamiliar to the performer, or if they are to be sustained for a whole performance, they can lead to unhelpful muscle tension patterns and even vocal fold phonotrauma.

Most performers are aware of the importance of warming up their voices. Warming-up regimes vary from performer to performer, but the aim is to prepare the voice for the performance to follow: for many, this will involve humming exercises, sirening (a glissando sliding of the voice from low to high), and singing scales and arpeggios. These warm-ups should not (at least initially) be performed at full vocal intensity. The aim, as with an athlete warming up before a race, is to encourage blood flow to the muscles, and to encourage flexibility in the muscles and other structures of the vocal tract.

Psychological issues