Hello, I'm Dr. Robert Bastian. My subject is what we call vocal fold swelling checks.
Vocal fold swelling checks are designed to let you detect vocal fold injury early. Even before you would
know it is there if you didn't use the swelling checks. And the point of it is that if you catch
vocal fold injury early, you can avoid something like this happening to your voice:
(Hoarse voice of a patient singing "Happy Birthday")
Think of it this way; our voices are often dressed up with layers of clothing. We use loudness
as a layer of clothing, or focus, or resonance or vowel shading. But these layers of clothing,
sometimes called vocal technique, can cover up the presence of vocal folds swelling or injury. So with
these swelling checks, we're going to remove those layers of clothing from the voice.
These swelling checks are purely for early detection of any possible injury, and they're not for voice
grooming or development, and they're certainly not for performance. Now back a step. What part of the
vocal fold is it that can swell? Well, it's called mucosa. Mucosa is the lining tissue in our mouths,
in our nose, down in the throat, in the airway here. And just as skin is to the outside of the neck
and the rest of us, outside of the neck, and all of— the all of the outside of us, just so mucosa lines
the inside of us. Now vocal fold mucosa, right here, is very special. It's made for vibration
and it is the sound source of the voice. And yet, the very vibration mucosa is designed for—if it
goes too far, if it's excessive—that vibration can cause swelling or bruising. Now both simple,
early swelling and simple bruising are easy and fast to resolve if they're detected early. But, if
they're not detected early and they're maintained, we keep concealing with clothing and we, we don't
pay attention to the signals of that swelling. Then over time, we can—without really fully recognizing
that we're doing it—we can develop nodules or polyps; kinds of injuries that take quite a bit
longer that are much more difficult to resolve then early simple swelling. So we want to help
you avoid that crisis that can happen if you overlook, or deny, or cover up swelling over a period of time.
Now there is a group of people for whom the swelling checks are especially important.
We call them vocal over-doers, and define them as having extroverted personality. But they also—due to
that extroverted, talkative personality—typically are involved in lives that are highly vocal.
Now anyone can injure his or her vocal fold mucosa, but the vocal over-doer group are the most likely to do
this. And a subset of that vocal over-doer group who are professional voice users, or who are performers,
the stakes are particularly high in that group to avoid chronic injury. So the swelling checks
are useful to you whether you're normal, whether you're a little swollen but still quite happy
with your voice because it does for you what you need it to, or if you're quite frustrated.
In any of those three circumstances, the swelling checks can be useful because they all let you know
the status of your mucosa. Well finally, let's get to the vocal fold mucosal swelling checks
themselves. To design them, we'd want to include very high pitch because that's where trouble is
most apparent. If we use low voice, we're going to conceal, but high voice is going to reveal swelling.
The second requirement of a good swelling check would be a vocal task that is very soft, because
if we use loud voice we can force swollen vocal folds to work and therefore conceal the swelling.
Soft voice by contrast reveals. And then we might add the idea of staccato; a lot of onsets. An onset
is the moment when the voice speaks. So if we do a lot of, "O, O, O, O, O" We have more of those onsets to judge
whether they're working or not. Well you could design a lot of different swelling checks but
we have found two seemed to be sufficient, and let me tell you what they are. We use the first phrase
of "happy birthday" and we often change the words almost to: "Hebby-birthday-do-you" because it's
easier to sing in a very connected. So we want to keep it very connected and it goes like this:
Just the first phrase not the whole song. So that includes high and soft.
Then the second check is staccato, it's:
That one targets not just high and soft, but also a
lot of onsets. Now each of these two checks is repeated semitone by semitone to find what
we call your initial mucosal ceiling. So let me demonstrate with the happy birthday. You might do:
And then at a certain point it's going to kind of resist a little. So I'll mimic what that would sound like:
See how it doesn't want to happen? So that "OOooOoO" would be my initial mucosal ceiling.
So right that pitch down and you know that's where your your mucosa wants
to, to not cooperate. For staccato, it might be:
And then it will fail it or start to struggle it at a point:
See how I'm mimicking, but it doesn't want to work at—so I write down: "Yooo" as my
initial mucosal ceiling. Now I can make it work by just getting louder at those initial mucosal
ceilings, but that's not the point. The point is to produce it and see where that wants to happen.
Well up to this point, we've established that the mucosa—here on the surface of the vocal folds—is
the part of the vocal folds that's the most vulnerable to injury. And also, that we need an
early detection tool to detect early injury before we're really all that aware of it. And we also
know that a good detection tool needs to remove layers of clothing from the voice, because those
layers will conceal the injury. And so, those tests, those checks need to be extremely high pitch, very
soft, and often we use multiple onsets as well. We've taught you our two favorite vocal folds
swelling checks: and .
So now, let's answer the final question: what is the strategy for the application of the swelling checks over time?
First, commit to doing the swelling checks twice a day, every single day.
The first time of the day, if you're a singer, should be before your warmup. Because if you think
of it, warmup is actually like the first layer of clothing on the voice. And then I often suggest the
second time to do it just before bed. 20 seconds each time. Second, lock-in on producing your voice
for the swelling checks exactly the same every day. It can't be one day, and (louder).
You have to absolutely resist getting louder because remember, this is for detection and not performance/
And a word to singers; I'm not sure I've ever taught these these little checks to singers
without having to say "Oh no no, that's way too loud you need to be much much softer." And a little
comment to men; I'm using falsetto a lot, but in men, sometimes varied highlight chest voice is quite
sensitive, and especially when you're getting near where the voice wants to switch over into falsetto.
So you do them every day, you do them exactly the same every day, and third, you compare each
day's mucosal ceiling with the original that you determined a week ago, many months ago, or even
years ago. Now for lots of people this may be all the swelling tests ever are. You know your mucosal
ceiling, you just do your swelling test day after day, they fluctuate by a semitone or two or three
around what you've established is normal for you, and all as well. But what if you are a person who
notes that for a day or for a series of days your normal is off by three or four semitones?
It's lower. And you start to fluctuate around that new initial mucosal ceiling that isn't as
good, meaning it is lower. Well here's what you do. On the first day especially, stop and think
about the past 24 hours. Ask yourself, "Does it make sense that my swelling checks have deteriorated?"
"Has there been extra voice use?" "Have I been at an athletic event? "Was there a party or a long phone
call, or did I rehearse more than my usual?" Now you ask these questions of yourself because any
of those kinds of things might have inadvertently, very unintentionally and almost outside of your
consciousness, produced very temporary vocal folds swelling. You can warm it up and sort of goes away
and you can get a little louder, but you've got a little bit of swelling. So if you do that little
review of the past 24 hours and the answer is "Yes, I guess this does make sense. I can tell you what
I did that was too much." Then what you do is to back off—as I'll explain in a moment—until your
swelling checks revert to their normal level. A second scenario might be that you say, "There
isn't an obvious explanation for this difference in my swelling checks." So it's kind of appropriate
that the first time or two that happens you can kind of shrug and say "Well, I'll find out
what the swelling checks do the next time, but not more than 12 hours later." There could be a third
scenario where day after day you can't identify why, but you notice your swelling checks are not
quite what they should be. In this third case, you might back off of voice use anyway just to see
if it makes the swelling checks return to their normal level. And if not, if they continue to be not
quite right, you can begin to think—after a couple or three or four weeks of putting the wheels in
motion—to have someone look at your vocal folds. Well, if we go back to the first scenario where
you say, "Definitely I know what I've done. This is clearly from XYZ, and I've got some swelling."
What do you do to back off? If you have a lot of meetings in your day, try to space them. Don't do
them back-to-back but put time between where you can be quiet. If you're going to a social event,
or a party, or a loud restaurant, you can consider canceling or changing to a different venue or at
least alerting the people that you're going to be with that you'll be a little quiet but you're not
depressed or mad at them. Try to submit yourself to periods of silence. If you're a teacher, look at
your lesson plans coming up. Maybe there's a movie that you had planned for a few days ahead that you
could move to tomorrow in order to let your voice recover. Well there dozens of other ideas of this
sort. Well in summary, just as you need monitors, early indicators or warning lights in your car and
in your home, in similar fashion you need an early warning system for your voice. Swelling checks like:
and
can be this kind of warning system for you, if you will take 20 seconds twice a day to do
them. And then respond appropriately to what they tell you in order to keep your mucosa healthy.
We might even say, "Two vocal folds swelling checks a day keep the doctor away." Thanks for listening!