Articles by Anthony F. Jahn

Doctor – Do I Cancel the Performance?

A sudden loss of range and voice quality – what is the way forward?

Dear Doctor Jahn,

For some strange reason I’ve lost my upper range and my lower range is quite raspy–I am currently scheduled to sing a pop concert, using my upper range, with a local symphony in two months! Their press goes out in a week. Do I hope for improvement and everything works out? Do I let the symphony know in advance of predicament? I don’t have a cold or flu. My voice, throat, vocal chords, etc. do not hurt.

-Kerry

For a well-trained singer performing legitimate repertoire, this might be > read more

Your Voice on Tour

Avoid hits to your health so you can sing your best. Dr. Anthony F. Jahn shows how.

Dear Doctor Jahn,

I’m about to go touring…again. It’s on a bus –across the country. Last year, it was a heck of a lot of fun, but I was plagued with low-grade infections which led to less than ideal performances. I don’t smoke (though I’m around it!) and don’t drink too, too much. I’m just wondering what advice do you have for me to be the healthiest I can be on this year’s trip?

Jack.

Dear Jack: Touring is difficult, both for your voice and your general health.

There are many reasons. The schedule can be hectic, arriving, unpacking, rehearsing, performing and packing up again.

It is stressful to deal day after day with new circumstances, different venues and different people.

You are constantly in a noisy environment, since even on the bus the ambient noise level is significant, which can lead to voice strain.

Depending on your group’s smoking policy, your bus may be a travelling gas chamber, filled with second hand smoke which is irritating to your throat.

Stress relief often takes the form of parties, which are again noisy, smoky, and not good for your vocal tract.

The Road To Vocal Health

First, get a good set of ear-plugs, or, if you can afford them, noise cancellation head phones.

Bose makes a rather expensive set, but cheaper ones are also available; just reducing the ambient noise level on the bus goes a long way towards alowing you, and your throat, to relax.

You can attach the phones to your iPod or CD player, and replace stress-inducing traffic noise with quiet music.

Next, try to prevail on the tour manager to get rid of smoking, or at least localize it at the back of the bus.

Limit second hand smoke irritation by breathing through your nose (not your mouth) and use saline nasal spray frequently to help trap smoke particles in the nasal tract.

Drink lots of water on the bus (you may need to sit near the toilet, but that is a small price to pay).

Have a routine that you adhere to daily. It should include some quiet time, even if just going for a short walk in a park or wooded area.

If your hotel has a gym, try to use it- exercise is great stress relief.

Go Beyond the Basics

If you know how to meditate, a few minutes daily can be very refreshing and balancing.

At the risk of being anti-social, don’t be the life of every post-performance cast party.

Your voice is your living, so don’t waste it on things you don’t get paid for.

This is especially important for shows where the roles are not covered: the show and the rest of the cast depend on you being healthy and strong.

Try to eat well, not out of machines back stage- few years ago, while touring with the Metropolitan Opera in Japan, I noticed that many musicians were eating out of the machines, which were filled with high sodium noodle soups.

These are not only lacking nutirition, but also can increase high blood pressure.

Final Prescriptions

Try to pick up fresh fruit and produce whenever possible.

If you get comfort from certain foods, try to make them part of your routine; a morning bowl of oatmeal, perhaps with fruits or nuts, is a very healthy anchor to your daily menu.

Take dietary supplements, especially Vitamin C, spaced over the course of the day.

Before leaving on tour, consider going to your doctor to pick up emergency drugs, such as a course of antibiotics, just in case.

Finally, call home! Some of the stress of touring comes from losing contact with your family.

If you can, call, or e mail, regularly to keep yourself emotionally anchored during your travels.

Anthony F. Jahn MD

Dr. Jahn welcomes your questions. You can send these to editor@voicecouncil.com

This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.

My Voice Has ‘Deserted’ Me…

Hello Dr. Jahn:

I’ve just moved to the desert and my singing voice is not the same. I’m assuming that my allergies are responsible for my constant mucus. When I hit a high note, it sounds awful. Furthermore, my left ear is always clogged up. Various remedies such as honey, water, neti pot etc. do not seem to work –and I have a gig next week. Help!

-Eve

Dear Eve:

You’re most likely dealing with an overly dry climate.

The vocal folds work best if the larynx is hydrated, both internally (the deeper tissues), and on the surface.

When the vocal folds vibrate, especially at higher frequencies, there needs to be a thin layer of fluid covering them.

In effect, the contact between the two vocal folds is this cushion of thin fluid.

You can compare it to ice skating: the reason your skates glide easilty on ice is because the blades slide on a thin layer of water which is generated by heat which is generated by the weight of the skater.

The actual sliding (or vocalizing) takes place on a fluid-covered surface;
If the fluid is not there then, in the case of the vocal folds, the voice sounds thin and rough.

Trying to produce your normal sound only leads to excessive squeezing and further rubbing together of two dry vocal fold edges.

Sooo- you need to hydrate! Drinking water is helpful, especially if it’s hot outside, and even more so if you exercise.

I would suggest at least 60 ounces, spread over the course of the day.

Keep your nose hydrated as well, with frequent sprays of saline.

This is one situation where a small squeeze bottle of saline used frequently is actually more useful than a Neti pot.

If you can obtain a saline nasal gel (marketed in the US under the brand name NaSal) this is even better, since the gel adheres to the nasal lining and keeps it moist longer.

Once your nose is wet, please remember to breathe through your nose (rather than you mouth) as much as you can; this humidifies the inhaled air, and reduces laryngeal dryness.

Another issue may be allergies. The flora indigenous to deserts is usually not very allergenic, but we have imported a lot of non-indigenous plants to these areas (this is certainly true in areas of the US like Arizona), and with these plants come allergies.

The dry desert wind carries pollen more easily and for greater distances.

Once the pollen is inhaled into a respiratory tract which is dry (i.e. under hydrated), it is more easily carried down to the larynx and the bronchial tubes.

So allergies are also a consideration- the dilemma here is, should you take a drying antihistamine to combat this?

Look either to non-drying medications like Singulair (a leukotriene inhibitor, not an antihistamine), or natural anti-allergy remedies such as stinging nettle tea or capsules.

Longer term allergy relief may be aided by eating local honey, which gently exposes your body to pollen- sort of like taking anti-allergy shots!

And finally, what is the elevation of this desert? Singing at higher altitudes actually adds to the misery, because the air is thinner, and makes it more difficult to support the voice.

The body does get used to this thinner air over time, but initially you definitely need to use more muscle effort to get the voice out.

Anthony F. Jahn MD

Dr. Jahn welcomes your questions. You can send these to editor@voicecouncil.com

This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.

A Fantastic Morning Voice

How can you have an ideal morning voice under less than ideal conditions?

Dear Dr. Jahn,

I’d like to have a great singing voice first thing in the morning! So, what would be your ideal plan? I have to also add that pollen allergies, some late nights and * ahem * less than ideal performance venues add to my challenges!

Best wishes,

Brad

Dear Brad:

Many singers have “morning voice”, especially after a performance the night before. While some of this in unavoidable, I have several suggestions that should minimize the impairment.

By way of prevention, try not to abuse your voice the night before: use good technique and minimize social voice use, saving it for your actual performance.

Minimize the use of alcohol— it has a dehydrating effect on the vocal folds, and an anesthetic and dis-inhibiting effect centrally, both of which can lead to excessive trauma to the larynx.

If your performing environment is smoky or otherwise polluted, a steam inhaler in your dressing room would be useful for moistening the vocal tract between sets.

Those breaks between sets are golden: guard them jealously! Rest your voice, try to minimize chatting with well-wishers, and stay in a relatively quiet setting, rather than mingling with customers or fans.

At the risk of having to get up at night for the bathroom, drink two large glasses of water on retiring, and keep the glass beside your bed for additional sips if you happen to wake up during the night.

If you feel you have abused your larynx excessively, you may also consider taking one anti-inflammatory pill, such as Ibuprofen (200 mg), provided that there are no medical contraindications to this.

If you have any history of reflux, a tablespoon of antacid will minimize the risk of further irritation to the vocal tract at night.

The next morning, start with another glass of water. Then, take a long hot steamy shower, and gently begin to vocalize in the shower.

Do this even before making any phone calls, or engaging in any conversations.

While vocalizing, concentrate on flexibility, doing some glissandos (slides) through the passaggio (the part of the voice where you transition from chest voice to head voice)— start with slides from top to bottom (easier), then from bottom to top, in a soft voice.

Don’t start your warm-ups by pushing the voice, especially at the top, and never start to sing full out without warming up, especially after a “less than ideal” performance situation the night before.

Anthony F. Jahn MD

Dr. Jahn welcomes your questions. You can send these to editor@voicecouncil.com.

This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician

When Smoke Gets In Your…Throat

How can singers avoid vocal set-backs from second-hand smoke?

Dear Doctor Jahn,

Is there any way to protect the voice in smoky bars? You see, I often perform in smoky places such as bars. I was wondering, what steps I can take to protect my voice, and to help me perform my best in such smoky situations?

-Ray

Dear Ray:

The problem you describe used to be much more common before the increasingly universal smoking ban was introduced in the North America, as well as in many parts of Europe.

Nonetheless, smoking continues, often in confined and poorly ventilated venues.

Most singers who believe they are “allergic to tobacco” are not so much allergic as > read more

Vegetarian Vocalist?

Dear Dr. Jahn,

Many of my friends in the arts scene are vegetarians; I’m attracted to the idea. But, the thing is, I’m a hard rocker, use tons of physical energy on stage and I don’t want to compromise my health in any way. Is it possible to have a perfectly healthy diet and be a vegetarian or am I heading down an endless road of supplements and dangers? There’s just so much propaganda on this issue and I was hoping you could clear the air.

-Alan

Dear Alan,

This is a great question and one for which there is no real answer, short of personal experience.

But I would re-phrase it: can a vegetarian get enough nutrition from a diet that lacks meat?

It seems to me that as long as you get the right amount (and the correct ratio) of carbohydrates, protein and fats, it shouldn’t make a difference whether they derive from animal or vegetarian sources.

Of the three, fats have the highest number of calories per weight (of food consumed) so this would have to figure into your diet. Surprisingly though, fats do occur in vegetarian food, such as nuts.

Protein is found in many non-meat sources, most notably in soy, while the best quick source of energy is simple carbohydrates, the sugars found in fruit, for example, so you should be okay in that regard.

You would, however, be likely to need to eat a greater volume of food to get all of the nutrition you need.

As you’re unlikely to sing well on a full stomach, I would recommend eating smaller amounts more frequently. This “grazing” style of eating is actually healthier than the usual three meals a day.

Now the really interesting question is: will you sing with as much passion and aggressive energy if you don’t eat meat?

Soy, the main source of protein in most vegetarian diets, is a prime source of the female hormone estrogen (called phytoestrogen) and for this reason it is often recommended to post-menopausal women. Would substituting estrogen-laden tofu for red meat change the masculine energy of your performance?

As I said, there is no real answer short of trying this, but do let me, and other readers, know!

Dr. Jahn

Questions for Dr. Jahn can be sent to VoiceCouncil Editor

Note: this discussion is for general information and not to be construed as specific medical advice which you should obtain from your own physician.

Singers: Avoid The Common Cold

Dear Dr. Jahn,

I literally can’t afford to catch a cold this time of year! Too many important gigs lined up. So, what are my best chances to avoid catching one – or, if I get one (gasp!), what is my quickest way through it?? I’m wondering if you will tell me anything my mother hasn’t already…

—Kitty

Dear Kitty,

If your mother is like mine, it is unlikely I can do better than her, but here it goes.

First, stay healthy: eat and drink enough, get adequate sleep, exercise regularly and avoid stress as much as possible. Stress can weaken your immune system and make you more vulnerable for the cold virus.

Second, minimize the potential for contagion: wash your hands several times a day, especially before touching your face (monitor that you don’t touch your face unnecessarily or habitually), don’t shake hands with sick people and try to avoid crowded places as much as you can.

At the risk of looking silly, cover your face with a scarf if you need to go on a crowded bus or train during rush hour.

If anyone in your family (or a room mate) gets sick, minimize direct physical contact and don’t share personal items such as toiletries, dishes or cutlery.

On the active side of prevention, take Vitamin C, about 4000 mg a day in divided doses during cold season.

Other remedies such as Echinacea may also be helpful, but Vitamin C clearly is beneficial.

At the first sign of a cold, double your Vitamin C intake, always divided over the course of the day.

Remedies containing Vitamin C, such as Airborne are very useful—don’t know if you have this in the U.K., but it is an effervescent tablet with vitamins and other remedies that you can drink at the onset of a cold.

Zinc lozenges are very useful, as are zinc nasal swabs— not as a preventive, but they do shorten the cold, make the symptoms less severe and make you less contagious. (Avoid zinc nasal spray, since some patients have reported a loss of smell using the spray formulation.)

If you do get sick, stop exercising, stay warm, drink lots of fluids and let your body heal itself. You do not need antibiotics unless the viral cold leads to a secondary bacterial infection, which manifests with mucus that is green or yellow.

Let me know how your season goes!

—Dr. Jahn

Questions for Dr. Jahn can be sent to VoiceCouncil Editor

Note: this discussion is for general information and not to be construed as specific medical advice which you should obtain from your own physician.

My Ears Can’t Take Flying

Hi Dr. Jahn

I just got back from a gig in Sedona and I cannot get my right ear to regulate. This happens whenever I fly (I usually try to travel by train). I’ve been given the remedy of washing out my ears with one part alcohol and one part white vinegar —does this do any damage?

I’m seeing an acupuncturist tonight to help me with my chronic back pain – will this help me with releasing the pressure in my ears?

-Brian

Dear Brian:

You most likely have a blocked Eustachian tube, which can happen when you fly with a cold, allergy or congestion.

Normally, as the ambient air pressure changes with airplane ascent (and especially descent), the pressure spontaneously equalizes between the back of the throat and the middle ear through the Eustachian tube. When the tube or the nasopharynx are congested, the pressure cannot equalize.

You may then notice discomfort in the ear, with a sense of blockage or hearing loss. In severe cases, you might even develop some fluid in the middle ear that may require drainage.

Try to open the Eustachian tube by using a decongestant, either oral (such as Pseudoephedrine – also known as PSE) or a nasal spray (such as oxymetazoline), and popping your ears. If you are seeing an acupuncturist, have her/him stimulate the “nasopharynx” point just inside your ear canal – this often releases the blockage.

Anthony F. Jahn MD

Note: this discussion is for general information and not to be construed as specific medical advice which you should obtain from your own physician.

I’ve Got To Improve My Voice…

Dear Dr. Jahn,

Outside of vocalizing, what are other activities, like physical work-outs, breathing exercises, or diet that have the biggest impact on improving the voice? I’m hoping you will be specific— we’ve all heard that it’s good to exercise and eat well but what do I really need to do MOST to improve my voice?

-Gerald

Dear Gerald:

I am not a physical therapist or a personal trainer; however, as a voice physician, I do have some suggestions.

Apart from voice lessons, practice and a solid vocal technique, the main issues relate to the lungs and the abdominal muscles. You need to maximally inhale and then fully exhale. From this point of view, almost any cardiovascular exercise you do that has you breathing deeply and fully through the nose (not through the mouth) is useful. Running on a treadmill, elliptical trainer or stairmaster are all good options here.

Pushing air through a small opening, such as a straw, has been recommended by voice scientists, since this further expands the lungs and teaches controlled, prolonged and complete exhalation of the breath. In this regard, playing wind instruments which offer some resistance (the most resistance comes from double reed woodwinds such as the oboe) is helpful for the breath.

Support for the voice comes from the abdominal and pelvic muscles. Exercises that strengthen the abdominal muscles include curls and sit-ups. Don’t neglect the oblique muscles of the abdomen, or the muscles of the back, which support your posture and give the anterior abdominal muscles counterbalance to work against. Back muscles (like the psoas) are slow-contracing postural muscles, and can be strengthened, by monitoring your posture during, e.g. deep knee bends.

Pelvic muscles, including those of the pelvic floor, anchor abdominal support. Lifting the pelvic floor, the so-called Kegel exercises that women do, strengthens this area.

Some general pointers: breathe through your nose as much as you can, since this increases the compliance of the lungs (called the naso-pulmonary reflex) and keeps your throat from drying out. Always exhale with effort, don’t hold your breath when you lift or push during exercise, since this can put pressure on the vocal folds. I would also advise you to consciously concentrate on the specific muscles being exercised: a major task in healthy singing is contracting specific muscles only, while relaxing other ones. You will miss the opportunity to train yourself in this regard if you are distracted during your efforts by a loud iPod.

Anthony F. Jahn MD

Note: this discussion is for general information and not to be construed as specific medical advice which you should obtain from your own physician.

Am I Losing My Upper Range?

Am I Losing My Upper Range?

Hi Doctor Jahn,

I’m a 40 year-old male and, after a hiatus, I’ve just returned to singing in bars and clubs. My upper vocal range has decreased and I experience a tight feeling in my throat. I also feel and hear a grinding on certain vowel sounds (A’s and I’s) the day after a gig or a particularly high-energy rehearsal. I’d like to get back to my old unencumbered singing self—can you help?

Regards,
Alan

Dear Alan,

Your history contains important clues as to where your problem lies and how to correct things. You have been away from singing for a while (months or years?), and have returned to a high-energy and vocally taxing profession. I suspect that your technique may need a tune-up! You are asking your voice to perform as it did when you were younger and singing regularly. A good teacher should be able to give you exercises to get your larynx back into shape. Trying to produce a voice with inadequate support or technical reserve means you are using more muscle tension in the laryngeal area to produce less voice. This accounts for the tight feeling you are experiencing.

By muscling the voice, rather than supporting it properly, you are increasing the trauma to the vocal folds which may result in some swelling. This swelling, in turn, would account for your difficulty with the high notes. If your “high notes” are in high chest, rather than head voice, the friction and trauma is even greater. And finally, a ‘high-energy rehearsal’ to me means a loud rehearsal charged with emotion. It is unlikely that, in the heat of the moment, you are monitoring the physical sensations involved in vocal production. It is therefore likely that you overusing and straining.

By way of treatment: see a good teacher to get you back on track. Drink plenty of water. Scrupulously monitor your voice during singing and, until you get your old voice back, perhaps adjust your repertoire to a less strenuous level.

- Anthony F. Jahn, MD

Note: this discussion is for general information and not to be construed as specific medical advice which you should obtain from your own physician.

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