Article - Medical - Hyperfunctional Vocal Dysphonia - voice disorder, larynx damage

After months of being croaky after losing my voice following a viral infection in August 2011 resulting in hoarseness, breathlessness and a husky voice which can at times be deemed as being very attractive when speaking. I was unable to clear my throat and found speaking tiring. At times if I held a conversation for too long I started to choke or cough. After reading an article about vocal nodes or nodules I decided to speak to my doctor who made me an appointment with an ENT Specialist. Three months later I was finally diagnosed as suffering from a disorder that usually affects teachers or singers when they over use their voices or vocal chords.

For months I had been terrified that my singing days were over and that I'd have to an operation on my vocal chords - you know the kind of thing, dreaming about Roy Castle didn't help. So it was such a relief to find that my problem can be cured with therapy.

Researching the internet about 'hyperfunctional dysphonia' I came across an article by Morton Cooper, Ph.D 1980 relating to a similar condition call 'spastic dysphonia' and the methods used with patients in therapy. Although not a step by step guide I found it very useful and decided to follow the program as best I could until my first appointment on the therapy program comes through. I devised a simple program from that article and from all the other information available on the web.

This hub will document my progress.

Correct breathing and self-monitoring

Over the years we can become prone to incorrect breathing - when we breath in our tummy's should push out and when we breath out our tummy's should draw in. To my surprise I was breathing incorrectly even though as a singer I had been taught to breath through my diaphram I had compensated my voice loss during my illness by using the chest cavity to assist my breathing. A knock on effect of this was that when I breath in my tummy tightens inwards and when I breath out it pushing outwards...thereby leaving no space for the breath. Retraining is required:

1. Lie flat on your back making yourself as comfortably as possible. Close your eyes and concentrate on your breathing for a couple of minutes, try to keep your mouth closed. Listen. There should be no sound.
2. Open your eyes at look towards your tummy, does it rise and fall when you breath?
3. Practice breathing in and out of your nose. Take long slow breaths, not deep breaths. Feel the rhythm of your breathing. As you breath in each breath should expand your tummy, your lower back and ribs. Your shoulders and chest barely hardly move. To self-monitor your breathing put one hand on your stomach and the other on your chest.
4. Gradually relax your face, neck, cheeks, jaw, temples and tongue, still breathing in and out through your nose.
5. Breath slowly in through your nose, hold your breath – then exhale through your nose, practice inhaling slowly then exhale for longer until your breathing is 8-10 breaths per minute. Allow your body to breathe when it needs to.
6. Repeat 1 to 4, sitting straight up against a wall

Repeat 1 to 4, standing straight

Each exercise should take no more than 10 minutes.

Vocalising without irritating the voice box

1. Lying flat on your back and keeping you mouth closed, say ‘uh hum’ as if agreeing with someone, check your breathing. Keep saying ‘uh hum’ until you feel a vibrating sensation in your nasal area. Concentrate on breathing through your nose.
2. Keeping your mouth closed ‘Hum’ in two notes within your range ‘hum hum’ like sirens on an emergency vehicle. Gradually move up and down the scales feeling the buzz in your nasal area. Imagine the inside of a bell - work from the bottom up to the top and back down the other side as you ‘hum’. Keep concentrating on your breathing technique – breath in – tummy out, breath out – tummy in.
3. Keeping your mouth closed ‘uh-hum’ in two notes within your range.
4. Repeat 1 to 3, sitting straight up against a wall
5. Repeat 1 to 4, standing straight

Gentle acapella warm up exercises

Some great acapella warm-ups

1. The ‘Ah’ (as if sighing) sound starting in your head voice, mouth open, sigh down a scale four times remembering to breathe in between each sigh.

2. Repeat 1 using your chest voice.

3. Do the ‘Ah’ sound starting in your head voice, mouth open sign down the whole scale into your chest voice, do this four times.

4. Brill your lips as if you are cold, fluttering the lips while humming between any two notes within your vocal range, do this four times, remember to breath in between each exercise. Try to make this exercise last as long as you can, monitoring your breathing.

5. Mouth closed ‘Hum’ between two notes first in your chest voice then in your head voice alternating between head and chest voice, you should feel a slight buzz in your nasal area. Do this four times.

6. Using the ‘v’ sound to activate that nasal buzz and vibration in the mouth, lips forward sound the ‘v’ sound moving into the ‘ooo’ sound move in between two notes within your vocal range first in the head voice then in the chest voice.

7. ‘Siren’ using the ‘sighing Ah’ sound from chest voice to head voice back to chest voice as if arching the note over a bell shape.

8. ‘oooo’ exercise – alternating between two notes within your vocal range, first in the head voice four times then in the chest voice four times then alternate between the two four times. You should feel a slight buzz and vibration around your nasal and mouth area.

26th January

Had my first session with a private vocal coach/therapist, the first half hour was free. First, we discussed the diagnosis, my knowledge of breathing technique and my music genre. We then ran through a few 'mask' exercises using the alternating 'yah, yah' and 'ah' sounds. She then listened to me singing one of my favourite songs using my own practice backing tape 'If Tomorrow Never Comes' I wasn't happy with the sound I was making due to my condition and I felt that I sounded more like a strangled cat but she disagreed saying that although I thought it sounded bad it actually sounded quite nice and that I needed to relax. She then listened to a previous recording of me singing the same song on a demo cd saying that it was clearer, airy and more relaxed. She agreed that she could help me explaining that as we get older our range changes however I did have a good range. She's going away on holiday so an appointment was booked for the end of February. An hour later I was on my home again but she did not want anything for the 2nd half hour because most of the session was talking through my problems and what I wanted to achieve..

My homework is to check my breathing,

• to listen to the way I speak (chest/throat) currently and try to redirect my speech to come from the stomach area/diaphram,
• to run through some 'mask' exercises
• to drink water or swallow/gulp if I feel like clearing my throat thereby redirecting the habit

Last Thursday afternoon I had my second session with my coach. She taught me how to produce my sound through my mask. To sing forward in the face using the mouth to shape the sound. To bring the sound up from the diaphram and through the voice into the mask bypassing any connection with the throat at all. It is actually quite difficult to change the habits of a life time. She says I haven't been singing incorrectly all my life but since I have this condition I have adopted an incorrect way of speaking and singing to compensate. My NHS therapist says I am using my 'false vocal cords'. The methods or techniques used to overcome such difficulties will help me not only to overcome my current difficulties but to produce a more comfortable and powerful sound without touching the voice box hopefully enabling me to carry on singing. She used to be an opera singer, still does the occasional show, her voice is still beautiful for all of her sixty years.

Any way, we went through a series of vocal exercises using vowel sounds and eventually added consonants some of which made my nose tickle ever so slightly and a couple of them sent me into a fit of giggles.

My homework is to practice the sounds and practice singing using the mask.

Well folks that is as far as I have got so far and I will have to practice those exercises over and over until I can do them automatically, breathing correctly.

When I start the next stage, I will start a new hub.

If, as a reader, singer or vocal coach, you have spotted anything incorrect please let me know as soon as possible 1) so that I can take it up with my therapist & 2) so that I don't do anymore damage.

Your comments mean everything to me and I will always try to reply in good time.

I have used a few external to hubpages links and some hubpages links by my favourite vocal hub hubbers.

copyright © leni sands