Posts Tagged ‘doctor’

Body & Soul: Vocal Care

Posted: 14th August 2011 by Webmaster in Body & Soul: Musicians' Health

The Body and Soul Section of contains frank discussions of health-related issues, including drug use and sex. Parental discretion is advised. talked to two top Los Angeles throat doctors about how to keep your voice in shape on tour and off. Although the interviews were done with singers in mind, anyone who uses his or her voice a lot can benefit from their advice. There’s a lot of information here, so we’ve divided each interview into sections by topic. Each doctor has his own suggestions on vocal cord care, so reading both interviews is recommended.


Dr. Alessi is Chief of Ear Nose and Throat at Cedars-Sinai Medical Center in Beverly Hills, CA. He specializes in performers with voice disorders and has treated many top professional singers. His voice examination of Limp Bizkit’s Fred Durst was featured on MTV News.


MBADC: What are some common problems singers come to you with?

DA: Vocal strain is a very common one…If they do too much singing or they do too many shows in a row, the voice tends to give out. Another common thing that we see is acute laryngitis, where they’ll have an infection and their voice will go out fairly quickly. Another common thing that we see is just plain old poor vocal technique. You see it in a lot of the younger rock and rollers who have a lot of natural talent and they’re afraid to take lessons and training because they think it’s going to change the good quality of their voices. But it’s very, very clear–especially when you see some of the older rock and rollers that have been around for a while–that with some vocal training to learn how to support your voice better, without changing any of the natural characteristics of it, you can actually have much more power in your voice, it can last a lot longer, you don’t have to push quite as hard to get the same kind of energy out of it.

Other maladies that you see too, are cocaine laryngitis in some of our rock and rollers, you also see a lot of smoke-related injuries—cigarettes are of course injurious to the vocal cords. You also still see people who will smoke pot through a pipe, and you can actually have some burning of the [vocal] cords from that.

MBADC: You said one of the problems is when they have too many shows in a row. What would be the ideal number of shows in a row, and what is the absolute maximum that an artist should have?

DA: There’s no one answer to that. It depends entirely on what kind of singing they’re doing.

MBADC: OK, let’s say for example, rock.

DA: There’s a lot of individual characteristics to it. For example, there are some people who can basically almost scream night after night, and still have a good quality to their voice. But that tends not to be the usual case. The usual case is somebody who has a lot of power to their usual voice, and if they do it seven to eight shows a week for more than an hour or so, they’re going to start to have some periods of vocal strain. A lot of it depends on what they’re doing between their sessions, too. There’s an old saying, “if you’re a performer, only use your voice when you’re getting paid for it.” So for example, a lot of my performers–especially the high-end ones–when they’re on tour, we’ll coach them on how to keep their voices ready for the show and how they’ll have to cancel some of their TV and radio appearances when they’re going to different towns, just so they’ll have enough voice left for the show itself…I was on MTV with Fred Durst, who is the singer for a band called Limp Bizkit. And he came to the office, and they videotaped the entire session with him in my office–that’s why I can talk about it–and he was having some problems on the road…We coached him on how to cut back on some of the non-essential voice use periods that he had.

So, that’s a long answer to your short question. In terms of how much is too much, it basically it depends on the individual. Certainly if they’re singing for a couple hours every night, that’s way too much. It [also] depends on how much energy they’re putting into their rehearsal sessions and things like that…But certainly if they’re two hours, five times a week, with full power, that would be about the max that anyone should really be able to do.

One of the biggest things you can really encourage [singers] to do is basically if they’re having problems, don’t try to sing over it. Number two, never ever be afraid of going to see a vocal coach if their doctor says everything’s fine that it’s just a technique problem. Even some of the world’s most famous rock and roll singers tend to have coaches, and they are helped tremendously…If that coach tries to change their style of singing, they will run, because they’ve made platinum records and made millions of dollars with their voice, so you would never want to change it. But you can keep that exact same quality, so going to a vocal coach will keep you out of trouble in the long run.

And the other thing they should do too, is if they have a manager who is pushing them so they don’t ever rest and cancel a show, or they make them perform when they’re sick and things like that, they should probably run from them, too, because most good managers right now are in it for the long [run]. They’re not like in the old days, where they’d just grind someone for six months or a year, give them a vocal cord rip or tear or some other very serious problem that could end a career, and then just go onto the next new talent. I know one of the owners of The Firm pretty well, and they have a lot of high-end artists. And he is so cautious about his performers–of how he handles them and treats them–and he gets them medical care at the slightest little bit of a problem. Most managers should basically model after that.

MBADC: Is it true that continual vocal abuse can lead to cancer of the vocal cords or other areas of the throat? We read this on a singer’s website.

DA: No. You cannot get cancer from vocal over-use.


MBADC: What are some symptoms that should send a singer to the doctor?

DA: Basically, if there’s two or three nights in a row where they can’t get their voice back, or if all of a sudden they’re completely, completely without a voice, which we call aphonic. If they’re completely aphonic, then that’s something that should bring them to the doctor. Because there are a few things that can be really disastrous, and they are: bleeding into the vocal chords, or an actual rip or tear of the vocal cords, and they will be presented with a complete loss of the voice. And the just other things that basically are chronic recurrent problems…Sometimes there’s a small little cyst or something on the vocal cord that intermittently will fill up with fluid, that can very easily be treated either medically or surgically and eliminate a lot of their problems.

MBADC: Are the treatments for vocal fatigue, soreness or pain in the throat, and hoarseness essentially the same? Or how do they differ?

DA: They’re all completely different. [For example,] a vocal nodule is like a little callous on a vocal cord from chronic vocal over use, and that is usually treated by vocal rest. Getting to vocal rest, no performer should really have complete, complete silence. What they should do is after having problems, they should minimize their singing and their speaking as much as they can. But it’s OK to do some singing drills and things that are easy every day… [Because] if they have complete vocal rest for a week or so, when they come back it’s actually going to be harder to do. But that’s the vocal nodule.


DA: A really common thing that actually ties into vocal nodules and is really common in performers–and something that all performers should keep in mind–is what’s called reflux laryngitis. And what that means, is that acid from someone’s stomach can come up and actually burn the vocal cords. There are many, many people–and I see it really commonly among performers–that actually have acid coming up, and instead of getting heartburn like the average person gets, they don’t feel it at all. So they let the acid come up all the way up and burn the vocal cords, and so they start getting symptoms such as throat clearing, sometimes they get excess phlegm in their throat, and it can also lead to vocal fatigue. And it’s a thing that’s very common among performers, especially rock and rollers, because one of the main things that will cause acid reflux–especially the silent type that can burn the vocal cords–is eating dinner late at night. It’s extremely common, because performers quite often will have big meals late at night and then they’ll go to bed. And that’s probably one of the worst things that they can possibly do.

MBADC: So how long before a performance would you recommend that they eat, since they don’t like to sing on a full stomach?

It’s a difficult thing to do, but two and a half hours before a performance. Then right after a performance nothing at all, or something extremely small.

MBADC: Would you say that most vocal cord damage is reversible, or is a little bit of it permanent?

DA: Almost all of it is reversible. You do see some irreversible vocal strain and tears. One of the things that can be irreversible is scarring that you can get from a hemorrhage or from a tear or a rip in the vocal cords. But most things that you see in the vocal cords are going to be repairable.


MBADC: Some singers who have voice problems on the road get steroid shots to get them through the tour. Are those given in the neck, and what do they do, in laymen’s terms?

DA: Steroid shots are typically given in the butt, because it’s the biggest muscle in the body. What steroids do is, they basically take away the swelling. Steroids can be very, very helpful if they’re used in the right way, and they can be very, very harmful if they’re used in the wrong way. A classic person to use a steroid shot would be someone who has an acute viral laryngitis, where they have swelling of their vocal chords and they have hoarseness, and they’re exceptionally well-trained, like an opera singer. Obviously that’s not your audience, but that would be the perfect person for it. The worst person for it is somebody who’s in the middle of a two-year tour where they‘re singing eight shows a week, and they basically have screaming technique. And you take them in and they have redness and swelling of their vocal cords, and the shot will help them for a few days, and then all of a sudden they’ll wind up being even worse off than they were before.

The steroid shots will take away swelling, but they will not erase the underlying pathology–the underlying problem. So if somebody has some vocal over-use, and then they take a steroid shot, and their voice sounds a little better for a couple days, then all of a sudden they’re banging their vocal cords together and they’re already injured, the steroid’s only masking [the problem].

So if they have an acute problem, like a really bad allergy attack, if they have just one really big show coming up, like a huge audition or if they have a gig in front of some record company executives that they really want to sound good for and all of a sudden they’ve got some problems, that’s the perfect time for steroids–as long as they’re going to have a couple days’ of rest afterwards. But in the middle of a long tour, where some of these performers have to go site to site to be able to get their steroid shot to sing, is really not what you want to do.

MBADC: So how long could a singer safely do the steroid shots?

DA: Everybody would be different, and many times people can get away with it, but when you do it often, then you have a bleed in the vocal cords because you’re already singing on already injured vocal cords, and it will cause permanent damage to your vocal cords. And that’s what you’re risking, and that’s what you don’t want to have happen…There’s not any clear answer to how many times you can do that. But basically whoever’s giving that shot needs to get into the head of that singer. They need to change something fundamentally if the only way they can get out there to sing is with steroid shots.


MBADC: What are the long-term effects of steroid shots?

DA: Number one, they will allow a performer to permanently injure their vocal cords, because they will mask some underlying problem. Number two, they can cause you to lose a hip. They can cause thinning of tissues of vocal cords and things like that, they can cause dimples in your butt where the shot was given—that’s very rare but I’ve seen that. They can make you really moody. They can make you acutely depressed–if you’re a little bit depressed to begin with and you get a steroid shot, they can make you acutely very depressed.

MBADC: Can that depression be long-term after the shots have stopped?

DA: No.

MBADC: So it’s only while it’s in your body.

DA: Yes, exactly.


MBADC: What is Bogart-Bacall syndrome?

DA: What it is basically—You see it more commonly with women, very commonly with career women, not even singers–where women want to have a lower, sexier voice, so what they do is, they’re basically just putting their voice in a lower register than what it’s really designed for. And basically they’re either singing or speaking with their voice in the wrong pitch. And that’s what a lot of vocal coaches will actually do, is they will be able to pick up for somebody that they’re actually singing in the wrong pitch and then keep that from happening. For example if you’re soprano and you’re singing alto very low, you can actually damage your vocal cords; you develop muscle strain that will completely corrupt your vocal range. The key thing to do is to find out what your vocal range is, and stick to it, and there are other things you can do style-wise or technique-wise to basically embellish the voice and make it sound better. For example, if the normal person sings middle C, it sounds very, very thin and strained. If someone puts some power behind it and sings middle C, it sounds about two octaves lower, because you’re putting so much power into it. So you can actually make your voice sound lower and richer without having to actually force it down to a lower frequency, which can be very injurious.


MBADC: Are male or female singers more prone to vocal cord problems?

DA: They’re roughly about the same. Females try to push to the higher registers so you see a little bit more vocal strain, but they’re really basically about the same. The only thing that women have is, since they menstruate, when they’re premenstrual they can actually have some swelling of the vocal cords. You can get some damage there, and they also tend to have a little higher chance of being hyperthyroid and of losing some of their thyroid hormones, and that can make them have a little more tendency toward damage. But overall, they’re gong to be about the same.

MBADC: I was also reading that birth control pills can affect the vocal cords. Can you explain that for us?

DA: Any performer has to be very careful what kind of birth control pills they’re getting. Some of them, especially ones from overseas–I think there’s one in the United States, but most of them are from overseas–If [the birth control pills] have any androgen or male hormones in them, can lead to a permanent lowering of the voice.


MBADC: We always hear about the importance of warming up, but what about after a show? Is there anything a singer should do post-show?

Yes. Not have a big meal, and number two is, be aware that after the show they’re on sort of a high, and that’s a good time for some unnecessary vocal use…So basically just be aware that they shouldn’t go out to an after-show party if they’re screaming and shouting and things like that, but warm the entire brain, voice and body down after the show.


MBADC: What should the singer do to protect the voice if they’re going to be out on the road for say, a year-long or fifteen month tour?

DA: Number one, be careful about how they eat, about not eating too late and having very good eating habits. Number two, generally try to stay in as good shape as they possibly can. Exercise is important. The idea of having a fat singer being a good singer is not true. Number three is just vocal conservatism. A great thing for young singers to have in mind is, if they had Jimi Hendrix’s original guitar in their hands and it was in pristine condition, you wouldn’t take it to a bar and blow smoke on it, and then spill beer all over it. And if their voice is there–especially if they’re talented—it’s worth far more than Jimi Hendrix’s or Eric Clapton’s original guitar, and they should treat it basically the same. If they decide to make music their career, they should treat their voice as if it’s a priceless instrument…If they have that in mind at all times, it makes it very easy when they’re on tour to take care of their voice.

One thing that singers always care about is what kind of lozenges they can take…A good lozenge for singers is something called Black Currant Pastilles, which are basically glycerin-containing lozenges, and the glycerin helps to keep moisture within the throat, which is what [singers] need. They should avoid mint and menthol—there are several reasons why, but they’re inherently drying. Even though they may feel good initially, they’re actually going to be more hurtful in the long run.

MBADC: Air conditioning—good or bad for the voice?

DA: Basically generally bad. Air conditioning tends to be very drying. Same thing on planes, it tends to be very drying. So the things you should do with air conditioning are: number one, never try to talk over it if it’s noisy, and number two, just make sure you’re drinking lots of water the entire time. That segues right into planes, where the problem you have on planes is, the ambient noise is very high, and it’s very, very dry. So what you should do if you’re travelling a lot on a plane is basically shut up on the plane and drink lots of water. Just put your stereo headphones on and zone out.

MBADC: What about Throat Coat Tea?

DA: It’s great. It has glycerin in it.

MBADC: What about ice cold beverages?

DA: Ice cold beverages are fine, as long as you’re not using them around the time that you’re singing. What you need to have around the time that you’re singing is basically plain old room-temperature water, not too hot, and not too cold.


MBADC: How should a singer who has pollen allergies take care of his or her voice?

DA: Basically, don’t use anything over the counter, because most over the counter medicines are extremely drying, and they should work with their doctors with regard to that. There are some very good medicines that are available, either nasal sprays or non-drying antihistamines, that can be very helpful. But most antihistamines over the counter are extremely drying, and that’s the worst thing you can do for the voice… One of the most important things any performer can do, whether they have allergies or not, is to drink 8-10 glasses of water a day and always, always, always keep their vocal cords very well hydrated. Especially if they have allergies and take medicines for that, it’s very important that they keep their larynx as well-hydrated as possible.

MBADC: What about singers with asthma. Is there anything special they should do?

DA: Yes, work with their doctor about getting off any kind of steroid-containing inhalers, because steroid inhalers actually thin the vocal cords. If they need to be on a steroid-containing inhaler, then have something called a spacer, which is a little thing that fits on the end of it that helps you to help you get [the medication] down to the lungs and not the vocal cords. If you are a singer, let the asthma doctor know about that–say ‘it’s very important that you don’t put me on an inhaler or I’m really going to be in trouble.’ Because there are so many other alternatives nowadays.


MBADC: What about caffeine? What does that do?

DA: There’s caffeine and there’s coffee…I’ll get into coffee in a second, but caffeine will basically increase the amount of acid you have in your stomach, and actually help to create more acid reflux. And especially if you’re like most performers and you don’t feel it, it’s going to be hurtful to your vocal cords. In addition, caffeine can be drying, because it’s a mild diuretic, and that can be drying to the vocal cords. And as far as coffee is concerned, coffee has lots of natural oils in it that are very acidic and can also cause a lot of problems with acid reflux, too.

MBADC: So even decaf is a no-no then.

DA: A definite no-no.

MBADC: Do you find that there’s any advantage to bottled water over tap?

DA: No. Unless you’re in Mexico.

MBADC: What about lemon? What does that do?

DA: Lemon or grapefruit juice is very acidic, so it can actually increase acid reflux. But a tiny bit of lemon in some warm water and a little bit of honey is a great little elixir to help soothe the vocal cords.

MBADC: What about dairy?

DA: Dairy is generally believed to increase mucus within the throat, but it doesn’t happen with everybody. A lot of people have very, very mild milk allergies that will increase the amount of phlegm they have in the throat. But each performer can try it; if they take it and there’s no problem, there’s not going to be an issue. If they drink milk and they feel a little more mucus in their throat when they’re done, then obviously they should avoid it.

MBADC: What about nuts?

DA: Same thing, very mild nut allergies, and if they have a lot of oils in them, that can increase acid reflux too. Overall, especially if someone’s a vegetarian, having nuts in their diet is a very reasonable thing to do.


MBADC: What about smoke?

DA: It’s always injurious. You definitely have to work with your manager and your set designer. Any kind of smoke is going to be hurtful. Especially cigarette smoking is going to be bad, because it has a direct effect on the nose and the vocal cords, it leads to a lot of coughing, phlegm, and things like that, [and] it can lead to getting colds easier.

Stage smoke, especially the oil-based kind, can also be extremely hurtful to the larynx. It can actually cause some permanent damages to the lungs, the nose, and to the voice box. If you’re going to be having smoke onstage, you have to basically think about yourself first. Be very, very concerned about your throat…And don’t let someone, for the sake of making the show look hip, screw around with your vocal cords. For example, [one of my performers] had some smoke sprays that were basically in the center of the stage, and he was having to walk through them. So it was a very simple matter–and of course it lowered the cost too. He just had them redesign everything so he didn’t have to walk through them…That’s what had actually hurt his vocal cords, and he’d started to have lots of problems with it.


MBADC: Alcohol?

DA: In moderation it’s OK. Alcohol is very drying, it tends to help to increase acid reflux, and the third thing is, especially while onstage it can inhibit the sense of perception… Most performers who have performed while intoxicated and then they become sober, are almost embarrassed by the fact that they used to think they were more creative and performed better while they were intoxicated onstage. And every single one of them–and these are great performers—said that they do much, much better when they do not have anything like alcohol inhibiting them onstage.

MBADC: Ibuprofen? [Examples: Advil, Motrin]

DA: Ibuprofen can lead to bleeding…If you’re a hard rock and roller, and eventually using either aspirin or Motrin or Ibuprofen, it can lead to thinning of the blood, and you can actually bleed very easily. So if you’re pushing through that, you’re headed for trouble. Occasionally it’s OK, but the classic example is someone who’s had a cold, a little hoarse, and they take some Advil, then they go out and push really hard, ultimately they get a hemorrhage on their vocal cord, and then they’re shut down for two months, maybe even permanently changing their voice.

MBADC: What is “occasionally” to a doctor?

DA: About once a month.

MBADC: What about cocaine?

DA: Cocaine, especially if you’re freebasing, can actually burn the cords. I remember getting called down to a set where they were doing a rock video and all four members of the band all had horrible cocaine laryngitis, and eventually they just had to shut the whole thing down. They had about 2000 people down there filming the thing, and they just shut the whole thing down. Snorting coke once in a while is not going to hurt the vocal cords, but once you’re addicted to it actually has a lot of effects on the nasal membranes, something called encrusting, sinus problems, colds, and can actually have a direct effect on the vocal cords. And so, one time partying is unlikely to be hurtful to the vocal cords. But any type of long-term use is going to be bad.

MBADC: What about ecstasy?

DA: It’s not going to be directly injurious to the vocal cords. It’s just that people will not be paying attention to their vocal cords while they’re on ecstasy or any other drugs, and can actually have problems arise from that.

MBADC: Speed–what does that do?

DA: Nothing directly injurious about the vocal cords. Obviously when you’re on speed you’re not going to be able to manage your vocal cord use very well. There’s nothing better than natural adrenaline that you get by going onstage. You don’t need to add speed while you’re performing onstage to perform better. You’re just going to make a fool of yourself and no one’s going to want you after that.


MBADC: Heroin—what does that do to the vocal cords?

DA: It depends on how they’re taking it. If they’re smoking opiates, then of course you worry about burning the vocal cords. If you’re injecting it has all the usual effects where, number one, it’s going to ruin your performance. Number two is, you’re going to wind up with some type of infection that’s going to wind up in your heart, and it’s going to be life threatening. I’ve seen so many 23 year-olds having open heart surgery because they had infected heart valves and things like that…

So someone injects, OK? They think it’s clean but it only takes a small amount of bacteria, it gets in their bloodstream and, gets in the heart valve. So then they have a little thing there, they get treated with antibiotics in the hospital for about six weeks. Then they come back and make an incision in the middle of your chest. They get a saw, and they cut your breastbone in half. Then they get this big–kind of like a retractor, kind of like a crank thing that you just crank around with a little handle, and you hear all the ribs splitting open and crack, and that’s how they get to the heart. And then they have to cut the heart valve out and put a new valve in. And all you have to do is just see one of those operations, and it’ll make anybody quit right away.


DA: All that from a little high, huh?


MBADC: It always amazes me that sometimes the one thing that will make an addict quit, no matter what else is happening around them, is, you tell them they’re damaging their vocal cords, and they’re like “Oh my God, get me to rehab quick.”

DA: You actually have a different audience nowadays, of course drug use in rock and roll is still rampant as you know, but the people who are really good are much more serious. I’ve been at this now since 1989, and I wish I could say theses guys’ names so you’d know who they all are, but I can’t. But some of the older guys, back then, they rarely would take care of their vocal cords; they weren’t serious about it. And the guys that are still around were just basically plain old lucky because they just happen to have cords that are a little bit tougher than others–and there’s no way of predicting that or training that. But nowadays, these guys are like talented business people. They understand what’s going on, they know how to get from Point A to Point B. They still have problems with addiction and things like that, but it’s so easy to work with them and get them off of it and send them to therapists, because they really, basically just want to perform. And it’s far easier to work with them today. And I think if you made a really strong pitch as to some of the things that can happen with the vocal cords in your career as a rock and roller on some of these drugs, then you’ll help a lot of people. They’ll listen more than they would a few years ago.


MBADC: Can a singer safely expand their range, or is your voice what it is?

DA: You can definitely–with training—very, very safely expand the range. Very safely. An octave even.

MBADC: What about doing things like surgically widening your nasal passages to improve your resonance?

DA: Surgical modifications of the resonating chambers really doesn’t work that well. It may or may not be helpful. A surgeon can make you have more room in your nose, they can make you have more room in the back part of your throat, but whether or not that’s going to correlate to an improved resonance is entirely up to the performer. And a classic example is somebody who has a really, really bad deviated septum, so they have a really bad nasal twang when they talk or sing. So, you go ahead and do the septal operation, or the surgery to make the breathing through their nose better, and all of a sudden they still sound the exact same way…They have to go through training—a lot of training, actually, and it’s pretty hard—to be able to get around that and to be able to get the air to come up through the nasal passages in a way that will make their voice improve. So if someone has a problem with resonance and thinks they’re going to go in and get their nose fixed and all of a sudden they’re going to be great, don’t count on it, unless they plan on really working hard afterward.


Dr. Hopp is a Laryngologist at Cedars-Sinai Medical Center in Beverly Hills, CA, and is a participant at Voice Center at Cedars-Sinai. He is a past Assistant Professor at Stanford University, has lectured extensively, and has given courses to other laryngologists in voice care. He’s treated many top professional singers.


MBADC: What are some of the problems singers come to you with?

MH: The most common problem is recurrent hoarseness and pain in the throat.

MBADC: What are nodules, exactly?

MH: Nodules are calluses on your vocal cords, from your vocal cords hitting each other in an abnormal pattern continuously.

MBADC: Are they reversible without surgery?

MH: Yes. Not all the time. But in the initial stages, absolutely.

MBADC: What about someone who has been out on tour, and they’ve done damage? Is damage usually reversible, or…?

MH: Well, it really depends on what they’ve done. Most of the things you can do are reversible.


MBADC: What are some symptoms that should send a singer to a doctor?

MH: Pain in your throat that doesn’t go away…

MBADC: After about how long?

MH: A week…Most people get a cold, a sore throat, a little hoarseness, usual viral problems should resolve in a week to ten days. Anything that goes on after two weeks needs to be evaluated. Any hoarseness that’s not associated with a cold or other reasonable sources of hoarseness, that would be excessive vocal use–You sang out of your range. You sang in a smoky club.


MBADC: Other than overuse of the voice, how does travel affect the vocal cords?

MH: There are a couple of really key factors: First is humidity and moisture. Water is the lifeblood of the vocal cords. Dryness is the enemy. Dryness makes your vocal cords tight, and makes you strain. And when you strain, you push your vocal cord muscles abnormally, and you make them worse. So keeping them moist is the most important thing, and the best way to keep them moist is with water: Drinking water continuously, being hydrated, having a vaporizer at nighttime, having a vaporizer before and after your performances…

An easy way for most singers to follow what they’re doing is to watch the color of their urine. If the urine is yellow, then they’re dehydrated. And you take into account a lot of people take vitamins, and that automatically turns the urine yellow. So, other than the normal drug-induced color of the urine, you should look for clear urine. If you’ve always got colored urine, you’re dehydrated. And this is particularly effective for people on the road, because travelling makes you dehydrated. You’ve got to drink water. The general advice when you travel is a glass of water an hour when you’re on the airplane.

And when you get off the airplane, go right to the hotel and take a steam shower before you perform. The best thing to do is not to perform the same day you land. But either way, whenever you get off the plane, you go right to the hotel, steam shower 20 minutes, and do mid-range scale in the shower to warm up. Mid-range. And then you’re ready to go.


MBADC: You mention water, but can you explain what a warm beverage does versus an ice cold one? Or do you feel it matters?

MH: Cold actually makes people a little dryer, with the reaction to the cold. Lukewarm is best.

MBADC: What about the throat-coating type teas?

MH: It’s worthless. The only thing that’s of any value that we’ve found is glycerine-based throat lozenges. Black Currant Pastilles are the most common one. There used to be a Luden’s that was glycerine-based also, but that’s hard to find now. The ones that are menthol, menthol is the enemy, it just dries you out. You need water, moisture, and the best thing to use is a glycerine-based lozenge in your mouth when you’re going between air-conditioned and dry environments. Have one continuously bathing your throat and keep it in constantly.

MBADC: What about lemon? Is that an old wives’ tale, or does that do anything?

MH: It’s OK.

MBADC: Generally speaking, would you say that air conditioning is good or bad for the voice?

MH: Air conditioning is fine, as long as it doesn’t dry you out too much and you don’t go continually between dry and hot. It’s the problem between going between air-conditioned and non-air-conditioned spaces that’s the problem. That’s the drying effect.


MH: The second most important thing about travelling, the first one being dryness, is your monitors. Lousy monitors are the number two cause of vocal problems on the road. You spend too much time tuning them [and] doing voice checks before the show, they’re not tuned well, and you don’t get enough feedback when you’re singing–and you strain yourself inappropriately. Number one [cause of vocal problems on the road] is dehydration, number two is monitors, number three is smoky clubs.

MBADC: Do you feel in-ear monitor systems are helping?

MH: Yes. Besides [inadequate] care of your voice, the number two problem is bad monitors. Over and over and over I see it. The singer’s straining because they don’t know where their voice is.

It’s almost a joke, because I don’t even have to look at people’s problems if I talk to them long enough. You find out what their monitor system is, and they go into a groan about how many monitor problems they’ve had, and it’s almost a slam-dunk in figuring out what their problem is. And it’s a slam-dunk in fixing it.

MBADC: We always hear rest, rest, rest and sleep, sleep, sleep. Does that actually physically have any effect on the vocal cords other than the fact that your body would be more rested?

MH: Well, you know, actually your body being more rested is a very important point. You cannot isolate your vocal cords as one part of your body and have the rest of your body be in bad shape…This may sound holistic, but your whole body has to be in balance. If you are straining because you have a neckache or a backache, you’re going to be straining on your vocal cords; that puts abnormal pressure on your vocal cords–and not symmetrical. Non-symmetrical pressure on your vocal cords results in straining. Straining results in hemorrhages, nodules, and vocal problems.


MH: A couple of the problems that have come up more recently in later medicine, that have shown up lately, are the problems of reflux–Acid coming up from food on singers at nighttime. They sing late, they go out to dinner, and they go to bed about a half an hour later, and they get a lot of acid reflux at nighttime and then during the daytime. And this has created very irritated vocal cords, more prone to hemorrhages, more prone to bleeding and strain. One of the things we have to educate people on is their eating habits.

MBADC: Yes. Although I will say, the riders are starting to look a lot better than they did about ten years ago. A lot less junk food, and a lot more chicken.

[Both laughing.]

MH: That is absolutely true. But the problem is, they eat it at midnight and then go to bed at 12:30. Or they finish their set at 12:00, and they go out to eat and it’s 1:00 and then bed at 1:30. And [acid] is just coming up and then irritating them all day, and all night.

MBADC: Physically speaking, as far as your vocal cords go, does it matter if you sing on a full or an empty stomach? I mean, nobody likes to sing on a full stomach, but would it matter physically?

MH: It matters if you have reflux. If you’re burping up acid or if you’re burping up food while you’re [singing], then you’re going to be in trouble. A lot of people have problems with abdominal muscles while they’re eating–That’s why a lot of people like to eat after they perform. Because you need to be in good physical condition and have all your body parts working to produce a good sound that’s continuous.

MBDAC: Do you think there’s an optimum number of hours before a performance to eat?

MH: Before a performance, two hours. Two to three hours.


MBADC: Obviously warming up is important, but is there anything a singer should do post-show?

MH: Post-show, a vaporizer is the best thing to do. Voice rest and a vaporizer for an hour. The best thing people can have on the road is, they can buy these small things called Pocket Saunas, which is actually not a sauna, it’s a small vaporizer. Steam yourself when you’re waiting in your dressing room for 15 or 20 minutes after a set, or between sets, and that rehumidifies your vocal cords and rests them. So humidify and voice rest immediately after a set for an hour is very helpful. Not talking. The old adage, “when you’re on the road don’t use your voice unless they’re paying you to do it” bodes well if you’re having problems. That’s what voice rest is all about. And warm up, in the shower, mid-range scale. Because if you have stem going on your vocal cords, you’re not going to strain them, just do them mid-range.

MBADC: No wonder everyone sounds so good in the shower, right?

MH: Hey, it’s fun, you’ve got good feedback, you don’t need monitors…And you won’t strain yourself, because you’ve got steam bathing your cords at the same time.


MBADC: I would guess that decongestants would be bad for the voice?

MH: Absolutely. They dry you out, and dryness is the enemy.

MBADC: What about caffeine? Is that a drying thing?

MH: Yes.

MBADC: I would assume alcohol is as well then?

MH: The worst. Not only is it drying, it’s a diuretic, so it makes you urinate, so you lose fluids.

MBADC: Can you explain what cocaine does to the vocal cords?

MH: The biggest risk you have using cocaine is that it numbs your vocal cords, so that you have the illusion that you’re singing well. But in fact you’re abusing your vocal cords. And the result is very traumatically abused vocal cords.

MBADC: Ecstasy, heroin, and speed would have the same effect?

MH: All this gives you a false sense of comfort when you have vocal abuse. The normal pain and discomfort from vocal abuse is a feedback mechanism to tell you that you’re singing wrong or you’re singing too much. If you’re singing wrong, you need to get speech and voice technique lessons. What many drugs do, like cocaine and other things, is that they give you a false sense of security that you’re singing OK, when in fact you’re abusing your vocal cords–and it results in vocal cord hemorrhages and nodules.


MBADC: Do you think singers can safely expand their range, or do you think it is what it is?

MH: With vocal training, you can absolutely expand your range. It’s because people usually have more potential–more talent–than they realize, but they don’t know how to extract it out of their vocal cords with proper technique. That’s why it’s so important to have good singing technique. Because with good singing techniques, you can produce any sound that you want, safely. You can sound gravelly, you can sound like you’re screaming, and you should be able to do it safely without hurting or damaging your vocal cords and be able to do it on a consistent basis–all with proper technique. There isn’t a single sound that’s made out of vocal cords that you can’t make properly. And no one should be harming their cords on purpose in order to get a certain sound. Through training, you can always produce the type of sound that you want.

MBADC: I heard about someone who actually surgically widened their nasal passages to get better resonance in their voice. What’s your opinion on this?

MH: The problem with surgery to increase your resonance is that you don’t know what the outcome is going to be like. It’s dangerous to do. You don’t know how this resonating structure is going to result. And the same thing for having surgery when you already sing well. You [should try to] have no throat surgery after you already have a good voice. You have to be very careful and be concerned about the outcome, because it’s not necessarily completely predictable. A small change in your resonating structures may have a fine effect on your voice that you may or may not appreciate. Most of the time it’s the singer himself who notices the change and other people don’t. But that can be a problem.

MBADC: What about a singer who gets a nose job for cosmetic reasons? I would imagine that would affect things.

MH: It can affect their sound, and they have to be careful about it.


MH: Singing in general requires a consistent voice that’s there all the time. There are a lot of singers that have a lousy voice, but it’s there all the time and they’re able to make money. People that have great voices but are inconsistent can’t have a good career. It’s the really great ones that have a great voice and they’re consistent–it’s there whenever they need it—who are able to be very successful. That is the difference between success and not: having something that’s consistent. Even people with lousy voices, if it’s consistent, they’ll work all the time. The trick to maintaining a lifestyle in singing is to learn how to care and feed the professional voice—how to take care of those vocal cords, how to take care of your singing voice so it’s consistent…The most important thing that singers need to realize is that care of their vocal cords continuously will provide long-standing professional voice success [in their] careers.


MBADC: What are some symptoms that should send a singer to a doctor?

MH: Pain in your throat that doesn’t go away…

MBADC: After about how long?

MH: A week…Most people get a cold, a sore throat, a little hoarseness, usual viral problems should resolve in a week to ten days. Anything that goes on after two weeks needs to be evaluated. Any hoarseness that’s not associated with a cold or other reasonable sources of hoarseness, that would be excessive vocal use–You sang out of your range. You sang in a smoky club.


MBADC: Other than overuse of the voice, how does travel affect the vocal cords?

MH: There are a couple of really key factors: First is humidity and moisture. Water is the lifeblood of the vocal cords. Dryness is the enemy. Dryness makes your vocal cords tight, and makes you strain. And when you strain, you push your vocal cord muscles abnormally, and you make them worse. So keeping them moist is the most important thing, and the best way to keep them moist is with water: Drinking water continuously, being hydrated, having a vaporizer at nighttime, having a vaporizer before and after your performances…

An easy way for most singers to follow what they’re doing is to watch the color of their urine. If the urine is yellow, then they’re dehydrated. And you take into account a lot of people take vitamins, and that automatically turns the urine yellow. So, other than the normal drug-induced color of the urine, you should look for clear urine. If you’ve always got colored urine, you’re dehydrated. And this is particularly effective for people on the road, because travelling makes you dehydrated. You’ve got to drink water. The general advice when you travel is a glass of water an hour when you’re on the airplane.

And when you get off the airplane, go right to the hotel and take a steam shower before you perform. The best thing to do is not to perform the same day you land. But either way, whenever you get off the plane, you go right to the hotel, steam shower 20 minutes, and do mid-range scale in the shower to warm up. Mid-range. And then you’re ready to go.

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