Swelling Checks to Detect Vibratory (Overuse) Injury to the Surface Tissue (Mucosa) of the Vocal Cords

Robert W. Bastian, M.D. — Published: September 23, 2016

Definition

Vocal tasks (swelling checks) that detect acute or chronic vocal fold mucosal injury reliably; Secondarily, they can also detect gaps between otherwise normal folds.

Purpose /rationale

To provide persons with a way to detect mucosal trouble for themselves. We are in effect “taking all of the clothes off the mucosa.”

Who they are for

Anyone who uses the voice extensively or vigorously—particularly vocal overdoers.*

What they are not for

Voice training or performance.

When they should be done

When first learning the tasks, they should be done often until the concept of one’s mucosal ceiling is understood (see below). Once both proficiency and ceiling are established, the tests require 20 seconds or less both morning and evening.

TEST I: “HAPPY BIRTHDAY”

  1. In your upper voice range, sing the first phrase of “Happy Birthday” as softly as you can, using a “boy soprano pianissimo.” Resist the temptation to “make it work” by getting louder!
  2. Repeat the phrase at progressively higher pitches.
  3. Verify carefully the pitch at which you falter (onset delays or air escape) or can’t go higher without getting louder. THIS IS YOUR MUCOSAL CEILING PITCH, FOR THIS TASK.
  4. If your mucosa is normal, the “soft voice” and “loud voice” ceilings should be about the same.
  5. If your mucosa is abnormal, the “loud” ceiling should be higher than the “soft.”

TEST II: STACCATO

  1. Sing again “boy soprano pianissimo” using the descending staccato figure so so so so so fa mi re do (5-5-5-5-5-4-3-2-1; e.g. G-G-G-G-G-F-E-D-C) Attack each note precisely in the middle of the continuum between an aspirated ho and a coupe de glotte. In other words, lightly, precisely, and with a little bounce.
  2. As for “Happy Birthday,” repeat at progressively higher pitches.
  3. Again carefully verify the pitch at which you experience onset delays or air escape or can’t go higher without getting louder. THIS IS YOUR MUCOSAL CEILING PITCH, FOR THIS TASK.

Common Questions about Swelling Checks

My mucosal ceiling is higher when I do the staccato exercise than it is when I do “Happy Birthday.” What does that mean?

Though needing verification via careful laryngeal examination, this phenomenon suggests that a small gap between the folds, rather than swelling, is the problem.

Again needing verification, this phenomenon suggests a mucosal disturbance rather than a gap as the explanation.

This can be answered best at the outset by individuals who can compare your performance with that of hundreds of others to whom they have applied these tests (e.g. laryngologist, speech pathologist, voice teacher).

It is also helpful at the beginning to correlate your mucosal ceiling with high quality visualization of the vocal folds.

The swelling tests are nevertheless just as valuable! Here’s how: Suppose an individual’s initial mucosal ceiling is abnormal because of small vocal nodules, but the person is happy with the voice’s capabilities. Here, the swelling tests can be monitored to help the individual prevent additional mucosal injury, by not allowing the ceiling to descend any further. A different person whose initial ceiling is abnormal might be unhappy with perceived limitations due to mucosal injury.

Now, ongoing use of the swelling tests can confirm the benefits of medical, behavioral (voice therapy) or, eventually, surgical treatments, because the ceiling will rise with successful treatment. Furthermore, these tests can help to avoid recurrent injury.

First, consider recent voice use for the possibility that it was “too much.” If so, and/or if the ceiling remains lowered on subsequent trials of the tests later in the day, “back off” by reducing voice use until the ceiling returns to your usual pitch, whether “normal” as compared to other persons or not.

Women: Some may find that the ceiling lowers routinely during pre-menstrual days, but returns to normal in a few days.

This depends on the severity of the lowering of the ceiling. Generally, however, careful strategy concerning amount and manner of voice use during this time will allow the mucosa to recover while you continue to work or perform.

If for some reason you are under contract and must perform, it becomes a matter of strategy:

  • All the basics of hydration, etc.
  • Rest as possible,
  • Remove the throat-killer song from the gig
  • Overarticulate
  • Make optimal use of amplification.

In short, hobble through, knowing that you are swollen and making every possible choice to allow swelling to resolve. In a pinch such as when reviewers are attending, or it is a critical audition, a brief course of steroids, although we try very hard not to use them except in exceptional circumstances.

First and foremost, is the tendency to adjust how the voice is produced when the voice begins to falter. A singer will, for example, unconsciously get a bit louder or use a slight glottal attack to “make it work,” thereby reducing the sensitivity of the tasks.

Another might be to perform them without a pitch reference at hand, so that the value of comparing with one’s known “ceiling” pitch is lost. A third might be to become a bit too obsessive and easily “spooked” with any ceiling change. And finally, comes the tendency to “lose the habit!”

First and foremost, is the tendency to adjust how the voice is produced when the voice begins to falter. A singer will, for example, unconsciously get a bit louder or use a slight glottal attack to “make it work,” thereby reducing the sensitivity of the tasks.

Another might be to perform them without a pitch reference at hand, so that the value of comparing with one’s known “ceiling” pitch is lost. A third might be to become a bit too obsessive and easily “spooked” with any ceiling change. And finally, comes the tendency to “lose the habit!”

Sure, the key is very soft and light production, not speed of production.

Swelling checks are mostly about assessing the mucosa (surface tissue) of the vocal cords. Injury of the mucosa almost always interferes with the high voice. If the problem is stability or control of low voice, we tend to think in other directions.

The answer is “no.”  To expand: The tasks are not for vocal grooming nor for rehabilitation. Their purpose is solely to detect swelling. Since they are  by design produced with a very tiny, quiet voice, and since it takes well under a minute to accomplish them, vocal cord swelling checks have no potential whatsoever to cause injury.

* Vocal overdoer: Defined as an individual with both of the following:

  1. A high propensity to use the voice. Generally, “sixes and sevens” on a 7-point (maximum) intrinsic talkativeness scale.

  2. A high extrinsic opportunity or invitation to use voice, based on family, social, vocational, and avocational considerations.

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Vocal Cord Swelling Checks: A Simple Way to Detect the Early Signs of Vocal Injury

Vocal cord swelling checks can help prevent a chronic vocal injury. The swelling checks, which are a pair of short, simple vocal exercises, help you to monitor the health of your vocal cord mucosa and detect the presence of any possible swelling, which could be the beginning of a potentially more serious vocal cord injury.

By performing these checks twice a day every day, you can hopefully respond quickly to any warning signs and avoid the need for treatment down the road.

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