Swelling Checks

Swelling checks are vocal tasks that reveal the vocal phenomenology of mucosal disturbances of the vocal cords. These mucosal disturbances may be vocal nodules, vocal polyps, vocal cysts (e.g., epidermoid cysts or mucus retention cysts), or others.

These vocal tasks incorporate high frequency (pitch), very low intensity (loudness), and sometimes rapid onset and offset of the voice. The two swelling checks used almost exclusively at our practice are the first phrase of “Happy Birthday” and a five-note descending staccato.

For both of these vocal tasks, the individual should produce the voice in a tiny “boy soprano pianissimo” kind of production; this tiny dynamic is insisted on because getting even a little louder tends to conceal the problem. Women should focus on the C5-C6 octave (~523 Hz to ~1046 Hz).

Signs of swelling check positivity include onset delay, breathiness that gets worse as one ascends the scale, and loss of expected upper range, as understood by a singing voice-qualified clinician. Note that a small gap between the vocal cords can also cause onset delay and breathiness, but differences in performance between the two can help to indicate whether the problem is swelling or a gap.