Vocal Overdoer Syndrome

Vocal overdoer syndrome is a term coined by Dr. Anat Keidar and Dr. Robert Bastian¹ to designate an individual whose amount and manner of voice use can be considered excessive and to thereby put the person at risk of mucosal injury.

Typically, the vocal overdoer syndrome comprises two parts:

Innate talkativeness
A life circumstance (occupation, performance, family, hobby, social) that permits, invites, or demands much voice use.

Mottled Vocal Cord Mucosa May Hide Glottic Sulci

Vocal cord swelling and mucosa (1 of 4)

This young “dramatic” soprano is also a bona fide vocal overdoer. Her vocal capabilities have been diminishing for over two years. In this medium-range view, note the rounded swelling of the right cord (left of photo), but more significantly as we shall see, the increased vascularity and mottled appearance of the mucosa.

projecting polypoid swelling — Same view under strobe light (2 of 4)

Under strobe light, at open phase of vibration at C#5 (523 Hz), we see a projecting, polypoid swelling of the right vocal cord, but not yet the more difficult problem.

Closed phase (3 of 4)

Closed phase of vibration, at the same pitch of C#5 shows the mismatch of the vocal cord margins. Is this the entire explanation for this patient’s hoarseness? Read on.

Glottic sulcus is visible (4 of 4)

At close range and high magnification, the open mouth of a right-sided glottis sulcus is seen. This side can be operated safely due to the excess, thick mucosa and would be expected to improve the margin match. On the left (right of photo), a sulcus is also seen, but the thinner mucosa makes successful surgery on the left more challenging.

Vocal Underdoer – Overdoer Continuum | Understanding Proper Voice Use

What is the Vocal Under-Doer and Vocal Over-Doer Continuum? Why is it an important concept for everyone interested in the voice (voice teachers, speech pathologists, voice doctors, singers, actors, etc.)? Because it provides critical insights into understanding and responding to potential voice disorders or risk of developing voice disorders.

Dr. Bastian’s 7-point “talkativeness scale” allows individuals to rate and become self-aware of their level of talkativeness and sociability.

“Vocal under-doers” may currently have, or eventually develop conditions such as vocal weakness, vocal inconfidence, and vocal fatigue.

On the other hand, “vocal over-doers” are more at risk than the average person of vocal cord injuries such as nodules and polyps. A “curriculum” is suggested by Dr. Bastian for persons on each end of the under-doer / over-doer continuum.

Nodules and Other Vocal Cord Injuries: How They Occur and Can Be Treated

This video explains how nodules and other vocal cord injuries occur: by excessive vibration of the vocal cords, which happens with vocal overuse.

Having laid that foundational understanding, the video goes on to explore the roles of treatment options like voice therapy and vocal cord microsurgery.