Singing and Performing Voice Services

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Duke Health offers locations throughout the Triangle. Find one near you.

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Specialized Care for Singers at All Levels

Singers, actors, and other vocal performers are at increased risk for developing a vocal injury or vocal disorder, including vocal nodules and muscle tension dysphonia. Your singing voice can also be affected by problems such as vocal cord paralysis and voice tremor, which can result from age, surgery, and certain medical conditions.

We understand that your voice is an essential part of your identity, your creative expression, and your livelihood. Our advanced training and experience ensure we have the knowledge and expertise to return you to the voice that makes you who you are.

Tests

A thorough singing voice evaluation assesses your pitch/vocal range, loudness range, vocal stamina, breath support, resonance, and register transitions. Our singing voice specialists will identify any muscle tension that may be contributing to your voice problem and evaluate your vocal technique relative to your singing style. We also identify strategies to optimize your vocal hygiene and vocal pacing. If needed, we will advocate for your vocal health with directors, producers, tour managers, and other artistic personnel.

Laryngovideostroboscopy

This detailed visual exam helps us evaluate how your vocal cords vibrate while you make sounds. A tiny camera attached to a small tube called an endoscope is inserted through your nose and allows us to see your vocal cords and larynx (voice box). A flashing strobe light simulates slow motion video images of your vocal cords. The exam takes about a minute; your nose may be sprayed with topical anesthetic for your comfort. The exam allows your team to look for lesions, stiffness, paralysis, irregular movements, throat strain, or incomplete closure of the vocal cords. Videostroboscopy is often essential to reach an accurate diagnosis and determine the best treatment for your voice.

Computerized Acoustic Analysis

This non-invasive exam is usually completed at your second clinic visit. It creates a visual display on a computer screen as you speak into a microphone. You and your speech pathologist can see characteristics of your voice, including pitch, loudness, and vocal quality. This test is used to identify abnormalities, including subtle vocal problems that cannot be detected with the unaided ear. It may be repeated during treatment to monitor your progress.

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Treatments

Voice Therapy for Singers

Customized vocal exercises designed to restore your vocal quality, stamina, and range while also helping to heal vocal injuries and protect you against re-injury. Our singing voice specialists teach you to maintain vocal health as well as strategies to return you to your highest level of vocal performance.

Vocal Hygiene

Your singing voice specialist will offer guidance on factors that support the health and function of your voice, such as improving hydration, reducing misuse or overuse of your voice, avoiding throat clearing and coughing, and, in coordination with your laryngologist, managing allergies, asthma, acid reflux, or other medical conditions that can affect your voice.

Vocal Pacing

Finding a balance between voice use and voice rest every day is important if you have a voice problem that worsens with overuse. Vocal pacing means not talking or singing for small intervals during the day to allow your vocal cords to recover from vibration. If your profession makes heavy demands on your voice, it's also important to take longer periods of voice rest outside of work. Without these recovery times, your vocal cords may be injured more quickly and heal more slowly. Vocal pacing is challenging but necessary, and your singing voice specialist will work with you to develop good strategies for vocal pacing while helping you get back to your singing baseline.

Voice Rest

While voice rest is not the first line of treatment for most voice problems, not talking is beneficial in certain situations, such as acute laryngitis, after voice surgery, or in the case of vocal cord hemorrhage. There are times when voice rest is recommended to give the vocal cords a break from vibration so they can heal from injury. Your laryngologist may recommend a week or so of voice rest. During this time you can communicate by writing, sending emails or texts, or using a text-to-speech app on your smartphone.

Microsurgery for Vocal Cord Polyps and Cysts

Surgery may be recommended to remove noncancerous vocal cysts or vocal polyps. While you are under general anesthesia, tiny surgical instruments are inserted through your mouth into your throat. The surgeon makes a very small incision away from the vibrating edge of your vocal cord, and a tiny flap of tissue is lifted so the cyst or polyp can be removed. Also known as phonomicrosurgery, this technique reduces the risk of scarring and offers the best voice outcomes. A course of voice therapy after microsurgery is essential for optimal recovery.

Need Urgent Voice Care Before a Performance?

We'll work with you to arrange a voice evaluation and expert voice care -- quickly, compassionately, and with discretion. Call 919-681-4984.

Why Choose Duke

A Team of Experts
Your team includes laryngologists -- ear, nose, and throat (ENT) physicians who have advanced training in voice disorders. It also includes singing voice specialists -- speech pathologists with additional training in vocal performance and singing voice rehabilitation. Because our singing voice specialists are also professional singers and voice teachers, we bring a performer's perspective to evaluating and improving your singing voice.

Personalized Approach to a Performer's Needs
Our singing voice specialists will determine the role of performing in your vocal injury and provide therapy for the specific needs of your performing voice. We can also advocate for you regarding planned performances and help you with vocal pacing and scheduling decisions. If your condition calls for surgery, we'll collaborate with your surgeon on steps to protect your singing voice before, during, and after surgery.

Coordinated Care
If changes to your singing voice are related to a medical condition such as allergies, asthma, or acid reflux, we coordinate your care with specialists throughout Duke Health to ensure you receive the best therapies to minimize your symptoms, improve your voice, and optimize your recovery.

Ongoing Research to Advance Voice Care
Our research into the performing voice ensures you receive the best care for your vocal disorder.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2020–2021.