Very interesting anlysis going on here. I had read this article before on the health problems of musicians -the singers, the string players, the harpists and also the horn players and the reasons for that.
Here I am going to share it with you the health issues of the singers :
Health Problems of singers
"Physician interest and involvement in the voice dates back at least to the time of Hippocrates in the fifth century B.C. His Corpus Hippocraticum provides some of the earliest medical speculation on the workings of the voice, recognizing the importance of the lungs, trachea, lips, and tone in phonation. Aristotle noted the role of the voice in emotional expression. Claudius Galen, who practiced from 131 to 201 A.D., is hailed as the founder of laryngology and voice science…Major advancement...[came with] the Renaissance with the writings of Leonardo da Vinci…Advances [also] occurred in the East, particularly in the ninth century, when Rhazes the Experienced in Baghdad described disorders of the voice and recommended respiratory and voice training." From "The Evolution as Seen Through Literature". Harman, Susan E. IN Textbook of Performing Arts Medicine. New York, Raven Press, 1991.
In modern times, Manuel Garcia, an opera singer born in 1805, became a teacher because he developed problems through poor technique and excess singing. He used a dental mirror as a way to indirectly view the larynx and vocal cords, a method still used today. High-tech examination methods are now available to otolaryngologists, including strobovideolaryngoscopy and electromyography.
Sound quality of the voice comes from the larynx, tongue, lips, palate, pharynx, nasal cavity, and the locations and positioning of these vis--vis one another. Minor changes in any of these organs or their positions can affect quality of the singing voice. Consider the hypernasal speech from a cleft palate or hyponasal speech with greatly enlarged adenoids (Julia Child).
Singers' voices, being a part of the body rather than a separate instrument, are vulnerable to almost all possible changes in the body. Of course, throat, mouth, nasal, neck, and lung problems have the greatest effect.
Singing teachers are a mixed bag, some great, and some who can ruin a career, with most fair to middlin'. Changing teachers, even if from a mediocre to a much superior teacher, can temporarily cause problems as the singer learns new ways. Young and beginning singers can be tempted to sing roles beyond their training and vocal maturity; most Wagner operas and some Verdi roles require sustained breath control and maximal volume production, and the somewhat looser vocal mechanism that comes with maturity and training.
Singers vary in the amount of muscle tension in the larynx, jaw, and other structures. Too little tension results in lack of control of the tone, but paradoxically, too much tension can also interfere with control. The ideal is to have good breath support using the abdominal and intercostal muscles, with the jaw loose, and throat and larynx only as tense as is required to produce a given pitch. In addition, as the pitch rises, the vocal cords must shorten to produce the pitch, and the opening in the surrounding tissues becomes smaller. Amateur singers will correspondingly tighten their throat muscles and general and a number of years of training are often necessary to overcome this tendency.
The type of singing also affects muscle tension. Classical singers have lower muscle tension scores than is true of other types of singers. Within classical music this also varies with the type of singing. Choral singers are the most relaxed, followed by art songs and operas, the last requiring singing over an orchestra and other factors mentioned in the next two paragraphs. Singing jazz or pop results in more muscular tension, musical theater more yet, then bluegrass/country/western, and the highest muscular tension is recorded in rock and gospel singers.
Stage singing presents various challenges. Concert and operatic singers preparing for performance often are learning new music and rehearsing extra hours. Operatic costumes can be heavy, and stage blocking can require the singer to sing from awkward body positions. Leg and back injuries can interfere with mobility, as well as throwing off a singer's preferred stance when singing, which results in throat tension and breath control problems.
There is also the "Lombard effect", in which a singer accustomed to singing a cappella or with piano accompaniment, upon singing with an orchestra, ratchets up the volume to achieve the same vocal feedback to his/her ears. Pop singers are especially vulnerable to this problem. Monitor speakers which direct the sound back to the stage can help. " Las Vegas voice" is a term coined to mean singing in dry conditions, with overamped bands, and sidestream cigarette smoke.
Needless to say, smoking is extremely damaging to oral, lung, and throat mucosa, and is entirely contraindicated for singers. To the extent possible, sidestream smoke should be also avoided. Smoking marijuana, which is unfiltered, is particularly toxic to the larynx and vocal folds. However, Dr. Robert Thayer, author of the chapter "Care of the Professional Voice", in Medical Problems of Performing Artists, referenced above, advises that if singers refuse to give up marijuana smoking, they at least use a water pipe!
Singers who conduct can strain their voices by singing along with different parts and demonstrating the correct note sequences or correct technique, often in varied registers according to the part they are demonstrating. Teaching from a keyboard with constant turning of the head and neck to see students, can be wearing. Singers also need to remember to carry good singing techniques over to speaking. Many Americans speak at a lower pitch than is optimum for their voice, and with a tight jaw. Especially when preparing for performances, or in less than optimal health, "Don't say a single word for which you are not being paid" is advisable, as well as avoiding phone use. Cheerleading and/or yelling at games are absolutely verboten!
Singers have been prescribed various drugs to ease performance anxiety. Propranolol and other beta-adrenergic blockers have been used but they dry the throat. Tranquilizers can produce confusion and memory difficulties, and antidepressants can also produce dry mouths and throats. Diuretics are also problematic for this reason. Singers should avoid aspirin products if possible as they can cause submucal hemorrhages in the vocal folds.
Alcohol in small amounts, say one glass of wine on a performance day, may actually be helpful, but alcohol addiction will ruin a career due to well-known adverse effects. Cocaine is particularly problematic for singers with its drying effects. Any substance which impairs clarity of thought will adversely affect performance.
Singers are subject to the inevitable changes with aging such as weakening of the vocal folds and surrounding musculature, or arthritis in surrounding supporting structures. Neurological problems which cause tremor will also affect vocal control. Hearing loss makes matching of pitches difficult. Hormone changes affect both sexes, as does hypo- or hyperthyroidism. and in women the phenomenon known as "laryngopathia premenstrualis". Birth control pills may affect vocal tone. Estrogen-alone pills are contraindicated and estrogen-progesterone combinations are best. They should not be used to postpone periods before performances. Androgen should never be prescribed for singers. During the later stages of pregnancy breath control is problematic, and vocal quality may be affected. (This writer's mezzo-soprano mother, who had four children, reported that she actually gained a high note per child!)
Temporomandibular joint dysfunction (TMJ) problems can cause headaches, and affect production of a free, relaxed tone, and singers are prone to this because they will hyperextend their jaws either downward or forward. Jaws can actually lock in place. A rock star was capable of opening his jaw to 77 mm; his jaw would lock open in performances, at which point he would turn his back on the audience and the percussionist would place his jaw back in the correct position.
Singers need to be careful about diet and exercise. Being fit is necessary for the best breath control. Eating a heavy meal immediately pre-performance will make good breath support difficult. Weight control is important as obesity interferes with breathing, and the diabetes which can accompany obesity will often produce dry mouth and reduce the energy needed for stage performance. If weight loss is needed it should be gradual as sudden losses affect vocal quality. Milk products make the throat temporarily phlegmy, and spicy foods and coffee can contribute to gastroesophageal reflux which irritates the vocal folds and surrounding tissues. Singers should avoid eating for several hours before retiring to bed. Singers with asthma and other allergies need to be treated as uncontrolled allergies really affect breathing, and are easily exacerbated by dusty stages and dressing rooms. Mold can be present on inadequately cleaned costumes and in areas with damp climates.
Upper respiratory tract infections are problematic for all musicians but particularly so for singers. Infections concentrated in the nasal and sinus areas will affect tone somewhat but otherwise do not interfere with singing per se, but chest infections make good breath control difficult, and throat infections and laryngitis directly affect the singer's instrument. Heavy singing at such times can result in lesions to the cords or even paralysis. Ability to sing loudly, hoarseness, changes in timbre, and breaking into different registers are all likely. (The writer has had personal experience when during a severe bout of laryngitis, she attempted to sing a note, the result being two separate pitches, neither euphonious, and neither the pitch she intended to produce.)
Treatment with broad-spectrum antibiotics or penicillin and its relatives, does not normally cause problems, unless the singer is allergic. Corticosteroids can be used for severe health problems when performances are imminent, but should be prescribed sparingly and carefully. Singing with severe infections, or singing too loudly over prolonged periods, or with poor technique such as excessive throat tension, can result in the singer's most dreaded malady: "nodes" or nodules on the vocal folds. Throat or vocal fold hemorrhage is possible in singing with infections or massive oversinging. Rest is the only remedy for hemorrhages, and the best remedy for infections and nodules, but the latter may require surgery. Surgery can be successful but must be very carefully done, and singers need topflight instruction in good vocal technique both before and after the surgery. Also, other surgeries such as tonsillectomy and thyroidectomy need extreme care. Intubation causes trauma to the soft tissues in the throat and will adversely performance for some weeks afterward.
Edited by adi_0112 - 18 years ago