The Professional Voice

Question 1

What are the conditions where steroids are indicated for the professional voice user? 4

When should you not give steroids?

Answer 1

“HELA”

H: Hemorrhage of the vocal fold
E: Edema from episodic abuse
L: Laryngitis (mild to moderate)
A: Allergic vocal fold edema

Do not giive for first time on night of performance

Question 2

What are the indications for the professional voice user to cancel a concert? 5

Answer 2

“BLESS”

1. B: Break in vocal fold mucosa
2. L: Severe Laryngitis
3. E: Enlarging vocal fold varix
4. S: Submucosal Hemorrhage
5. S: Significant systemic illness

Question 3

An opera singer with vocal fold edema wants to sing, what do you suggest?

Answer 3

1. Vocal hygiene: Voice rest and hydration
2. Medications: Systemic steroids & PPI
   - Inhaled steroid can dry the VF and are generally less favourable

Question 4

An opera singer with intracordal hematoma and performing in 8 days; what are your recommendations? 6

Answer 4

1. Voice rest!
2. Stop any anticoagulants
3. Humidity and Hydration
4. Mucolytic (Guaifenesin - Humibid)
5. Anti-reflux
6. Reassess in a week prior to next performance

Question 5

An opera singer with good vocal hygiene and acute laryngitis, what are your management options? 10

Answer 5

1. Vocal rest until day of performance
2. Modify practice schedule
3. Increase amplification measures
4. Alter repertoire for the upcoming performance
5. Use feel of singing rather than sound quality
6. Sing in normal, unforced voice without whispering
7. Offer steroids for short term
8. Antitussive agent (if cough is a problem)
9. Educate about increased risk of VF hemorrhage that could cause permanent damage
10. Follow up after performance, and counsel as to when normal activities can be restarted