voice conservation

Tips for a healthy voice.

Balance demand with rest. If you know you have to abuse your voice either by having to speak loud or long it makes sense to use it less or give it rest before and after the episode.

Humidify the envoirnment: dryness causes hoarseness and voice embaressment it makes sense to use humidifiers particularly at night since chances of mouth breathing is more. If you have a tendency chronic dryness then inhalation is a good idea.

Go slow on medication: over the counter medication like decongestions, anti-allergy medications tend to dry out body fluids, including the ones from the vocal folds. Always check with your physician about this and compensate with fluids. Oh! By the way caffeine and alcohol are also drying components.

Pamper laryngitis: if you are suffering from laryngitis particularly associated with the upper respiratory tract infection then it makes sense to rest your voice. If you have to use your voice use a soft breathy voice until the swelling resolves. Ideally don’t talk. You could harm your vocal folds if you over ride this.

Watch out for LPR (laryngopharyngeal reflux disease)  a rough voice in the morning with bad taste in the mouth and sensation of heart burn should ring bells you could be heading for LPR,there is irritation of the throat, excessive mucosal collection this requires a different kind of care.

voice breakdown

Break down of voice

Voice break down happens quite often let’s look at how exactly it can happen.

Sound process: generating air pressure

Brief description: breathe support Coordinated functions of diaphragm, abdominal muscles, chest muscles, lungs and chest cavity moves the air column upwards through the vocal folds.

Work distribution:  diaphragm abdominal and chest muscles move air into and out of the lungs. Lungs are the organs air; bronchi and trachea are passages for the air from the lungs.

Possible breakdown: that could affect the voice.

·         Lung disease

·         Airway obstruction like asthma, or hardening below the glottis(subglottic stenosis)

·         Paresis or paralysis of the muscles.

Possible symptoms:

·         Shortness of breathe

·         Weak voice.

Sound process—glottic closure of the vocal folds:

Brief description: vocal fold position critical. The vocal folds close during speech or singing and open during breathing. This is controlled by glottis.

Work distribution:

·         Laryngeal muscles contract to close vocal folds

·         Arytenoids cartilages pivot to move vocal folds towards midline

·         RLN and SLN bring nerve input to the muscle.

·         Vocal fold mass and edge contribute to the glottis closure.

Possible failure:

·         Nerve paralysis or paresis

·         Muscle weakness

·         Neurological disease

·         Arthritis of arytenoids cartilage.

·         Nodules, polyps, cysts at on the vocal folds

·         Atrophy of the vocal folds

·         Scaring of the vocal folds.

Possible symptoms:

·         Hoarseness

·         Breathlessness

·         Effortful phonation

·         Vocal fatigue

·         Diplophonia.

Sound process vocal fold vibration:

Brief description: wave like vibration from top to bottom repeated in cycles. With each cycle a puff of air escapes producing a buzzy voice sound. Singing voice produces a unique sound spectrum that is different from the spoken voice.

Work distribution: superficial lamina propria is the main vibrating layer in vocal fold mucosa. The integrity of the vocal fold surface allows the mucosal wave propagation. The vocal fold mass and edge contribute of the glottis closure.

Possible breakdown:

·         Vocal fold scar

·         Vocal fold lesions like cyst, nodules, polyps Papillion etc.

·         Grannuloma of the vocal folds

·         Swelling and infection

·         Paralysis

·         Haemorrhage, vascular ectasis.

Symptoms:

·         Hoarseness

·         Effort in phonation

·         Weak voice

·         Speaking voice is lower than usual

·         Voice fatigue.

Sound process—voice volume or loudness:

Brief description: amplitude of sound waves loudness is achieved by increasing pressure/flow. Or increasing vocal folds resistance.

Work distribution:  breathe support. Laryngeal muscles contract to adjust to the tension of the vocal folds. Vocal folds elasticity allows the fold to open wider and stay apart longer.

Breakdown

·         Scars on the vocal folds

·         Paralysis or paresis of the vocal folds

·         Lesions, cysts, nodules polyps, papilloma in the vocal folds

·         Swelling and inflammation.

Symptoms:

·         Unable to project voice

·         Weak voice

·         Voice breaks.

Sound process of voice pitch or highness or lowness.

Brief description: frequency of sound waves increases for high notes and tension decreases for low notes.

Work distribution: laryngeal muscles contract to adjust tension of the vocal folds. Specially for higher notes. The integrity of the vocal fold edges decides the elasticity or pliability of the vocal folds.

Possible breakdown:

·         Paresis or paralysis of the nerves

·         Scars of the vocal folds

·         Oedema of the vocal folds

·         Lesions on the vocal folds.

Symptoms:

·         Unable to hit high notes

·         Loss of glissando

·         Voice breaks.

This is rough sum up of what could be the cause and effect of the breakdown of the voice system and why it is necessary to see a doctor immediately.

the voice box

Our voice is created by the voice box.  When the voice comes up from the lungs the vocal cords to vibrate and continue up through to the mouth.

The voice box is within the larynx.

Phonation is production of sound by the voice box.

Larynx essentially has three functions

·         Sound production

·         Air passage for breathing

·         Protecting the air passage during swallowing.

Vocal cords are the soft tissues mainly responsible for the vibratory component of the voice.

Glottis is the opening between two vocal folds and closes during the swallowing and sound production.

The spoken words are recreated by three components

·         Voice sound and basic sound produced by the voice folds. This sound is often described as buzzy.

·         Resonance of sound and amplification is modified  by sound retraction.

·         Articulation produces recognizable sound this is created by voice articulators like soft palate, tongue and lips.

Voice mechanism is created by three subsystems each with specific roles.

Subsystem	Organs involved	Role.
Air pressure system	Diaphragm Chest muscles Ribs Abdominal muscles Lungs	Provides air pressure to bring about vibration in the folds.
Vibratory system	Larynx (voice box) Vocal fold	Vocal folds vibrate change air pressure sound waves often described as buzzy . Varies the  pitch of sound.
Resonating system.	Vocal tract (pharynx) Oral cavity Nasal passage	Change buzzy sound to recognizable voice of a person.

Functions of the voice box

·         Breathing opening of the glottis

·         Cough reflex close glottis and open it.

·         Swallowing closing of glottis

·         Voice creation close the glottis and adjust the vocal tension

The process of voice involves three steps.

air is moved out from lungs and towards the vocal cords due to the co-ordinated action of diaphragm, abdominal muscles, chest muscles  rib cage and vocal cord vibrations. Voice folds use muscles, nerves and cartilage to create sound.

Vibratory cycle occurs repeatedly and each cycle is as follows.

·         Column of air pressure opens at the bottom of the vocal folds.

·         Column of air continues to move upwards towards the top of the vocal folds and opens at the upper most.

·         Bernoulli’s effect is created by the low pressure caused by the upward moving column causing the bottom folds to close followed by the top one.

·         Closure of the air column releases a pulse of air.

The cycle repeats.

Rapid air pulses created by repeated vibratory cycles produced a sound that is just buzz.

This gets amplified and modified voice tracts resonators producing voice as we recognize it.

·         Loudness increases in air flow blows vocal folds wider apart which stay apart longer during a vibratory cycle

·         Pitch increases in frequency or vocal fold vibration raises pitch

Voice can break down

·         Air pressure system gets hampered. Air flow is inefficient .e.g. asthma, emphysema.

·         Vibratory system gets compromises causing hoarseness and voice symptoms eg.cold.

Iceland's tobacco legislature

The government of Iceland is conserving a physician sponsored legislative tat provides a new approach to tobacco control.


If this law gets passed then tobacco, cigarettes would be sold only in pharmacies to adults over 20yrs and they would need a permit for it.

Since tobacco/nicotine addiction is best handled by primary prevention once addiction sets in it deserves therapy.

But still does not address answer what happens to secondary smoking or tertiary smoking.

It could also give rise to illegal sales, and the other issues.

The doctors bill

Watching Hindi movies about corrupt doctors, or organ stealers hurt.


I have grown up being a doctor’s daughter and a general practitioner’s grand-daughter. Heard stories about my great grandfather’s healing skills. This meant, we were prepared that at a family evening out my father would be called for an emergency. Many times my father was away during our annual school concerts and never around when we received our awards.

That’s when I decided I would go for dentistry instead of general medicine. I have a home practise, my patients think its their royal right to barge into the clinic be it after 9pm or even a Sunday, since I am at home, and they save their leave.

These are the very same patients who crib about the doctors fee. But do doctors get concessions when it comes to grocery bills or school fees? If a corporate worker can bill overtime, isn’t the doctor’s family entitled to his time?

Is a doctor not entitled to a family life, and if he does give up that time should he not be compensated?

This is not just the Indian scenario I am sharing an article about family doctors in the states

http://www.kevinmd.com/blog/2011/04/society-frown-doctors-earning-reasonable-living.html

dignity of risk

With life expectancy increasing we are grappling with chronic disabilities and atrophies. The needs for hospital care and home care givers have re-invented themselves.


The society is constantly being brainwashed to accept its own incompetency to handle either the young or the old. Our role as care givers is being shaken. Look at the parenting classes and magazines that mushroom.

The same is applied to the senior citizens. There is a lack of faith in the senior citizens to take care of themselves. I have come across many of my peers who assume judgemental errors from their parents, despite parents being perfectly capable of handling themselves. There is an increasing tendency to segregate them into old people’s homes or senior citizen’s settlement.

When it comes to senior citizens there is a need to let them take the dignity of risk and decide if they need to leave their familiar surrounding and relocate, from things they value particularly into institutes. Just as our parents had to prioritize and make choices while bringing us up we need to give the choice as long as the choice is possible.

The risks are enormous and sometimes in retrospect we might feel guilty of leaving them in a less conducive atmosphere, but the choice as far as possible should be left to them.

Medico-legal provisions have been made to define the extent of live saving procedures the decision to live in a home environment is more difficult.

We need to allow the elders in our life to live their remaining life as independently and as freely as they want. We will have to make time to listen to the scraping of knees sometimes even more serious things, but they will be living and not just waiting to die.

health care what exactly we mean

During the hospital stay there were some interesting things to observe and learn.


Morning rounds, rushing residents, some of them seem to think they were like the Cabots who only spoke to Gods.

Dr.Viraj Kandolkar was resident that every patient used to look forward, brusque yet the patients would look forward to him being in the ward. The answer was simple he took the trouble talking to the patient. He made the patient feel he cared.

When we now talk of health care we seem to be talking of two mutually elusive goals, one health which is techno driven, ensure the patients health no compromise on it. Yet the vital factor is missing which is the second goal.—CARE

• Careful attention or careful heed

• To take charge of, look after, provide for

• To feel concern about or interested in.

That is the actual reaching out, to the patient.

This could be a direct fall out of us taking on more patients than we can really handle, or it could be our increased trust in technology and reluctance to talk to people.

Easier to deliver health than healthcare.

But it is time to get our act right.