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The Singer’s Silent Assassin

Earning a living as a professional vocalist is a wonderful occupation. It’s all that I’ve ever wanted to do. However, in order for the voice to work properly, you do have to treat it with the respect it deserves and take the necessary steps to maintain a healthy working mechanism.

In my previous article, Vocal Hygiene, I touched upon a few different ways in which we can look after our voice, i.e. drinking plenty of water, and the importance of vocal rest before performing. Yet, even if you do these important things, there are some lifestyle choices, which can harm your vocal cords (or vocal folds), sometimes resulting in total loss of voice. I found this out the hard way.

Picture yourself on the day of a concert. You rehearse in the late afternoon and then grab a bite to eat a few hours before the concert. You sing for two hours and then, as is The King’s Singers way, go out into the lobby after the performance to meet and greet the public, sign whatever is put in front of you and then get changed. After all this – certainly with an appetite like mine – you’re almost certainly ready for another meal! So, after this bite to eat, you make your way back to the hotel and then go straight to bed. This routine of eating after a concert and then going to sleep is normal practice amongst performers and something that happens night in, night out. What singers may not know, however, is that this really is a recipe for vocal disaster.

A few years ago, I lost my voice during a recording session. There was no resonance to the sound and I had no control over the tiny amount of noise that I was able to produce. I couldn’t understand it. I thought that I had been doing everything right: keeping hydrated, getting as much vocal rest as possible, warming up before rehearsals and performances. What had gone wrong? Why was my voice not working as it should? I went immediately to an Ear, Nose and Throat Specialist in London. I told him that I was a singer and described my symptoms: the main ones being a dramatic reduction of my range and an excess of breathiness in the vocal tone. Before I could carry on talking he remarked, “Acid reflux”. I said, “Excuse me?!” The ENT Specialist went on to ask me about my routine on concert days and after I told him he said that, without doubt, this was a case of acid reflux – ‘The Singer’s Silent Assassin’ as he called it. To confirm his suspicions I underwent a nasendoscopy. The nasendoscope is a flexible tube with a small video camera on the end of it. This was passed into my nostril and gently backwards so that he could see my larynx. As the Specialist suspected, a typical case of acid reflux. His solution to the problem was a long course of a drug called Omeprazole (which decreases the amount of acid produced in the stomach) but longer term, and more crucially, it was simply the need to change my touring lifestyle. This is something he has said to hundreds of singers over the years. His instructions were as follows:

1) Do not eat a big meal before singing

2) Finish your evening meal at least 2 – 3 hours before going to bed

3) Sleep elevated on multiple pillows

I was initially terrified by this diagnosis but I was reassured that many singers had suffered from this condition and had regained their normal voice relatively quickly. Yet, I was told in no uncertain terms that I needed to change my habits on tour in order for my voice to return, following the three key steps. However, I was left with some questions: What did these three statements actually mean? Why was this condition called ‘The Singer’s Silent Assassin?’ What had the stomach acid actually done to my vocal cords?

Before answering these questions, there is some simple terminology regarding the human body, which should be discussed in order to fully understand the forthcoming answers.

Oesophagus: The long tube of muscle that runs from the mouth to the stomach.

Diaphragm: The flat, horizontal muscle that sits underneath our lungs.

Lower oesophageal sphincter: The ring of muscle towards the bottom of the oesophagus. This acts like a valve which opens to let food into the stomach and closes to prevent acid leaking out of the stomach.

Stomach acid: Helps to break down the food in your stomach which allows your body to absorb key nutrients and also helps to kill any harmful bacteria.

So, now the answers to those questions!

1) Do not eat a big meal before singing

As singers we are constantly aiming to take deep, low breaths (a diaphragmatic breath), engaging our diaphragm which allows us to support our sound. After all, it is the breath that is our fuel as singers. If you have eaten a heavy meal and then attempt to sing straight afterwards you will notice that your breathing will become more shallow and you will struggle to take in sufficient air. During this diaphragmatic breath, our diaphragm moves downwards and compresses the stomach and intestines to make space for the lungs to expand. With a full stomach the diaphragm simply cannot move downwards as far and therefore the lungs are limited in how far they can expand. However, whilst still trying to breathe properly and take these supportive, low breaths you can actually weaken the lower oesophageal sphincter muscle. This is what I believe had happened to me. After years of singing on a full stomach, I had slightly weakened this muscle and consequently a tiny amount of stomach acid, on occasion, was allowed to pass from my stomach up through the oesophagus and onto my vocal cords.

2) Finish your evening meal at least 2 – 3 hours before going to bed

This was certainly the crux of the situation, the main reason why I lost my voice. Night after night I had been going to bed on a full stomach. During the night, as the food was digesting, stomach acid was allowed to make its way up to my vocal cords due to the fact that I was lying down. The stomach is always producing this acid, but once you have eaten, the production of stomach acid increases and it’s therefore easier for a small amount to leak out of the stomach, up through the oesophagus and onto the vocal folds. You should therefore always aim to finish your evening meal at least 3 hours before going to bed. This time allows digestion to get well under way before you lie down, ensuring most of the acid activity has already happened.

3) Sleep elevated on multiple pillows

I now had to sleep elevated, on two or more pillows. This would reduce the acid from my stomach making its way up to my vocal folds, as it would now be fighting against gravity!

Why was this condition nicknamed ‘The Singer’s Silent Assassin?’

Acid reflux can essentially occur without any symptoms at all. In this case, it is known as ‘Silent Reflux’. I had no heartburn, bitter taste in my mouth or burning sensation at the back of the throat, which are all typically associated with acid reflux, meaning that my condition fell into this ‘silent’ category.

What had the stomach acid actually done to my vocal cords?

Essentially my vocal cords had been singed. In exactly the same way as a match would burn a piece of paper, my stomach acid had been allowed to come into contact with my vocal folds and had ‘burnt’ them. The result of this was that my cords were now unable to meet or vibrate properly together, creating the very hoarse nature to my voice during this time.

In conclusion

I’m very happy to say that after following the ENT Specialist’s advice, and taking an 8 week course of Omeprazole, my singing voice did return in a couple of weeks or so. I continue to follow these three simple steps on tour and in my home life, too. It’s important to remember that this condition is really not a rarity. Acid reflux is thought to affect at least one in ten people in the UK alone, and many more simply go undiagnosed. Everyone has their individual ‘food triggers’ for this condition but the usual suspects are fatty, fried foods, very spicy meals and overly-acidic food types. As performers, our lifestyle is often not conducive to the best practice for optimum vocal health. As long as we take every opportunity to look after our unique voices, and make important lifestyle changes if we need to, there’s no reason why we shouldn’t be able to maintain a healthy and long career doing what we love.

Timothy Wayne-Wright

 
 
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