Vocal Health For Singers Series: Dr. Anthony F. Jahn, MD, a leading voice doctor for more than four decades, answers a series of questions from singers, teachers, and parents.
Vocal Health For Singers Series: Dr. Anthony F. Jahn, MD, a leading voice doctor for more than four decades, answers a series of questions from singers, teachers, and parents.
Dear Doctor Jahn,
How does acid reflux actually irritate the voice? If acid is coming up in your esophagus, how does it irritate the vocal cords, given that they are in the wind pipe? – Connie
Dear Connie,
Thank you for your thoughtful question. You’re right, when stomach contents (acid and enzymes) reflux up the esophagus, they enter the throat behind the larynx.
Depending on the amount of material, it can spill over the ridge of tissue that separates the top of the esophagus from the larynx (the interarytenoid area), and cause irritation. In fact, this tissue between the arytenoid cartilages is often red and swollen with reflux, and this finding is one of the cardinal signs of acid reflux.
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It is, however, extremely uncommon for acid to actually spill into the larynx or to damage the vocal folds directly. For this reason, I’m always upset when a doctor scares a singer by saying “your vocal cords are burned by acid”. This is unnecessary fear mongering, and does the patient a disservice.
The commonest vocal effect of acid reflux is an irritation of the pharynx. This causes irritation of the muscles around the larynx and results in an elevation of the larynx. There are also neurologic receptors in the lining of the pharynx which, when irritated, cause the vocal folds to tighten and come together.
The net effect is an increase in muscle tension, which makes it more difficult to sing freely, causing problems negotiating the mix, and decreased resonance and power due to pharyngeal constriction.
Dear Doctor Jahn,
How long will a young woman’s voice continue to grow? What are the factors affecting how big a voice will get? My daughter is just a few months shy of 15. She has a fairly large and well developed voice for a 15-year-old. But we have been told that because of her petite, slender 5′ 1″ frame that her voice will probably not get large enough to be very competitive in the classical genres after the age of 18. – Ivy
Dear Ivy,
A number of factors can affect how long a young woman’s voice continues to grow, some developmental and some technical. Developmentally, the voice will continue to grow for some time after menarche, and the best rough guide to whether she is “fully grown” would likely be bone age, which can be checked with a simple X-ray to look at the epiphyses (the ends of the hones).
Of course, a fully grown young woman can he petite and slim, or tall, or more robust in size: the best indicator would be to look at the parents. Typically, teenagers grow in their trunk and extremities first, and the head assumes its adult dimensions last. Since the size and resonance of the voice relates not only to the size of the thorax (trunk) but also to the length of the vocal folds and the size of the resonating cavities above them, full growth can take several years.
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Now, the technical side. While the voice may be fully developed in terms of sheer power (i.e., lungs and vocal folds), it can continue to change in color and even register for many years during a singer’s development. It is, for example, not unusual for mezzos to start with lighter roles such as Cherubino and then, over time, move to the heavier mezzo roles. The lighter soprano voices (like the souhrettes), in my opinion, do reach their full adult voice earlier than the more complex or dramatic ones. Like wine, voices can be fresh and fully developed early, or can take many years to mature and unfold. I hope this helps to answer your question.
