Question: Have you ever heard of any voice changing effects from using the drug Advair? What about Advair combined with Prednisone? My doctor put me on both (Prednisone was temporary) and my middle voice has gone completely out of whack. I’ve stopped the Advair and am almost done with my Prednisone. Can you suggest any better alternatives for preventing asthma other than Advair, something that will not affect the voice?
Answer: I spoke with my local representative from Glaxo, the drug company that makes Advair. The answer, according to the company, is that a number of patients do get husky or hoarse with Advair. This is due to the steroid component of the drug, which is the same as found in Flovent. According to Glaxo, the hoarseness is temporary and ends after a couple of weeks.
However, Glaxo’s response deals with the general populace, not singers specifically. My guess is that the hoarseness may persist, in a subtle but still vocally-impacting form, as long as you stay on the medication. You may wish to consider a non-steroidal (i.e., not cortisone) alternative, either as an inhaler or as a pill.
Question: I’ve recently become a serious runner. I’ve been running for years, but have begun to increase my mileage up to 25 miles per week. I’m not training for a marathon or anything; I just enjoy running. And, as my family has grown and my time has been squeezed, I find it a very efficient way to stay in shape. Is there any known effect on the voice of which I should be aware? I generally run outdoors unless it’s extremely cold (well below freezing) or icy, then I stay indoors on a treadmill. Any information would be greatly appreciated.
Answer: As a relatively recent convert to running, I congratulate you. By all means, keep it up.
I think if you were to have any problems, they would have already developed, since you are doing 25 miles a week. The most important issues are catching cold and exposure to pollution and allergies. Try first of all to dress appropriately, and if you run outdoors, try to get to a warm environment soon after the run, rather than cool down completely outdoors. Also, try to breathe through your nose as much as possible: it decreases exposure to pollutants and allergens, warms the air, and helps expand the lungs, due to the so-called naso-pulmonary reflex. If you do have allergies, don’t run outdoors during allergy seasons or at times when the pollen count is high. Drink lots of water, since you lose more, both in sweat and exhaled vapor, when running. And keep it up!
Question: I read with interest your article in Classical Singer’s March 2002 issue on thyroid problems in women and singers. However, you leave out the next step: what will thyroid medication do for or against the voice? Is this a noticeable problem? The local nurses say it should make no difference and it may be they’re right. On the other hand, they’re awfully good at reassuring people.
Answer: The answer to your question is actually simple. If you are hypothyroid, which means “under active,” you should be on enough thyroid replacement medication to bring your levels up to normal thyroid, or “euthyroid,” levels. If you overdose, the result is the same as having an overactive thyroid. The most noticeable effect on the voice would be a tremor. You would also have a number of non-vocal symptoms.
Question: I am a 31-year-old soprano still in the stages of developing my technique. I have discovered that in the days leading up to my menstruation and during it, the low and middle part of my voice do not phonate. It becomes an extreme effort to produce any type of sound. I would be very interested to know how a woman’s monthly cycle affects singing, and if it is typical for the voice to change. Colleagues have suggested going on the pill to manipulate my cycle so that I am not experiencing the above-mentioned problems, especially if I have a performance. This has been the cause of great frustration for me and I would appreciate any thoughts you may have on the subject and welcome any information and advice you can offer. Also, I take a small dose of Propranolol (5 mg) before a performance to help with nerves. To your knowledge, does this medication affect singing?
Answer: I think much of this has already been answered, but here are some thoughts. The middle- and low-voice difficulties you experience are likely not related to a swelling of the vocal folds themselves, but more to general fluid retention in the tissues of the pharynx, and even the muscles that move the vocal folds and raise and lower the larynx in the neck. You could try a mild diuretic about a week before your period; try the herbal ones first. Also, try to cut back your sodium (salt) intake. The pill can regulate your cycle, but I’m not sure it would reduce your premenstrual vocal problems: it does help some women with premenstrual cramping and more systemic symptoms. The pill can, however, alter your voice a bit, and more significantly if you have a high voice.
Propanolol is often used for performance anxiety. Five milligrams isn’t a high dose and shouldn’t affect you adversely. Some feel it takes the “edge” off the performance, but if for you that “edge” equates with terror, it might be a worthwhile tradeoff. Good luck!
Question: Thank you so much for your informative and helpful articles in Classical Singer. I always read them first. There have been several articles concerning women and vocal health. The most recent article was about the thyroid gland. Very interesting! I was wondering if you might consider addressing the effect of PMS on the voice. Many singers such as myself suffer from this every month. I’ve kept a journal each month for quite some time. I’m positive that hormonal fluctuations during the month have a direct effect on my voice. PMS tends to take away the “glow” from my sound, the cords don’t come together as cleanly, and there is a veneer of air around the sound. Sometimes it’s better than others, but for someone who depends on her voice for her livelihood, it can really get in the way. Do you have any suggestions on how to help alleviate the problem? I know that exercise and certain vitamins such as the B complex help other PMS symptoms. I also know that some women find relief by taking birth-control pills. Can these methods also help the voice? I hope the subject is not too sensitive to discuss, but I would really be curious to hear what you had to say and I’m sure that I’m not the only one.
Answer: Again, let me preface this by saying that I am neither a gynecologist nor an endocrinologist. My understanding of premenstrual voice problems is that female hormones, progesterone in particular, lead to fluid retention. They also change the viscosity of the ground substance in the cells, causing a stiffening or thickening of the vocal folds. This typically will make the voice less flexible, more unwieldy, and takes some of the ring out of the voice.
Treatment? It depends on how much this encumbers your singing. In the same way that some women have minimal premenstrual problems versus others who suffer greatly, the voice can also be affected a little or a lot. If you retain a great deal of fluids, you may consider a mild diuretic in the week before your period. If periods are heavy, crampy and uncomfortable, oral contraceptives may help. There is also a wealth of alternative-medicine-type herbs and vitamins that may be of benefit.
I would suggest you consult a gynecologist or a naturopath. As a final point, the problems, both systemic and vocal, may be greater at the extremes of your reproductive span, i.e. shortly after the menarche and before menopause.
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and are not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
