One of the more controversial topics in treating voice disorders is the use of vocal rest. What is the benefit of vocal rest? When is it appropriate? And how long should it be continued? Can vocal rest ever be harmful?
Vocal rest refers to any period of time during which the voice is not used. Even the term itself is unclear. Does it mean simply not singing, or not speaking (“modified voice rest”), or does it refer to a period of strict silence (“complete voice rest”)? There is a difference of opinion. We know that in opera, the exhortation “Zitti, zitti, piano, piano” is usually followed not by what is called for—quiet and softness—but instead by its opposite: a long aria or ensemble piece! This is NOT what is meant by vocal rest.
Voice rest is a period of no phonation, usually lasting a few days, which serves to rest both the muscles of the larynx and the mucous membranes covering the vocal folds. Keep in mind that even with complete silence, the larynx is never completely at rest. Breathing, swallowing, coughing and throat clearing are all activities which involve movement of the vocal folds and of the laryngeal muscles. But in avoiding the prolonged muscle tension and pressure associated with phonation, the larynx has the opportunity to recover from exertion or trauma.
When is vocal rest appropriate? After any significant amount of singing, the performer should minimize vocal exertion. A performance the night before should normally be followed by modified vocal rest: no singing, minimal speaking, lots of fluids and breathing through the nose as much as possible. This is particularly important when the singer has a series of nightly performances. The larynx is normally slightly swollen after singing, and the edema and exerted muscles need an opportunity to recover.
This is a brief period of voice rest, to recover from physiologic exertion. When the larynx has sustained damage, longer and more stringent rest is needed. A vocal fold hemorrhage requires strict rest, for periods up to two weeks. This means absolutely no singing, speaking or phonated whispering, until the blood and edema have cleared from the vocal fold. Vocal fold polyps may also respond to voice rest, the duration depending on the response of the larynx. Any surgery requiring intubation should be followed by modified voice rest for several days, to allow the vocal folds to recover, and laryngeal surgery requires at least a week of absolute silence.
Voice rest not only allows acute edema or other damage from trauma to heal, it also prevents the singer from unconsciously adopting harmful compensatory techniques for overcoming the hoarseness. Thus, the purpose of a few days of voice rest in acute laryngitis is not so much to allow laryngeal inflammation to subside, but rather to prevent the development of harmful muscle tension and squeezing as the singer tries to overcome the temporary loss of voice.
Depending on the condition being treated, voice rest is not always of lasting benefit. Nodules will seldom go away with voice rest, and placing someone on more than two weeks of silence to treat nodules will not solve the problem. The real treatment for nodules lies in the active relearning of correct phonation, so that the vocal folds can be approximated with less tension and trauma. Prolonged voice rest (over 2 weeks) may at times be actually harmful, and require a gradual relearning of how to use weakened muscles.
A couple of simple rules should help to clarify this topic. Short periods of rest, especially if squeezed into a taxing performance schedule, are good. If it hurts to sing, or you notice that you require excess muscle tension, cut back or stop. If hoarseness persists
after a few days of voice rest, or improves partially but recurs on singing, stop and have your larynx examined. If you are placed on prolonged voice rest (over 1 month) with no concurrent voice therapy or other treatment, consider obtaining a second opinion. Voice rest is a double-edged sword with potential benefits but also potential problems.
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and 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.
