Resting the voice is something most singers intuitively do. After a particularly stressful performance or a long rehearsal, you feel some huskiness, perhaps a slight ache in the neck area, and vocal fatigue. Resting the voice, like resting after a workout at the gym, just makes sense. And after a day or so, your voice is usually back to normal. But not always. There are situations where prolonged voice rest needs to be imposed, not as a common sense measure but, strictly, more like a prescription.
Situations such as vocal fold hemorrhage require strict voice rest that may last one or two weeks. Voice rest, perhaps in conjunction with medical treatment, may also be suggested when the vocal folds are significantly swollen. Yet another situation is when a patient is scheduled for vocal fold surgery, and we don’t want any additional temporary swelling to confuse the picture.
Voice rest may be modified or complete. Modified voice rest can be mildly or moderately restrictive—avoid singing and loud speaking but speak, if necessary, in a well-supported and soft (so-called “confidential”) voice. Complete voice rest means avoiding any phonatory activity: singing, speaking, or whispering. In my practice, I also encourage patients on voice rest to avoid any noisy environment.
The reason for this is interesting—background noise, heard by the ears, instinctively tenses the larynx, preparing it to phonate. Even if you do not speak, sitting in a noisy bar will cause laryngeal tension. If you are flying on a noisy airplane, you may also experience this effect, although to a lesser degree. I sometimes advise singers on complete voice rest to carry earplugs to limit reflex tension in the larynx, in case they inadvertently find themselves in a noisy place.
But is the larynx ever at complete rest? The answer is a resounding “no!” With each breath (nasal or oral), the vocal folds gently pull apart and then come together. This of course happens 16–20 times a minute, day and night. With every swallow, the larynx is pulled up and forward in the neck, and the vocal folds firmly close. As we lift or push down, the vocal folds come together even more forcefully (the Valsalva maneuver). Considering the above, it is clear that the laryngeal muscles are working all the time, whether you are on voice rest or not.
What voice rest accomplishes is something more specific. It lets your larynx take a break from mechanically rubbing the vocal folds together while the muscles are in a state of sustained contraction. Unlike the vocal fold movements described above, which consist of intermittent and active muscle movements, vibrations during phonation are actually passive, driven by volleys of air puffs from the trachea. These vibrations, which occur hundreds to over a thousand times per second, impact maximally on the surface layer, right at the vibrating margin of the vocal fold. Like a flag fluttering in a gale, it is easy to overdrive the vocal folds and traumatize their contact edges.
In this regard, we need to clearly distinguish short-term vocal rest for muscle strain from longer-term rest for vocal fold edema or damage. Muscle fatigue or discomfort usually resolves within 24–48 hours, as lactic acid is removed from the muscles, electrolyte balance is restored, and the muscles recover. Vocal fold edema or structural damage can take much longer to heal. This is due in part to the fact that the circulation to the muscles is much more generous than to the edge of the vocal folds. Any repair—whether removing toxic metabolites, resorbing edema fluid, or supplying nutrients to facilitate repair—involves blood vessels. For this reason, you may find that after a short rest, your laryngeal discomfort is gone but your high notes have not yet returned.
When is voice rest appropriate? After any strenuous vocal activity, it makes sense to lie low for a day or two. Modified voice rest is enough to let the muscles recover, and often enough to allow the slight post-traumatic edema to resorb. Vocal fold hemorrhage, manifesting as a sudden loss or change in voice during vigorous phonation, requires absolute voice rest, usually for at least a week. This needs to be monitored with your laryngologist, since the rate of resolution varies depending on the amount of hemorrhage. Even after all visible hemorrhage is gone, there is often a degree of residual edema which impairs high and soft phonation. Vocal fold polyps also may improve with voice rest, but only in conjunction with more aggressive medical treatment.
By contrast, vocal nodules only rarely resolve with voice rest. They may decrease in size, but will almost always recur or swell up again once singing has resumed. I have used voice rest for nodules (along with medication) only as a temporizing measure, when a singer needs to get through a particular performance, and can do so when the nodules are somewhat smaller in size. Definitive treatment for nodules is not vocal rest but voice therapy, retraining the singer to phonate with less laryngeal tension.
Can you rest your voice too much? Unless you are a member in a monastic order, bound by a vow of silence, the answer is yes. For swellings, it is unlikely that more than 2–3 weeks of strict vocal rest will accomplish anything beneficial. Most swellings that will respond to rest will do so in this time frame. Some cases of hemorrhage may need more time, but this is not a rule and is based case by case on weekly laryngeal examination. Resting the larynx after vocal fold surgery is routine—but here as well, most vocal folds are healed within a couple of weeks.
As you come out of your period of complete vocal rest, resume vocalizing gradually and mindfully. A frequent finding at this time is that the laryngeal position has changed. The larynx has risen in the neck, and the distance between the thyroid cartilage and the hyoid bone has become narrowed. This is nothing mysterious: the larynx has simply resumed its normal, pretrained anatomic position in the neck. The vocal result may be some difficulty in the passaggio and decreased power and resonance. If you find this to be the case, you will need to work to get the larynx back down to its singing position, opening up the resonating spaces in the hypopharynx.
So, as a singer recovering from your vow of silence, my suggestion is to first try to see whether your top notes have come back (just a gentle check, no Turandot!). If they are there, then focus on the passaggio, smoothing out your middle voice, until the entire range is back. If, however, the top notes have not recovered despite adequate voice rest, you will need to consult your laryngologist to see whether there is persistent swelling impeding full adduction of the vocal folds.
