....dedicados a su salud

Centro de Foniatría y Audiología

5 th International Congress of World Voice Consortium LUXOR, Egypt Oct 2012

1-“Singing after Indirect phonosurgery in singers”

In the indirect phonosurgery in singers the main objective is to sing as good as before the complaint or even better .

The correct glottal closure after phonosurgery has to be complete in all registers. The vocal folds flexibility has to be reached completely before singing again , that means the elasticity to produce and sustain the scales, intervals and agilities .

The management of different volumes for crescendo and diminuendo needs to be strong enough in order to sing messa di voce.

The first eight days after surgery the patient has a complete voice rest with breathing exercises. Speaking voice use is after complete voice rest, beginning with 5 minutes speaking and thirty minutes voice rest. The first voice therapy includes vowels and nasal sounds with breathing and voice placement exercises.

Corporal voice routines are performed to give more breathing support and vocal folds elasticity.

Depending on the lesion it is a good advice for singers to begin with songs in the middle range and musically not so demanding.

In our group of singers to be ready for opera the rehabilitation time were six weeks.

There were pop singers who were ready in five weeks.

Singing lessons were taken two weeks after surgery beginning with triads , middle register and 80 dBs. volume.

The inhalotherapy during complete rest voice was made only with water, during rehabilitation a mixture of mucolytics was used.

Electrotherapy was performed in many of the voice exercises.

Medically it is important to take care of medicines for inflammation, avoid reflux, and controlling allergies or environmental irritation.

In general the voice therapy began one week after surgery.

The voice therapy for cysts and papilloma was longer in some cases one year voice therapy and singing lessons together.

The patient has to be examined at the beginning , once in a week performing laryngeal endoscopy , stroboscopy and acoustical analysis with spectrography .

The singing lessons were at the beginning once a week and under medical consultation according to the stroboscopy.

The main advantage in performing indirect phonosurgery is the possibility of controlling the perfect closure and free mucosal wave immediately ending the surgery under stroboscopical light.

This examination gives the confidence of a correct function after all the healing process.

In a group of 200 singers the analysis of the post-surgery rehabilitation is made.

The different exercises for laryngeal rehabilitation are analyzed.

The treatment and rehabilitation after phonosurgery for singers has to be very careful and the patient has to be confident in singing again. 

2-“Indirect endoscopical surgery in singers”

The indirect phonosurgery in singers is performed under a good knowledge of the abilities of each singer and the characteristics of the singing problems.

The ideal for singers can be considered the indirect endoscopical procedures because the glottal area is free of tubes or laryngoscopes . The disadvantages of the intubation and the use of laryngoscope that can harm the pharynx and laryngopharynx are not present in the indirect surgery.

In good and experienced surgeon hands the microsurgery gives good results.

During the indirect surgery the function can be used as guide for the procedures and the ideal functional results are better.

In this local anesthesia surgery the patient needs to have normal blood tests mainly coagulation, a cardiologist evaluation is important .

The anesthesist controls the main vital signs and induces a slight intravenous sedation.

The image amplification through a camera and a monitor helps to have a larger image during the surgery.

The equipment has the facility to use stroboscopical light allowing to study the different mucosal wave conduct during phonation.
The complete surgery is recorded.

Epithelium, degenerative, malign lesions can be operated by indirect surgery.

It is also possible to apply intracordally different substances like autologous fat, botox, cidofovir. In intracordal lesions it is possible to perform microflaps.

The indirect laryngeal surgical procedures exist for many decades but due to the improvement of stroboscopical synchronized light and the development of optical fiber and digitalized system of recording .

A comparison is made between direct and indirect surgery for singers and the rehabilitation.

Indirect endoscopical surgery in singers is a very important procedure to recover the characteristics of singing voice.

3-“Ranchero singers discomfort in open air presentations”

Ranchero singers are singing in all social events in Mexican country. The most important group of ranchero singers is the mariachi .The mariachi group has many metal instruments and usually they sing without microphones.Under these circumstances the singers sing with more effort . By singing in open-air spaces it is possible to have discomfort and sometimes pain .

Mariachi singers also perform in restaurants, streets, big parties in the churches and arenas.The mariachi singers can have discomfort due to the open air spaces where they work .The open air spaces have more dust, changes in the temperature and the acoustic is not ideal.The hearing or masking effects of the metals during singing is also difficult for the fine feedback singing regulation.Some of the mariachi singers play at the same time instruments like guitar, guitarron, trompet, violin, small harps and special string instruments called ¨Tololoche¨ and ¨Vihuela¨ and some other percussions.The ranchero singing style uses very often falsetto voice and chest register.The main discomfort is dryness with sore throat. When the pain is more severe the singers can be hoarse .The main pathology of the mariachi singers is more frequently polyps or degenerative polyposis.

An analysis of discomfort and pain in a group of 100 mariachi singers and conclusions are made.


5-“Management of voice teachers pathology”

The teachers voice is one of the most demanding use in the professional voice users.The teachers voice need endurance, flexibility, brilliance and projection.

After laryngeal endoscopy and stroboscopy the management is directed to solve the inflammation or other signs of the mucosa. The posterior third of the vocal folds and the arithenoid area have to be examined to look for reflux signs and determine the pharmacological treatment. The quality of the mucus is important. The signs or symptoms of the nasal breathing allow us to treat the resonance areas and the projection exercises.

The different phoniatrical techniques for the teacher have to be directed to diminish the effort of the larynx with a correct glottal attack through an improvement of the air support, projection and brilliance.

There are corporal techniques to improve air column support with different movements and positions of the body.

The head position with corporal balance during the voice exercises avoid a greater tension of the extralaryngeal muscles in the neck. The shoulders have to be in a relaxed position.

The voice exercises include breathing support, glottal attack, volume and pitch management; consciousness of oral and nasal resonance and voice projection.

If surgery of the vocal folds is necessary it has to be made in the best conditions and without any sorrounding inflammation to permit a quick recuperation.

Masking exercises are important in order to similar situations that the teachers have daily due to the noise of the classrooms.
Environmental conditions are analyzed.

6-“ The voice of the future : the man and his environment ”

The human civilization has experienced several changes in its environment.

As a mammal, the human being has an airway system with an heritage from the parents , a personal immune system but also has many influences from the environment.

The environment is considered in two aspects : outdoors and indoors.

The vicinity to other human beings can develop morbidity problems.

The airway system is covered by a mucosa with a mucociliar system that transports the mucus and cleans from foreign bodies.

The hydration and lubrication functions are vital for a good respiratory physiology.

The environment has changed due to climate, industrial and political situations.

The personal habits like smoking and drinking, the quality of the food and the general body structure are defining some of the future health conditions.

The presence of noisy environment can harm the auditive feedback of the communication
Epigenetics analyzes influences and interactions around the genetics.

All over the world cities and towns, rural and urban areas have different atmospheres.The air quality and the human impact are being studied through the last decades.

The human voice is a function related directly with all these conditions.

It is briefly pointed and focused the main aspects of this relationship and the prevention that can be made.

7-“Efficacy of allergological treatment in artistic voice”

The allergic response of the airways provokes inflammation of the respiratory mucosa.

The voice production needs a correct mucosa in the vocal folds that permits a good mucosal wave getting some important characteristics for the artistic voice.

If the resonance chambers have inflammation or phlegm the facility for placing the sound mainly in the high register is handicapped and the richness of the formants production is lowered. The personal feedback can also be changed.

The artistic voice is not only strong but esthetically has different qualities.

There are different treatments for controlling the allergic response to the environmental allergens .The multiple dilution test with optimal skin end titration or in vitro RAST (radioallergosorbent test) allows to begin with desensitization of the patient without risk.

The desensitization treatment helps to control the symptoms and the signs will diminish.

The artistic voice production has side effects problems with the intake of long-time antihistamines.

Mucosa dryness, changes in the viscosity of secretions or esophageal-gastric reflux is the most frequent side effects of the antihistamines that can have noxious influence in the artistic voice.

The continuous increasing desensitization with personal vaccines does not provoke side-effects and is relatively simple due to the possibility of subcutaneous or sublingual intake.

The time of use of the vaccine is at least one year and it depends of the level of the allergies and can take until 3 years, sometimes is necessary have reinforcement every year in a special time of the year.

Anti- leucotriens, monoclonal antibody are helpful for the stabilization of the immune response .Transfer factor is also a new treatment for the allergic pathologies.

To know exactly by these tests methods which particles can produce allergological symptoms avoids sudden unknown reactions during performances.

The use of (H.E.P.A. filter) purifier helps to have a better environment during sleep.

In our phoniatrical voice group from 269 patients 80% were artistic voice users.

75% of the artistic voice patients were tested by skin end titration, multiple dilution tests 
25% were tested by RAST.

20 % of the patients needed at the beginning of desensitization during 2 to 3 months support of 5 mgs. desloratadine at night.

65% used antileucotriens 10 mgs constantly during the first year once a day.

100% of the patients used daily purifier.

The artistic voice patient cannot be treated in the same way as other patients.

To avoid damage to the respiratory mucosa and the presence of esophageal reflux the use of immunotherapy is important.