Vocal Damage: How Does it Happen?

Pain, hoarseness, losing your voice or even developing a lump or polyp on your vocal cords: these are all some of the greatest fears of any singer. So, how can you best protect your voice and prevent damaging your vocal cords? And if you are having vocal issues, how can you get rid of them? Rather than fearing that you’ll never be able to sing again, the first thing to do is trust the healing ability of your own body and take the time to relax every moment you get!

This blog was written by Alfons Verreijt, the developer of the VocalFeedback method and author of the book The Essentials of the Voice.

Vocal Damage

We could easily list a host of national and international singers who, at some point or another, have suffered some form of vocal damage. Vocal damage forces concerts to be cancelled and, in many cases, the damage comes in the form of a lump or polyp which forms on the vocal cords, preventing the artist from being able to sing at all. A polyp is just one possible form of vocal damage and is the worst form that a singer can ever be confronted with.

Vocal damage can range from the mild to the drastic, varying from slightly swollen or fully swollen vocal cords to the dreaded polyp – and everything in between. You could divide possible forms of vocal damage into two different categories: damage caused by singing itself and damage caused by external factors. These external factors can be smoking, drinking alcohol, an infection, acid reflux, the menopause or paralysis (where one vocal cord is paralysed). In this blog, we’re going to focus on vocal damage caused by singing – so the damage that can be caused by simply using your voice.

Recognising Vocal Damage

How do you quickly recognise the vocal damage that can arise from simply using your singing voice? Firstly, there’s a distinction between short-term and long-term damage. Short-term damage can happen quite suddenly while you’re actually singing and can come in the form of the sudden urge to cough, a tickle in your throat or a raw throat. In the longer term, after singing, vocal damage manifests itself in one of the following symptoms: a hoarseness that wasn’t there before, a raw feeling in your throat, the sensation that you have a lump in your throat that you can’t swallow and/or the loss of vocal range. If you carry on singing with any of these symptoms, then in the long-term, the damage could just get worse and develop into one of the following issues: further loss of range (especially the higher registers), constantly sounding hoarse, diplophony (the sounding of two notes at the same time), a cracking vocal sound and pain when vocalising generally. If you experience one or more of these symptoms, then you need to take action immediately. Depending on the severity or persistence of the problem, you may need to seek professional help.

“You can damage your vocals by doing something wrong even just once,” insists singing coach, Alfons Verreijt. “Even just one wrong scream or shout can make you hoarse. But that’s short-term damage so, as long as you simply rest your voice and allow it to heal, it’s nothing to worry too much about and will quickly clear up. If you’ve damaged your voice because you tried something new, then don’t be scared of trying it again later. To be a better singer, you have to take a few risks. When you try out the technique again, try a slightly different approach. Doing something the wrong way more than once just doesn’t make any sense. If you keep going wrong despite adjusting your approach again and again, then stop altogether or get some advice from a vocal coach.”

Image 1: Here, you can see what healthy vocal cords look like as you breathe out, viewed from above the throat, so the back of your neck is in the lower portion of the image.

Image 2: Healthy vocal cords while singing or speaking.

Image 3: The swellings you can see here are small lumps.

Image 4: This is a polyp.

Vocal Cords

We’ve already looked at the various forms that vocal damage can take, but what exactly is vocal damage? To answer this, we need to know a little about the anatomy of the throat, especially the vocal cords. The vocal cords are part of the larynx while the glottis is found between the vocal cords (see the image included above). Air flows out of the lungs and through the glottis between the vocal cords, so if your vocal cords are relaxed, then no sound is made. If the vocal cords are tensed enough, then they vibrate as the air from the lungs flows through the glottis, making sound. The vocal cords are tensed simply by flexing the vocal cords themselves and/or the muscles around them. This is the part that we need to remember if we want to know more about how vocal damage can occur and how we can prevent it.

Clap Along

The vocal cords are coated in a layer of mucus, which might sound disgusting but has a protective purpose. Beneath that layer of mucus is a thin mucus membrane, which is only a single cell thick. When you’re using your voice correctly, the vocal cords vibrate in a sort of wave movement, causing them to lightly brush against each other. When you’re using your voice incorrectly, that smooth wave movement disappears and, instead of brushing against one another, your vocal cords uncomfortably clap together. Here, the energy isn’t flowing along the length of the vocal cords, creating that smooth wave movement, but instead is concentrated at one point – namely, the first point where the vocal cords brush against each other when vibrating. This point is usually in the middle of the vocal cords, since this is where the vibrational ‘wave’ is at its widest. By ‘clapping’ the vocal cords against one another again and again at the same point, the protective layer of mucus is worn away and the tissue of both vocal cords becomes damaged at that specific point, resulting in redness, irritation and subsequent swelling. The swelling is actually a sort of blister – the same kind that you get when you wear shoes that don’t quite fit properly. Since the vocal cords are swollen, they can no longer close properly and, as a result, ‘wild air’ flows through the vocal cords, which is vocal-coach-speak for airflow that results in no sound, but makes a vocalist sound hoarse.

Chill Out

“At this point, it isn’t such a serious issue,” advises Alfons. “If your voice is sounding hoarse when singing, there’s actually only one remedy and that’s to rest your voice and, most of the time, the swelling will simply go away. But by rest, I really mean rest. So that means no talking as well as no singing. Write down what you need to say to someone instead and avoid resorting to whispering at all costs, because that can be damaging too. When you whisper, there’s a lot of tension in your vocal cords, which is exactly what you’re trying to avoid.” Then, even if the problem naturally heals after a bout of rest, you still have to ask yourself how it happened in the first place.

If your vocal cords are already slightly swollen, making your voice sound a little hoarse and limiting your vocal range – especially the higher registers – but you carry on singing anyway, and maybe you try to sing a little louder just to sound good, this can be genuinely dangerous for your voice in the long term. You’re basically encouraging that slight swelling on your vocal cords to develop into a lump, which will eventually make singing painful and even impossible since it’ll prevent your vocal cords from closing at all. That lump can turn into a polyp (swollen tissue on a short stem). Vocal cord polyps can also be caused by other external factors, like smoking. Most of the time, a lump can disappear on its own as long as your vocal cords are allowed to fully rest, but sometimes, it’ll need to be removed. But if you do develop a polyp, then surgery is often the only solution.

Diplophony

If you want a good idea of what a lump on the vocal cords looks and sounds like, then have a quick look on www.voicedoctor.net. It’s a really informative site put together by Dr. James P. Thomas, an American doctor who specialises in vocal damage. Click on ‘Diagnosis’ at the top, then on ‘Hoarseness’ in the drop-down menu and watch the video clip on that page. It’ll give you a really clear picture of what can happen, including the phenomenon of diplophony – or two-note tones. When a small swollen lump develops or the vocal cords are slightly swollen, usually in the middle of their length, it’s as if you have two sets of vocal cords in a row, and these ‘sets’ of vocal cords vibrate at a different frequency, so two notes are heard. In Dr. Thomas’ video, this is clearly demonstrated. Diplophony is always a sign that there’s something wrong with the vocal cords unless, of course, your name is Lalah Hathaway (see below).

Volume & Compression

Prevention is always better than a cure. This also applies to vocal damage. To prevent vocal damage, you need to be aware of the causes. “It’s almost always a combination of causes,” says Alfons. “There’s always a main cause, but it only leads to vocal damage because of other factors that are at play.”

According to Alfons, the most common cause of vocal damage is singing at too high a volume with compression. Throughout our entire blog series on singing techniques, we’ve repeatedly gone over what’s involved when singing with and without compression. Alfons also goes into greater depth about the subject in his book ‘The Essence of the Voice’. Put simply: when singing with compression, the vocal cords tighten on their own. When singing without compression, the vocal cords are tightened by the surrounding muscles. “By singing without compression, the volume can be varied all the way between 0 and 10,” explains Alfons. “To gain the upper limit of your vocal volume, you’ll need to belt, as was explained in a previous blog. Singing without compression gives you more volume options before it starts getting risky for your voice.” But when it comes to pop vocals, compression seems to be the standard. “That’s the compromise. With compression, your volume control is stuck between around 3 and 7. Try to sing any louder than 7 with compression and you’re likely to damage your vocal cords. In my opinion, this is the most common cause of vocal damage and, since most people also speak with compression normally, you can even damage your vocal cords by just speaking. Just spare a thought for the poor vocal cords of lecturers or military drill sergeants.”

You can sing with just a little compression, a lot of compression and everything in between and every level of compression also has its own volume level limit. But when singing with any level of compression you should never breach those limits and try to sing louder and harder. “For any vocalist, it’s crucial to know precisely where their volume limit lies when singing with a little or a lot of compression. As soon as you step over that line, you risk causing irreversible damage,” insists Alfons.

Tiredness & Stress

As we’ve said a few times already, drastic vocal damage arises due to a combination of different factors. According to Alfons, “Stress and fatigue can also play a big role. There’s a good reason why singers who are going through tough times in their private lives often also develop vocal problems. But a common cold, a sore throat or the flu can also exacerbate things. I work with a professional singer who can do so much with his voice and, I think that part of the reason he can pull all of that off, is that he also works hard on his physical condition. At precisely the same time that his company was on the brink of bankruptcy, he started to suffer from vocal issues. Things like this are no coincidence: stress definitely played its part, but I think that, while he was going through all of that stress, his workout schedule also suffered because he had other things on his mind.”

Don’t Be Afraid

Considering everything that we’ve learned so far, can’t you just avoid vocal damage entirely by always singing without compression? According to Alfons: “No. Singing with compression is an important part of vocals in all popular music, simply because of the kind of sound it produces. What’s really important is to really acknowledge the fact that, with compression, your volume knob can only go up to 7 and no further. If you want to sing any louder than that, then you’re going to have to drop the compression and start belting. But it’s also worth asking yourself if you really need to be so loud. When it comes to pop vocals in general, it’s less about actual volume and more about the sound and intensity. Even at a medium volume level with compression, you can create a far more cool and interesting sound than you ever could singing at high volume without compression. The challenge for any vocal artist is to make the right choices for their voice and style and avoid damaging their voice at the same time. If you always find yourself almost yelling in the rehearsal room just so you can hear yourself, then ask the rest of the band to turn down the volume – or find another band. You only have one set of vocal cords (and ears for that matter) so you need to take care of them.”

Alfons also advises vocalists never to be scared of really letting their voice work. “Learning how to press your vocal cords together to create compression is essential, but anxiety is your enemy here. Fear and anxiety results in the wrong kind of tension and that just isn’t what you want, because all of that anxiety also tenses up the vocal cords, increasing the chance of vocal damage. Trust your body, listen to your body and figure out where your boundaries lie.”

Singers Who Are Always Losing Their Voice

Say you’re a successful singer-songwriter staring down the barrel of a sixty-date tour. You have everything to look forward to, but that’s also a pretty stressful prospect. The big question is: ‘How do you look after your voice throughout all of that travel and all of those shows?’ Renowned vocal coach, Babette Labeij offers some practical and personalised tips, but apparently the true secret to maintaining your voice is surprisingly simple: relax whenever you can.

It’s Actually Simple

In the music world, the name Babette Labeij doesn’t just stand for a big reputation, but a professional vocal coaching and education brand. Her music school resides in a beautiful building in the centre of Amsterdam, where many well-known Dutch singers attend as well as ambitious young musicians. Singer-songwriter Peter Elders has made the journey all the way from his home town near the Dutch-German border to be here, having grabbed the opportunity to get a personal band coaching session with Babette Labeij with both hands. Today, he’s an open book, allowing the vocal coach to see, hear and feel where Peter’s vocal and even personal weaknesses lie. This young musician knows that, without the right coaching, the sixty-date tour he has ahead of him is likely to wreck his voice, so he’s more than ready to absorb and take on every lesson and tip that Babette has to offer. Music is a strong and constant thread in Peter’s life and he’s already lucky enough to have had the success required to start making a living out of it. And he’s dedicated. Ready to play and play and play again until his fingers hurt and his voice feels raw, and it’s exactly this level of intensity that brings him here, perched on a stool, a Spanish guitar on one knee and filled with the same tension he probably has before every gig.

At least he’s smiling: “On stage, I can feel the adrenaline running through me, but halfway through the first song I’m already struggling to even sing. I put so much energy in. I need to change that if I want to survive sixty shows.” Babette looks at him with pity, but it’s already clear to her what Peter needs. “During a performance, you can, of course, lose control over your voice,” she says calmly. “A lot of people worry too much about singing, but it’s actually very simple.”

Lose the Guitar

But we’re forced to wait a little longer to hear her wise words. “I need to hear you sing first. Could you play me a song?” she asks, with impatient enthusiasm. You don’t have to ask Peter twice, his posture immediately shifts, his left hand finds the first chord on the fretboard and he begins to sing. The melody and lyrics come directly from the heart and Peter’s voice compliments them with sultry sweetness. As he hits the chorus, it immediately becomes clear that he’s only showing off a fraction of what his voice can do. Babette sees this as well: “This is beautiful,” she says. “The melody and lyrics are so sensitive.”

Peter continues to play as Babette stands behind him, listening closely. It’s clear that even a little vocal coaching could help Peter bring so much more out in his voice. Babette notices that here and there he’s missing breath support and is forgetting to relax. When he’s finished, Babette says simply: “You have a deep and lived-in voice that’s really persuasive. This is what you are. As a vocal coach, it’s important for me to know what a singer does normally and to know what works for them. What suits them. I’ve also worked with singers that play the guitar or a bass at the same time. Playing their instrument is what they do, but playing an instrument also demands a different approach and attention to singing. I teach people to sing naturally, or more naturally. So, if I were to take your guitar away from you now, you would sing differently,” she tells Peter who replies earnestly: “But I’m doing that now. I’m doing what I always do. Otherwise, you wouldn’t be able to hear where I’m going wrong.”

The Speaking Voice

“Singing is no more and no less than simply using your normal speaking voice,” explains Babette. “Singing is simply a lengthening of the speaking voice. You use your mouth to create the sound. The tighter you hold your mouth, the harder you have to push the sound and the breath. To sing well, therefore, you need to clearly articulate what you’re singing, then you don’t need to work so hard to talk or to sing. At the same time, it’s important to relax the muscles in your neck. The whole area around the vocal cords needs to be relaxed. To make sure that the muscles around the vocal cords are relaxed by the time you perform, those muscles need to remain relaxed all day. This is something that requires practice and conditioning.”

According to Babette, the song that Peter performed included many lines that worked perfectly for the range of his voice, but his voice still sounded tense. “The first thing you need to do is simply relax and then, ‘Bam!’ start singing and show yourself: ‘I’m here and I’m going to tell you a true story.’ You have a beautiful voice, so you need to try to get the most out of it.”

Babette asks Peter to play the song again, but this time, with a more relaxed feel, as if he’s telling a story. Peter begins and is immediately more restful, but Babette quickly interrupts him: “Almost. Make it even smaller.” Peter continues, but Babette is still unconvinced: “I’ll teach you a little trick,” she says. “You’re used to blasting it out and maintaining the emotion and energy using your adrenaline. This makes everything very tense. Try completely relaxing your belly after every line you sing. Then, take a breath, relax the abdomen and at the end of every line, let everything go. Peter responds: “I always hold the breath and tension through the whole song. Now I have to let it go. I’ll have to think about that every time from now on.”

Clearly Articulate

With this new approach in mind, Peter starts to sing the song again as Babette stands behind him, saying gently after every line he sings: “Let go.” When Peter has finished, she says: “So, how easy and relaxed was that?” Peter smiles. He immediately felt that it was better and it was clear that he had far more control over his voice and the melody.

Babette already wants to go a step further: “Now, pay attention to both your breathing and the story as you sing and pay attention to what you’re doing with your body.” As Peter sings, Babette takes up her position behind him, offering soft instruction: “Smaller… Yes. Now let go… Now you need to give a little more…. Pay attention to your belly… Sing that bit again and focus on relaxing your belly.” Now, Babette wants to hear the chorus again: “Try putting a little more urgency into the words. Place and separate the words more. You don’t have to sing more loudly, just articulate the words more clearly. Your articulation is a little lazy and you’ve found a way of singing that works for you, but it’s made your enunciation a little too relaxed. Try to sing the words more consciously and with more feeling. Lose a little of the relaxed enunciation and you’ll be able to use your voice even better.”

Yet again, Peter starts to sing but Babette is like a nurturing pitbull and won’t let go: “More feeling,” she says. “You need to work much harder for your voice.”
“I don’t know how to do that properly,” replies Peter, a little doubtful, but with clear determination.

“You need to turn your voice into an instrument,” advises the singing coach loudly. “Always be aware of what you’re doing and you’ll learn. Right now, you’re still fiddling with things. If you want to be able to sing well, you need to stop that.” Peter readily accepts the advice and starts to sing again.

“Work for that note,” cries Babette. “She’s sad and she wants you to hear it and feel it. Yes! Like that. That’s exactly what I mean.” Suddenly, the penny drops for Peter and he’s able to find the concentration needed to breathe consciously, relax his abdomen and, at the same time, sing with strength and feeling. Singing might be simple but it definitely isn’t easy. He’s triumphant. “I already feel like I can sing for much longer and get way more out of my voice. More power. More feeling.” Babette is just as delighted.

It’s a Day Job

Any singer with a lot of shows booked needs to see singing as their day job – as a daily priority. According to Babette, to preserve your voice you need to do everything that you can to avoid overloading both the voice and the body. “There are a few simple things that you can do during the day. I once had problems with my voice and really wanted to avoid having my vocal cords operated on, so I deliberately started training every day to heal my voice. All I did was re-learn how to speak. Even just talking takes a lot out of your voice. Learn how to clearly articulate and relax your belly after every sentence. This needs to become automatic, because on stage, you’re really going to need that automatism. The truth is, no one learns to sing well on stage. It’s something you learn through daily practice.”

“You can do a lot with your voice, you have a good range and plenty of power, but no matter how good your voice is, you should always realise that preparing for every performance and looking after your voice is important. Try not to talk too much on a performance day. Even an interview before or after the show can strain your voice – especially if you’re not speaking in the right way – the safe way. “

“The pop and jazz singer, Caro Emerald used to give a lot of interviews, and eventually, they strained her voice. The trick is always to just rest after singing.”

“So don’t hang out with the fans after the show?” asks Peter, rhetorically. “And always speak softly?” Babette replies with a sagely nod.

“If you’re in the pub and want to talk to someone, remove yourself from all the noise. Listen closely to your body. If you’re serious, then you’ll do it. You need to have excellent discipline. Being a singer is like being an athlete. You need to prepare physically and mentally before every show. Warming up well is also essential.”

Yum Yum Yum

Babette finally sits behind the piano to show Peter a few vocal exercises to help teach him how to loosen up his voice, warm up his vocal cords and train them at the same time. “This exercise is a really important one,” she warns. “This is what the buzz is all about.” She plays a note and instructs: “Sing an octave lower and make an ‘M’ sound. As if you’re saying ‘Mmmmm. Tasty!’ This activates the abdomen. Let the note go and your belly with it. Be relaxed about it and don’t use any vibrato. Why? Vibrato is a trick of the voice and you need to know how to turn it on and off. Once you get the note, let the voice fall away. Do this exercise every morning, sounding the N, M and NG sounds.” They repeat the exercise together for a while and Peter quickly notices the difference when the lips are involved. Peter: “It actually feels nice and I already feel like I’m becoming more aware of my voice.”

Babette moves onto the next exercise, first asking Peter: “What do you do when you reach the highest range of your voice?” She doesn’t expect an answer, so provides it herself. “You switch to singing in falsetto. Try it.” Peter starts to sing, pushing the pitch higher and higher but stops before he’s forced to switch to falsetto. According to Babette, he needs to sing more relaxed and, as always, she has a little trick for that and asks him to sing ‘Yumyumyumyumyum’ as he rises higher and higher in pitch. “Don’t sing too loudly and make sure that you’re not singing the low notes lazily. You need to remain active in the lower regions as well.” Babette starts and Peter follows. She looks satisfied.

Show Expression

Babette wants to offer Peter one last tip. Singing is more than just feeling. Next to feeling, it’s also about technique and expression. “You seem like a strong person,” she says, “but you don’t dare to show your face and are very careful about your facial expressions. Singing is the most vulnerable aspect of making music, but if you look past that vulnerability and do it anyway, you’ll only gain respect.” Peter admits that he wants to expose himself more, which means that he’ll have to come out of his comfort zone. “You need to show expression without it becoming fake. You need to really bring the music and the lyrics. Rip down that wall and get it out of your way.”

“I need to shrug off a few of the layers of my personality. Then I’ll be able to achieve more,” offers Peter.

“That’s right,” replies Babette. “But all of that requires good preparation. If you’ve already done the work, then you’ll have even more confidence on stage. It can give you wings. By following this advice and doing your exercises every day, you’ll be ready and able to manage that sixty-date tour. But discipline is the key.”

Babette Labeij

Vocal coach Babette Labei runs a renowned music school in Amsterdam where she teaches performers to overcome fear and enjoy the full glory of singing. Her effective method and excellent results have earned her international acclaim as a vocal expert, talent spotter and creative consultant for international competition TV shows including Idols, X-Factor, The Voice of Holland, The Voice Kids and the Latin American version, La Voz Kids. She has coached a host of big names throughout her career and has since moved to Los Angeles, taking her teaching methods to an international stage. Her passion for music and education also makes her an advocate for music teaching in schools.

Good to Know

Bel Canto is No Medicine

There seems to be a perception that vocal damage is exclusive to pop and rock singers and that classical singers, because they sing bel canto, are immune from vocal issues. This just isn’t true. There are also bel canto singers who experience vocal issues. Bel canto is definitely not a remedy for vocal damage.

Singing When You Have a Cold

As long as it’s just a head cold – so, just nasal – then it’s perfectly safe to sing with a cold. As soon as you think your cold has reached your throat, then you should stop singing. An itchy throat is already a warning sign and, if you have a throat infection, then you should definitely stop singing. While you can still sing with a runny nose, you should still be careful because your vocal cords could be swollen, limiting your volume level, so you might start compensating for the volume loss by using the wrong technique. This isn’t necessarily harmful but the problem could be that, after you’re healed, you might unconsciously carry on using the wrong technique, causing too much tension and resulting in damage. If you have the signs of a cold, then stay aware and stop yourself from compensating as soon as you can.

Good Vocal Technique isn’t Everything

Having a good vocal technique isn’t the only way to avoid damaging your vocals. External factors also play a role, such as dehydration, chemical stimulants and fatigue.

The Diplophony of Lalah Hathaway

In this blog, we mentioned the phenomenon of diplophony, where the voice seems to sound two notes at the same time. Because the vocal cords are swollen or have developed a lump, it’s as if there are two sets of vocal cords, each vibrating at their own frequency, making it sound like two notes are being sung at once. Normally, diplophony is something that singers avoid, but not Lalah Hathaway, the daughter of the singer Donny Hathaway. Lalah has the unique ability to call up diplophony whenever she wants. Have a listen to the song Something included below, which she released with the band Snarky Puppy. It’s a stunning song, and even picked up a Grammy award. The standout moment is when Lalah breaks into diplophonic singing at the end and it sounds as if she’s singing three notes at once – but that’s up for discussion. The moment this happens, the rest of the band goes nuts as well – just like they did at the Grammy Awards.