Voice Care for the Professional Voice J. David Cunningham, MD; Timothy Heffron, MD; Frances E. Marchant, MD; Ernest L. McKenna, Jr., MD Many patients' livelihoods depend on maintaining adequate vocal strength and a good vocal production in their careers as teachers, professional speakers, salesmen, vocalists or singers. Any changes in vocal use may result in trauma to the vocal cords, causing hoarseness and the inability to use the voice in its most proper form. The most important aspect of maintaining a good vocal tone and quality involves keeping a well-hydrated vocal cord with minimal sources of swelling. Prior to performances or speaking engagements, voice rest is recommended. Shouting, whispering, or heavy vocal use may result in additional swelling of the vocal cords and result in hoarseness and poor vocal quality. By the same token, dehydration is a big factor in the poor quality of many voice disturbances. This may be aggravated by many medications that are required for high blood pressure or allergies, which have drying side effects. Certain dietary considerations are also problematic. Heavy alcohol use tends to result in a water-losing diuretic effect on the kidneys with dehydration. The alcohol itself also acts as a dehydrating agent to the vocal cords themselves. Tobacco use will also create a certain degree of dehydration, resulting in vocal cord swelling and should be minimized prior to performances. Caffeine products result in water loss, along with diuretic antihypertensive medication that may be prescribed. Antihistamines used for nasal allergies are also drying to tissue. Some sleeping medications and anxiety medications, along with many of the hypertensive medications, also result in additional dryness to the nasal and oral cavities. Increasing water intake, the use of saline nasal sprays (for moisturization of the nasal cavity), and, in some instances, lozenges (which may increase salivary flow) may compensate for this dryness. Even the anxiety of a performance often results in oral dryness, which can impair the vocal quality. Good vocal preparation and technique cannot be overemphasized in trying to sing or talk with a relaxed vocal apparatus. During times of upper-respiratory infection, antihistamine medication should be avoided. Decongestants and mucous-thinning medicines, such as Robitussin, will help to decongest while providing good moisturization to the vocal cord. As for the singing voice, increased warm-up time will be required any time there is increased vocal swelling. Acid reflux, which may result in heartburn, may also result in hoarseness. This hoarseness is particularly problematic in the morning. The acid from the stomach refluxes because of poor sphincter tones and possibly a hiatal hernia. This may result in increased swelling of the vocal cords. Acid reflux will require occasional antacids to minimize the acidity and special precautions will need to be taken in regard to eating prior to sleep. No food should be eaten two hours prior to laying down and alcohol, caffeine, and chocolate should particularly be avoided in the evening, due to the chance of acid reflux and causing hoarseness, and resulting in vocal cord swelling. Unfortunately, some viral infections will cause a true laryngitis which, prior to a performance, should be evaluated by a physician. Many times, performers are able to perform with medication if their vocal cords will allow. Occasionally, the only advice is to cancel the performance or to rely on other techniques for vocal production.