Microsoft word - voicing-concerns.doc

VOICING CONCERNS by Dr. Sadhana. Nayak
Certain medicines either prescribed by your doctor or taken over the counter may affect the voice directly or indirectly. These medications affect the voice in different ways- some by producing dryness, some by causing tremors, some by slowing down the functioning of the central nervous system, some by increasing the susceptibility to haemorrhage. If you are a vocal performer or a professional voice user, you should be aware of these effects so that you may take simple preventive measures, if possible, to counteract the negative effects of these medications. Certain medicines should be avoided just before performances or before a rigorous voice schedule. A medication's effect on the voice varies greatly from person to person due to dissimilar dosages, duration of use, and individual differences like age, overall health, other medications taken concomitantly, etc. The 200 most frequently prescribed medications in the U. S and their effects on voice and speech have been tabulated by the National Center for Voice and Speech. These are a few of the commonly used medicines that may affect the voice negatively. Antihistamines are often used for colds and allergies. Antihistamines can produce drying of the throat and mouth, leading to increased throat clearing, frequent coughing, hoarseness and irritation in the throat. Dry vocal folds are more prone to vocal injuries, and laryngitis. Some of the commonly used antihistamines are Pheniramine and Chlorpheniramine Malleate, Clemastine, Cetrizine, Diphenhydramine, Promethazine, cough cold mixtures etc Vocal performers should be cautious about using medications that impair clotting of blood during strenuous voice use due to an increased possibility of hemorrhage in the vocal cords. Some medications like Aspirin, Ibuprofen which are commonly and frequently used can cause vocal fold haemorrhage. Singers and vocal performers often develop ' sore throats' shortly before a performance and start themselves on inappropriate antibiotic therapy, which they discontinue immediately after the performance. This can lead to resistant throat infections. It is therefore important to use the appropriate dose of the antibiotic for the prescribed duration. Diuretics [i.e medicines which increase the output of fluid from the body] like Frusemide are sometimes prescribed at the request of singers and other performers to deplete excess water in the premenstrual period or for weight loss. Unsupervised use of these drugs may result in dehydration and consequent drying of the tissues in the throat and the larynx [voice box]. Hormone use esp. oral contraceptives and inadequate thyroid hormone may alter the voice. They may cause vocal fold edema [swelling] which lowers the pitch of the voice. The National Center for Voice and Speech does not attribute any voice effects to oral contraceptives. High dose vitamin C ( 5to 6 gm. / day )which is used by some people to prevent respiratory tract infection may lead to dehydration with consequent drying of the throat and the lining of the larynx [voice box] ACE inhibitors are prescribed for hypertension [high blood pressure]and some cardiac problems. A dry cough is sometimes caused by the use of ACE inhibitors, which if persistent, may lead to hoarseness. Examples are Benazepril, Ramipril, Lisinopril, Enalapril, etc. Narcotics e.g pentazocine, codeine [also used in cough mixtures], sedatives, antidepressants like amitriptyline may produce symptoms of slow, slurred speech. Antidepressants like Fluoxetine, Sertraline may have a drying effect on the body, including vocal fold tissues. Other medications like mucolytics [substances which thin out and soften mucus], steroids and some of the drugs used for the treatment of acidity may have favorable effects on the voice. However, self medication with inadequate dosage and duration of therapy should always be avoided.


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