Vocal Fry and the Importance of Voice Health

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Happy New Year! I have been asked to do a live, local TV News interview next week to comment on the topic of vocal fry. If you haven't heard by now, "vocal fry" has recently gained much press and recognized as a new and quickly emerging speech pattern in young women. Dr. Nancy Snyderman, a fellow Ear, Nose, and Throat surgeon and amazing broadcast journalist covered this story on the TODAY show. If you Google "vocal fry" you will also see its coverage by CBS News and Huffington Post as well as many other media and science and health blog sites have reported on this phenomenon.

This blog is focused on why awareness of this "trend" should be important to parents and more importantly, why we need to teach our children how to protect their voice, laryngeal function, and learn more about the "larynx" (voice box) which we take for granted each and every day.

If you've watched the YouTube video, which I linked above, you can now pick up when someone, likely a young woman, is using vocal fry. Thanks first to Kim Kardashian and Britney Spears, who are both poster celebrities that have fueled the contagious, wildfire wide spread of conscious use of this method of speaking or singing, we now may have a real reason to worry about our adolescent or preteen voice health.

Vocal fry is a voice pattern that basically sounds like low, creaky vibrations when a woman speaks. Vocal fry register is well recognized from a few decades back and is the lowest vocal register produced by human voice. Anatomically, to create this "popping' or cracking sound, air has to "leak" or "pop" through the vocal cords at a very low frequency. To create this effect while speaking, the arytenoid cartilages which are joints that control the opening (when we breathe in)  and closing (when we speak or phonate)  of vocal cords are drawn together but the vocal cord or folds are loosely closed  so that it allows more air to get through making a popping or rattling sound of a very low frequency.

As a Pediatric ENT Specialist, I frequently meet both preschool and school aged children for "hoarseness" or "raspy" voice. These children are often sent to me either by school speech therapists, or referred by their pediatricians, or self-referred by parents. The reason all of us need to care about our voice and laryngeal health is that voice and human communication is undoubtedly the most critical of bodily functions for social interaction and everything else we take for granted. From the time an infant is born, the ability to cry, breath without difficulty, and swallow safely without milk going down the wrong pipe (windpipe or trachea instead of the swallowing pipe or esophagus), this is all critical stuff and parents whose babies have been diagnosed with abnormal vocal cord function know what I am talking about. For everyone else who is blessed with children without voice problems, we only appreciate the importance when we or our children "lose" our voice.

I think because parents nor physicians can see the larynx (prounounced "layer-rinx", NOT "lar-nix") unless you are an Ear, Nose, and Throat Specialist, you will not hear about voice health and we may not emphasize laryngeal health and voice hygiene as much as we should. Speech language pathologist are the only other professionals that would be passionate about laryngeal health as their entire profession deals with helping adults and children with a variety of voice disorders and often work alongside ENT specialists or in the communities to do so. When I meet a child with any voice abnormality regardless of whether the concern is from  the parents, their doctors, or speech therapist that has concern, I perform a quick office procedure called flexible laryngoscopy. Basically, I spray a little bit of nasal decongestant and numbing medicine into one nostril, and after 15 - 20 seconds, I use a 2 mm angel-hair pasta thickness noodle like camera and insert it gently into the nostril along the nasal floor, then curves it down to the back of the throat immediately above the voice box so I can see it through my scope. This is how I am able to tell the parents if their child's vocal cords move normally, and I am looking for vocal cord nodules—the most common reason why young children have raspy voice.  Vocal cord nodules are like "calluses" which are usually due to excessive voice use or basically, screaming and yelling. Young children with temper tantrums, preference for voice abuse, and or excessive character voice or abnormal use of voice may lead to nodules. Other causes include polyps, even papillomatosis (warts) which can block the airway and is a serious problem that requires long term treatments. There is a long list of causes for laryngeal dysfunction especially for adults, but in those with exposure to nicotine and excessive alcohol, cancer of the vocal cords which may spread to the entire voice organ must always be ruled out.

Another serious issue affecting our youth today is the lack of drinking water - good old fashioned plain water. As our children consume more and more beverages loaded with sugar, and increase their risk of reflux causing irritation to their larynx and dehydration effects of consuming sugary drinks can all affect and lead to raspy voice or less than optimal voice quality. Actually, professional singers like Celine Dion would be great at sharing her secrets for maintaining as perfect laryngeal health as possible. Vocal warm-ups, hydration, avoidance of nicotine and alcohol, humidity, avoiding voice abuse, are all things that are commonly practiced by those who rely on their voice professionally.

Back to vocal fry. Recent research study published in the Journal of Voice found that about 2/3 of Native English Speakers between ages 18 - 25 use vocal fry in their speech patterns. There is no medical proof nor truth that all forms of vocal fry is pathologic or a "disease," yet one may easily argue that Kim Kardashian is not the ideal female role model for our young daughters, especially mimicking of her speech patterns. If people unintentionally use vocal fry as a part of their communication and speech pattern, and it does not negatively impact their voice character and quality and effectiveness of their communication with others. No one knows the long term and possible negative impact vocal fry may have on our laryngeal function and health. What we need to do as parents, is have an open discussion with our preteen and teen daughters about why mimicking unnatural voice patterns, or adopting any "fad", whether it's diet, fashion, or behavior, may have negative consequences. You can read more about effect of vocal fry on perception by others that one may be less intelligent or competent, and even outright annoying. Do our children need help becoming more annoying? I say that with a kind heart as a loving parent  I will give a big thank you to Kim Kardashian and Britney Spears for bringing focus to the larynx and voice box, and hope that we can take this opportunity to appreciate the importance of laryngeal health.


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