I received my 12 page Vocal Pedagogy paper back from my professor today.
I had a blast writing about Acid Reflux. It opened me to the world of singers with Acid Reflux as well as, making me aware of taking good care of my own voice and being well hydrated at all times.
Below is a part of my paper.
Why does Acid Reflux the Singers?
Some people may wonder how reflux affects the professional singer. The vocal process, which includes the arytenoid cartilages, is attached to the posterior end of the vocal folds, near the uppermost opening of the esophagus. The acid irritates the mucous membranes lining of the esophagus and “eats away” the very thin, delicate covering of the arytenoids cartilages.[i] The mucosa, covering the arytenoids, becomes red and swollen and a clear. The LES is a one-way valve to keep stomach contents from refluxing up into the esophagus. When the acid spills up to the larynx while singing or after eating meal, the acid inflames and irritates the vocal chords, which may create vocal problems and dysfunctions for the professional singer. Singers will experience loss of range and volumes, hoarseness, feel it hard to practice, long warm ups, a low speaking voice in the morning, excessive phlegm and inability to sing softly, especially in upper range. Of course not all acid reflux patients experience all of these, but patients should at least experience a few of the symptoms mentioned above.
Professional singers have been shown to be at a particular risk for reflux. In 1991, noted otolaryngologist Dr. Robert Sataloff reported reflux laryngitis in 265 of 583 consecutive professional voice users (45%) who sought medical care during twelve-month period.[ii] The reason for this high risk of reflux is that the LES is located just beneath the diaphragm. The increased intra-abdominal pressure needed for performing works against the esophageal sphincter, a full stomach interferes with abdominal support.[iii] Whenever a singer takes a deep breath, the stomach and LES are compressed, and the LES weakens. The food that is left undigested, normally food eaten within 1-2 hours, will lead up through the LES, produce acid reflux, and eventually affect the tone quality. This is a good reason why singers should not sing on a full stomach. The vocal folds are very sensitive and only a brief exposure to stomach acid can damage the folds.
How to avoid Reflux?
As I mentioned before, the vocal chords are very sensitive and therefore it is not a reasonable decision to go straight into surgery. There are two suggested ways of treating acid reflux without surgery, lifestyle change and drug therapy. Lifestyle changes include changing eating and sleeping habits and thinking about general health. Lifestyle changes often apply for overweight people. Drastic changes can occur regarding the heartburn by loosing weight and switching to a low fat and low-caffeine diet. It is recommended to avoid acidic, spicy and fatty food, tomato and citrus products, chocolate, and mints. Caffeine should be avoided as possible. Singers, normally, won’t eat big meals before performances. Performances are normally in the evenings and, after a big performance the singer will be hungry. This is a natural thing to happen, where singing is workout for the body and the body will need energy after a performance. The singer will want to eat out or prepare a big meal right before going to bed. However, this is a bad thing for a singer to do. The body will not have time to digest the food properly and therefore the reflux will occur in sleep and possibly damage the chords, where the acid is stuck in the larynx the whole night. Digestion problems are also dangerous for acid reflux patients. When a patient does not have constipation for a day or a more, the pressure on the abdominal cavity increases and increases the possibility of reflux. Therefore it is important to eat nutritious food and as few unprocessed food as possible, because they are harder to digest than less processed and natural food. It is important to avoid eating within 3 hours before going to bed, it will prevent any pressure on the back that could push stomach contents upward when sleeping. Also, make sure to eat small meals frequently throughout the day. Because, when a person eats a big meal the LES becomes weak and reflux can easily occur. A good, restful sleep is important for general health reasons and is it suggested that an acid reflux patient should raise the bed up 4-6 inches below the head, that is, under the bed. Raising the head with pillows will not work and will increase the pressure on the neck and larynx. Raising the bed will allow gravity to assist in keeping stomach acid where it belongs. If raising the bed is not possible, another option is to add a foam wedge under the upper body. It is recommended to avoid tobacco and alcohol, not only because of general health reasons, but also because it lowers the pressure on the LES. Standing straight can have a tremendous difference on the reflux, because being hunched back has a bad effect on the diagraph, which can arise the reflux. Patients should avoid wearing tight clothes and heavy lifting is not recommended. Both things can place extra pressure on the abdomen. Surprisingly, stress is a major cause of reflux, personal stress, performance stress and physical stress. Extreme tiredness, also, can contribute to reflux. If a reflux patient is dealing with a lot of stress it is recommended to attend yoga classes, seek “mind healing”, exercise or seek homeopathy. Homeopathy has been proved to have relaxing effects on patients, and work especially well for acid reflux patients.
[ii] Melanie A. Mitrano, “Treating Acid Reflux in the Professional Singer,” Journal of Singing, 57, no. 4 (2001):3.