Voice Rx: Birth Control, Tylenol and Breath Support?

I was listening to a podcast from NATS (National Association of Teachers of Singing) this week and was surprised when I heard that Dr. Robert Sataloff was being interviewed. He is a special physician because he has his Doctor of Musical Arts in Vocal Performance from Combs College of Music in addition to being an otolaryngologist and a musician, which peaked my interest immediately. I am sure that others know of him already, but this was news to me and it made me excited. I couldn’t wait to hear the questions that the NATS group had for him.

This chat was on the subject of performing arts medicine and care of the professional voice. The first question raised was in regards to PMS. I immediately thought back to voice changes that Moya Andrews talked about around “that time of the month” in one of her books. The doctor said to consider avoiding any diuretics or water-shedding pills when you are about to start your period. Why? Because during the pre-menstrual time, the vocal folds are swollen, like other muscles in your body, with a protein-bound edema fluid which will not be expelled by a diuretic. The only thing that taking these pills would do is strip the essential epithelial lubrication on your vocal folds and make them more susceptible to damage from overuse and misuse. The swelling remains until the woman’s period has finished. His recommendation for the few days prior to your period beginning? Stay hydrated. I’m thinking, yeah….let’s add more fluid to the mix….Mucinex will not compensate for the benefits of hydration, but it might help you thin secretions when they are too thick. You should avoid any bloating pills if you are a professional voice user. He also recommends in some extreme cases that birth control pills can help with avoiding that fluid overload altogether by hormone regulation.

Next he addressed pain killers. Ibuprofen and aspirin were discussed in detail in regards to the effects on the voice, but the consensus was that Tylenol or any acetaminophen was usually safe for the vocal performer. Ibuprofen (Advil and Motrin) thins your blood and puts you at risk for vocal fold bleeding for only about 24 hours. For the time the drug is still in your system, you should be careful not to strain or overuse your voice. Aspirin, he warned, is even more dangerous to the professional voice because its effects last 7-10 days after just popping one pill. It interferes with platelet function, so it increases the bleeding risk for a person. He also says that if your blood vessels are already dilated and delicate (ie you are about to begin a period or are sick with laryngitis or a cold) and then you consume ibuprofen or aspirin, you are at very high risk for hemorrhage of the vocal folds. Old types of birth control pills with high doses of hormones used to cause some consumers to lose part of the upper vocal register and when pills were ceased, the voice returned to normal. New BC pills, though lacking formal studies, don’t seem to be having that dramatic of an effect on the voice because they contain much lower amounts of hormones. He warns women to be wary of birth control pills containing androgens (male hormones), as they may lower the pitch of the voice.

He discussed vocal fry with one listener. This is the way a Kardashian speaks, with a low, guttural creak at the end of almost every utterance. We categorize our voices within 3 registers or physiological frequency ranges: modal (normal)– falsetto (high)– and fry (lower). For modal register, the vocal fold vibratory cycle contains vocal folds spending an equal amount of time open as they spend closed. Falsetto produces sound with the vocal folds barely touching or not at all. Vocal fry is different. Vocal Fry produces sound with a very long vocal fold contact time. Here, the majority of the sound production time is spent with closed vocal folds. It is this constant contact in combination with the pressing that causes the vocal fold damage and makes this a vocally abusive behavior. Most of the time, Dr. Sataloff says, people are using poor breath support when they utilize the fry register. I know I find myself doing it when I’m lying in bed on the phone or when I’m tired.

When a person presses, he or she is squeezing the muscles of the larynx to make sound instead of letting the breath do the work. He reminds us that most of the time, using vocal fry is abusive to the vocal folds.

He also discussed the importance of diaphragmatic breathing and body awareness to treat MTD or Muscle Tension Dysphonia. He encouraged relaxation awareness to improve outcomes for professional voice users and even gave a “shout out” to Speech-Language Pathologists and singing voice specialists and our important role in treating this disorder in speakers and singers.

This was a nice breath of fresh air about voice and medicine and I am thankful this was shared on a twitter account I follow.


Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on vocal health to area choirs and students. She also owns and runs a mobile videostroboscopy and FEES company, Voice Diagnostix. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders, and a member of the National Association of Teachers of Singing and the Pan-American Vocology Association. Knickerbocker blogs on her website at  www.atempovoicecenter.com. She has developed a line of kid and adult-friendly therapy materials specifically for voice on TPT or her website. Follow her on Pinterest, on Twitter and Instagram or like her on Facebook.


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