Vocal fatigue in professionals: from symptom to management

In many cases, the diagnosis of vocal fatigue is based on the individual's reported symptoms, such as increased tension with continued voice use and relief after vocal rest.

Symptoms like hoarseness, dysphonia, and voice quality alterations typically appear in more advanced stages. The onset of dysphonia often indicates a more serious disorder. The timbre of the voice may change—becoming metallic, breathy, hoarse, strained, nasal, tremulous, etc.—or may become very deep, sharp, or excessively high. Sometimes, the voice loses its usual volume, becoming flat, weak, and monotone. In other cases, the voice breaks or disconnects, suddenly shifting from normal tone to "falsetto".

However, it is also possible for the larynx to appear normal despite signs of fatigue.

Phonasthenia may appear as an isolated issue or as a symptom of another pathology. It is defined as “pure” phonasthenia when there are no evident organic lesions justifying it. Otherwise, it may be associated with conditions such as cysts, Reinke’s edema, nodules, hemorrhages, polyps, contact ulcers, among others.

Physically, vocal fatigue manifests both as perceived effort during phonation and as a loss of muscular strength. The individual must be able to use natural vocal economy during speech and singing.

People affected by vocal fatigue need to learn to normalize their voice, finding melodic effects and subtle variations that enhance their vocal performance based on their personal needs.

Clinical and epidemiological studies have so far indicated that vocal fatigue is one of the most frequent and disabling symptoms. Up to 80% of teachers may suffer from vocal fatigue which, when combined with other symptoms, can lead to a loss of work capacity.

Voice professionals, such as singers, are engaged daily in long rehearsals and extended performance seasons. For this reason, it is essential to provide them with sufficient resistance to vocal fatigue. In the world of singing, there are various factors that increase fatigue, such as shifts in vocal range (tessitura) toward lower or higher registers—often caused by incorrect vocal classification; singing on vowels that cause excess horizontal tension in passaggio notes and in the upper range (e.g., closed vowels); producing open vowels on or above the passaggio notes; excessive use of chest voice in the female register—common among mezzo-sopranos and contraltos when trying to reinforce the lower range; and the absence of proper breath support, which causes inexperienced singers to push their sound and lose expiratory control.

For exhaled air to maintain the necessary sound pressure, there must be no tensions or limitations in the respiratory mechanism. Therefore, it is necessary to adopt correct posture that allows the respiratory act to function freely. During inhalation, the abdomen moves forward, and during exhalation (phonation), it contracts to provide the necessary air to maintain subglottic pressure.

This costodiaphragmatic mechanism is what allows the greatest air intake, as it mobilizes the lungs from their base. The amount of air inhaled must be adapted to the phrase to be spoken or sung. Too much or too little air limits the voice. When there is not enough air to complete a phrase, the larynx compensates by closing (reducing its diameter), thereby compressing the vocal folds. Habitual constriction can damage these structures.

It is important to prevent fatigue or avoid reaching that point. Speaking with tension results in a weaker voice, whereas speaking in a relaxed manner produces a different voice—flexible, fluent, and expressive. It also provides greater and improved communicative ability. Tension breeds tension, and this reduces vocal capacity. Moreover, prolonged vocal work demands this relaxed manner of speaking, otherwise fatigue will set in easily.

A well-trained osteopath specialized in voice will be able to monitor the entire phonatory system, from breath support to final emission, balancing all structures so they can work in a synchronous, harmonious, and ergonomic way.

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Valentina Carlile - Osteopath specializing in Osteopathy for Voice and Speech Disorders since 2002. For information and bookings, visit the Contact page.

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