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Are any of these voice health items new to you?

It’s almost never mentioned. 

Have you ever heard or read that the state of your mouth and teeth can affect your voice health?  Me either.
 
Turns out that large armies of good and bad bacteria and viral ‘nasties’ fight vicious wars in our teeth, mouths, noses, and throats, and in our ears and on our skin.  They are waaay microscopic, of course; never visible to the unaided eye, but with an electron microscope….  [Hmmm.  Make a great cartoon series with Night on Bald Mountain in the background, eh? (This last sentence was written in the Canadian language, which I am now studying…just so you know.)]
 
Some context for deep understanding.  The noses, ears, eyes, and teeth-containing mouths of us human beings are huge entryways for “non-us stuff” to get inside our bodies (e.g., foods, liquids, airborne chemicals and particles, microorganisms like bacteria, viruses, fungi). [The word microbe is an abbreviation formicroorganism.]  Non-us stuff gets there in the air we breathe, the food we eat, the liquids we drink, and anything that gets in our eyes or ears, on our lips, or in our noses or mouths, (like fingers, pencils, and such), or between our teeth. 
 
The absolute first line of defense against those non-us ‘evildoers’ is the mucus that coats the surfaces of all our internal spaces (our upper and lower airways).  Mucus ‘arrests’ those evildoers and puts them in a flowing mucus-jail so that cells of the immune system have many opportunities to execute them before they ‘get us.’  Well, the mucus-jail needs to be abundant and thin so it can flow ‘real good.’  It needs to have a lot of water in it to be thin enough to flow right.  If the jail doesn’t have enough water, the mucus gets thicker and more adhesive to the skin surfaces.  That makes it easier for the bad guys to escape jail and hurt us.
 
The two major ways that infective (pathogenic) microbes are spread from person to person are:
 
1. air, e.g., infected people exhale or cough them into surrounding air, then uninfected people inhale them into their airways (noses, mouths, throats, larynges, lungs) and…
 
2. touch, e.g., infected people cough or exhale them into surrounding air (or they cough them onto their hands or their clothing) and they fall onto nearby objects (computers, cell phones, carrying cases, desks, chairs, and the like).  And then…uninfected people touch the “infecteds” or hug them, or touch the objects they’ve coughed upon, and then rub their own clothes or eyes, wipe their lips, and the like.  [Some of those nasties may remain alive on some surfaces for as long as about 1.5 hours.]
 
Also, when we eat and drink, microscopic ‘films’ of the food/drink contents attach onto our teeth, and larger bits can become embedded in the “nooks and crannies” of our teeth.  Then, Some of the biochemicals that are in our mouths begin to break those films-and-bits down.  Over enough time, they rot (in a manner of speaking) and can be an attractive environment for various microbes.  So…when we swallow, and when the mucus that coats our airways moves around, a lot of non-us stuff gets moved onto the surface tissues of our throats where viral microbes have a chance to attach themselves onto our local cellular ‘machinery’ and start reproducing themselves and spreading.  And, the bad bacteria have a chance to embed themselves in those tissues and colonize and spread in them. 
 
But then, (cue strong trumpet fanfare) cells of our immune system charge in and marshal gazillions of ‘non-us-fighters.’  They send out biochemical signals (immunotransmitters) to prepare the infected tissues for battle by producing inflammation.  Blood vessels (usually capillaries) that feed the infected area dilate (expand) and that opens microscopic-sized ‘holes’ in the vessels that are big enough to allow plasma fluid (containing cells of the immune system) to leak into the infected tissue (producing what we refer to as swelling), but are not big enough to allow red blood cells to pass through (vessels have to be ‘crushed’ for bruising to happen).  [Note: The suffix -itis only means that inflammation has happened.  The word that -itis is tagged onto indicates the anatomic area in which the inflammation has occurred, thus gastritis, appendicitis,  and colonitis and so on.] 
 
Typically, we have upper airway infections (nose/mouth openings to vocal folds).  But…if enough of those bad guys make their way into our trachea and lungs, they have a chance to infect our lower airway. When our throat area becomes inflamed we may say we have pharyngitis.  If the vocal fold area becomes inflamed and we sound hoarse, we say we have laryngitis.  When we have inflammation in the bronchi of our two lungs, we say we have bronchitis
 
Bacteria have very short lives, but they reproduce themselves rather rapidly.  When they subdivide, their genes create copies of themselves.  But bacteria adapt their genetic expression to the environment in which they live.  So, the genes of bacteria that are more successful at reproduction even when they have encountered antibiotic killers over time, their progeny will become adapted and resistant to the antibiotic killers. 
 
HERE ARE THE THE VOCAL HEALTH WHAT-TO-DOs:
 
Eye Health:  When touching your eyes (or mouth), use the backs of your hands/fingers.  Fronts of hands are much more likely to have live ‘evildoer’ microbes upon them.
 
Ear Health:  Placing objects like hairpins, cotton swabs, or paper clips into your ear canals to clear them, puts your ears at risk.  Vulnerable soft tissues, e.g., an eardrum, can be abraded or ruptured, and the objects may then deposit bad-guy microbes and other materials (e.g., allergens) into your ears to increase the risk of infection.  Microbes can then grow into your middle ear area, and that could bring on big trouble.
 
To clear your ears of wax buildup and nasties:
 
·      Gather:  a small syringe, two facial tissues, a pool of warm water in a clean sink, and a bottle of hydrogen peroxide.  It’s cheaper and more effective than brand name over-the-counter (OTC) stuff.
 
·      With a fairly small amount of hydrogen peroxide in the syringe, lean your head to one side so that your ceiling-pointed ear is nearly level with the floor that you’re standing on.
 
·      Fillyour ear canal with the hydrogen peroxide.  It will ‘fizz up a storm’ as it loosens the wax.  If de-waxing hasn’t happened in a while, let ‘er fizz for a while.
 
·      When you think it’s fizzed enough, turn your ‘upper’ ear down to dump the liquid into a facial tissue, or some other absorbent material, then use it to clear your external ear of the excess. 
 
·      Fill the syringe with the warm water, lean over the sink so the treated ear points down toward it, and then irrigate that ear with pretty good pressure about three times.  Some bits of earwax will 
       likely fall into the sink’s water.  Use the tissue again, to clear your external ear of the excess water.
 
·      Repeat with the other ear.  If de-waxing hasn’t happened in a while, you may have to irrigate about every three days or so, to get eventually a satisfactory clearing.
 
Teeth and Mouth Health:  Dentists call it oral hygiene
 
A major preventative for upper and lower respiratory infections (and for halitosis—bad breath) is brushing and flossing our teeth daily, and using a non-alcoholic mouthwash afterward (check labels). Alcohol in mouthwash contributes to a drying of the mucosal skin surfaces.
 
1. Mouthwash is for swishing around in the mouth onlyno gargling with it.  Too much of a chance of killing off immune system cells and ‘good’ bacteria in the throat that help keep the infective bacteria in check.  After the swished mouthwash-only is spit out, wait a short while and then swish water around in the ol’ mouth to dilute what’s left, spit that out, then swish more water and do what my voice education colleague from California, Lisa Popeil, calls a “deep gargle,” that is, allow the water into your throat as deeply as you can without triggering a gag reflex.
 
2. Try swishing and gargling with warmed water.  The ‘soothe’ can feel good.
 
3. If you add salt to water before you gargle it, add only a small thumb-to-forefinger pinch of it to reasonably match the small degree of salinity that’s in your mucus.  I’ve heard and read recommendations to add a teaspoon of salt to a glass of water and stir it before gargling.  That’s waaaaay too much salt and it becomes an irritant to your mouth and throat tissues. 
 
Nose Health:  If you are ever afflicted with chronic thickened mucus in your nasal cavity, especially if you feel that it flows down the back of your throat (sometimes called post-nasal drip) and it interferes with your breathing and singing, one way to clear it is to:
 
1. Purchase:  (1) a Neti pot at a Health Food Store or a Drug Store (Apothecary Shop) and (2) a supply of a liquid that can be used for nasal irrigation (ask a Pharmacist).  The liquid is mostly water, but it is prepared in such a way that it approximates the ‘thin flowability’ (viscosity) and salinity characteristics of normal human-produced mucus. 
 
2. Pour an appropriate amount of the liquid into the Neti pot, and then follow the provided directions for pouring the liquid into one of your nostrils so that it flows into your nasal cavity and then drains out.  Repeat by pouring into the other nostril.  Nasal clearing is then achieved.  Afflicted people rave about the help that nasal irrigation provides.
 
General HealthStop frequent use of antibacterial hand soaps for hand washing.  Wide use of antibacterial soaps has resulted in mutations of ‘bad,’ infective bacteria that are resistant to our common medical remedies such as penicillin.  Personally, I use antibacterial soap only when my hands have been in contact with some potentially nasty stuff, like garbage or cleaning old dirty/dusty places.  Nearly all my hand washing is with regular soaps…for whatever that’s worth.
 
Ahh, choices and adaptations; the adventure of life.
 
[Coming later is an update of research info about Hydration: The Well-Watered Body]
 
Replies (3): Threaded | Chronological
on November 9, 2010 8:42am
Hi, I can attest to the benefits of nasal irrigation, though I don't use the Neti Pot. I use a product called "Neil Med," which was given me by my ENT. The water used has a special mixture (available at drugstores), which is contained in a pre-measured packet, consisting of sodium chloride, sodium bicarbonate, eucalyptus oil, aloe vera extract. This mixed with a measured amount of warm distilled water (though tap water is possible, but not recommended) has helped me a lot.
I wonder if any reader has a remedy for the adverse side effect of steroid-based inhaled asthma products, like Advair or Symbicort? I cannot talk, much less sing, when I am on this type of treatment (and the treatment usually lasts 6 -8 weeks). I try a high dose of guaifenesin but that is not helping enough.
on November 10, 2010 8:56pm
Excellent post, Richard!  I wasn't familiar with the NeilMed product (NeilMed® Pharmaceuticals) that your ENT had recommended, so I went to my neighborhood Walgreens Drug Store this evening and bought one.  I bought the SinuFlo® Ready Rinse™ delivery system with premixed fluid irrigant in a 'large volume' plastic bottle with a 'low pressure' spray nozzle on the top.  NeilMed also produces their specially designed version of a Neti Pot (NasaFlo® Neti Pot) for those who prefer a 'gravity flow method' of nasal irrigation.
 
The outside of the packaging says that the product is a "therapeutic and preventive saline nasal irrigation, moisturization, and daily nasal hygeine system."  Two of the refill packets that you described so well are included.  Also, an informative booklet about the ancient practice of nasal irrigation, and about the product's benefits and use, are included in the package.  Anatomical drawings in the booklet help illustrate the benefits of nasal irrigation to:
  • the whole nasal cavity and its three turbinates (located on the right and left sides of the nasal cavity),
  • the several paired sinuses that empty into the nasal cavity [the paranasal (maxillary, ethmoid), frontal, and sphenoid sinuses, as well as
  • the end-areas of the right and left eustachian tubes that drain from the two middle ear cavities into the back of the nasal cavity.
I have not yet used the product (I will in the morning), but based on what I've seen and read, I recommend the NeilMed products.
 
Richard, I'm in the process of contacting a few of the ENTs that I know for further info about the effects of steroid-based inhaled asthma products on vocal tissues, conditions for which they are prescribed, their appropriate use, and possible alternative meds.  When I get the info, I'll post it here.  Meanwhile, be well and keep up the good work that you do.
Leon
on November 11, 2010 11:09am
Hi Leon, I am simply addicted to the sinus rinse from Neil Med. Amazing, how simple the thing is. When I had some surgery to remove polyps on the septum, ca 1995, I had to irrigate with an ear bulb syringe, not bad, but nothing like this.

On the other subj. I have tried Advair, Symbicort and Dulera. Advair helped with the breathing but destroyed my speaking and singing voice. ENT did the laryngiscope and found excess mucus on the vocal folds, but no evidence of permanent damage. I went off the Advair, and within three days got my voice back. Then as the season changed, breathing took another dive, so I am now on Symbicort. When taken with guaifenesin, the buildup of mucus on the vocal folds is somewhat lessened, but I still cannot sing. The Dulera had bad side effects. Next on the list (after a month long treatment with these so-called LABAs, i.e. Symbicort) is a new steroid product called Alvesco, which claims not to cause dysphonia.
We'll see. I am told that for allergy related asthma, there is only one known treatment: steroids. Albuterol inhalers won't help with the allergic inflamation. They are bronchial dialators (sp?).

PS I even tried prednisone in the liquid form. Again, helped with the breathing, but shut down my voice.

Rick

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