Allergic, dietary, chemical, stress, and hormonal influences in voice abnormalities

Abstract

Summary Allergic, dietary, chemical, biochemical, stress, and hormonal abnormalities have long been recognized as important factors in both abnormalities of the voice and in the general health of the professional vocalist. In recent years objective methods have become available to evaluate and treat allergic, dietary, and chemical abnormalities and to better understand the effects of stress and hormonal variations. Assessment of allergic disease is efficient and cost effective through the use of in vitro testing techniques combined with skin end point titration. This provides highly specific and objective results and leads to accurate planning of desensitization treatment. This form of treatment can be especially beneficial in the prevention of recurrent laryngitis. An accurate nutritional history provides evidence of food sensitivities that can lead to cyclical allergic-like vocal symptoms that can be prevented with the use of elimination diets and the judicious use of desensitization therapy. An adequate knowledge of the potential effects of chemical sensitivities will assist the patient in the avoidance of provocative chemical exposures. An in depth evaluation of biochemical abnormalities and a specific assessment of the nutritional status must be considered to evaluate the underlying causes of long-standing general health problems that can affect the voice. Likewise, hormonal variations are not only important in their direct effects on the vocal mechanism but in their cyclical effects on the patient's basic biochemical balance. Lastly, stress, which has long been related to problems in professional performance, is only now being fully studied to determine its actual biologic influences and these must be related to the causes of voice disturbances. Understanding all these influences and planning a rational and efficient evaluation of these potential problem areas are imperative in the complete care of the patient with voice abnormalities.