Vocal disorders and the professional voice user: the allergist's role

As the modulating and power source for the voice, the upper and lower respiratory tracts play a key role in management of voice production. Allergic respiratory disease can impair vocalization, which can be a particular problem in the professional voice user.

The goal of this review is to facilitate the evaluation and management of professional voice users who have allergic respiratory problems contributing to their vocal dysfunction. This article discusses the anatomy and physiology of voice production, laryngeal pathology, and special diagnostic and therapeutic considerations relative to the allergist's role in treatment of these patients.

Mechanisms of voice production are reviewed, as well as common laryngeal pathology effecting voice production. Allergic respiratory diseases are summarized, with particular attention to those aspects of management that are altered in professional voice users.

Professional voice users require modification in their management to optimize vocal function and minimize abnormalities of the vocal tract. This includes avoidance of medications that produce drying of the airway, as well as avoidance of inhaled corticosteroids. Subtle changes in respiratory function, which may be of no consequence to other individuals, may adversely affect performance ability, and need aggressive management. Allergen immunotherapy, because of its lack of adverse effects on the vocal apparatus, is particularly well suited for treatment of professional voice users.

Allergists have an important role to play in management of the professional voice user. With careful attention to the unique requirements of these highly trained individuals, the allergist can enhance their performance ability while minimizing side effects from treatment.