British Association for PERFORMING Arts Medicine
Vocal health: What to do if you have a problem
Introduction
Professional voice users who experience vocal health problems need clinical assessment and support from a range of voice-specialist professionals. These practitioners may include a laryngologist, speech therapist, musculoskeletal experts such as a physiotherapist, osteopath or registered massage therapist, plus mental health support from a psychotherapist and technical input from a specialist vocal rehabilitation coach. BAPAM can help you plan the care you need. Read our guidance below, and if you need further help and advice, including information for your NHS GP, please get in touch.
Guidance produced by Mr. Declan Costello (ENT), Mr. Nick Gibbins (ENT), Ms. Tori Burnay (SLT), Ms. Linda Hutchison (VRC), Mr Dane Chalfin (VRC), Mr Ed Blake, (Physiotherapist)
The literature on dysphonia demonstrates that singers and elite voice users who present with voice disorders are most likely to have Muscle Tension Imbalance (MTI) rather than organic pathology or structural abnormality, and this is not always picked up in general ENT clinics, or even in all Voice Clinics. Ideally, MTI in singers is assessed via nasendoscopy by a Multidisciplinary Team (MDT) including a Vocal Rehabilitation Coach with experience/training in the assessment of the larynx and vocal tract in a wide range of singing styles. Such MDTs are available in the NHS in certain Specialist Voice Clinics, which have access to equipment including high definition cameras with stroboscopic or high-speed videos. The team in these clinics would normally include:
- Voice Specialist Laryngologist*
- Voice Specialist Speech and Language Therapist
- Vocal Rehabilitation Coach (Singing Voice Specialist)
- Performance Specialist Osteopath/Physiotherapist (in some clinics)
*Some Specialist Clinics are SLT-led with Laryngologist review.
Referral
There are many Voice Clinics in the NHS nationwide, but we recommend that, whenever possible, professional voice users, including singers, are seen in Specialist Voice Clinics as described above, where there is stroboscopy and access to a Multidisciplinary Team, or in a clinic that is led by clinicians who are highly experienced in caring for the professional voice and are knowledgeable about the multidisciplinary approach and optimal care pathways.
For all professional voice users, referral to an NHS Specialist Voice Clinic (or privately if waitings time are long and if funding is available), should be made for any vocal symptom lasting more than 2-3 weeks, or persisting for more than 2 weeks after the resolution of a viral or bacterial upper respiratory infection.
Direct referral can be made by the patient’s NHS GP to one of a list of NHS Specialist Voice Clinics (so that diagnostic tests can rule out any pathology and a multidisciplinary assessment can be made and appropriate treatment recommended). Recommended management might include rehabilitation by a speech and language therapist, a physiotherapist or osteopath, a psychotherapist or a VRC working as part of the clinic team under clinical supervision.
Recommended NHS specialist Voice Clinics include:
- Birmingham, Queen Elizabeth (Anita Sonsale ENT)
- Cardiff, Royal Glamorgan (Huw Williams ENT)
- Cardiff, University Hospital of Wales (Gareth Williams ENT)
- Doncaster, Royal Infirmary (Jane Shaw SLT)
- Dublin, St Vincents , Mr Mark Rafferty (cross border referrals from Northern Ireland accepted)
- Fife, Victoria Hospital (Mr Richard Steven ENT)
- Glasgow (Mr Stuart Robertson, New Stobhill, Greater Glasgow and Clyde)
- Liverpool, Royal Liverpool and Broadgreen University Hospitals (Mr Webb – ENT, Sally Dennis SLT and Jo Clayton SLT)
- London, Guy’s/St Thomas’ (Yakubu Karagama – ENT led, and Tori Burnay – SLT led)
- London, Lewisham (Nick Gibbins ENT, Tony Aymat ENT, Rehab Awad SLT)
- London, Royal National ENT and Eastman Dental Hospitals (John Rubin ENT, Jonathan Fishman ENT)
- Manchester, Wythenshawe (Paul John McKenna SLT, James Smithson SLT)
- Newcastle, Freeman (Natalie Eastwood SLT)
- Nottingham University Hospitals (Julian McGlashan ENT)
- Slough, Wexham Park (Declan Costello ENT)
Who to refer
BAPAM recommends that the following groups of patients presenting with voice problems should be referred to NHS Specialist Voice Clinics:
- Elite Performers (professional singers, actors, broadcasters, etc.)
- Studying Performers (FE, Undergraduate and Postgraduate singers and actors)
- Quality of Life Performers (amateur singers for whom singing is their primary means of socialising, such as older local choir members)
Examples of Relevant Presenting Voice Problems
- Loss of range, power, flexibility
- Pain, fatigue, hoarseness
- Gaps in range, delayed onset of phonation
- Increased recovery or warm-up time
- Chronic throat-clearing, sensation of lump in throat (globus).
Patient Outcomes
- Faster recovery times due to accurate diagnosis and specialist treatment, saving time and money in the long run
- If organic lesions are present the patient can be listed for surgery immediately or referred for Speech Therapy and then reviewed
- Functional disorders will be referred for Speech and Language Therapy and/or Vocal Rehabilitation
- Musculoskeletal disorder will be referred for Osteopathy/Physiotherapy
- Psychogenic disorders will be referred to Speech and Language Therapy and onwards to Psychology/Talking therapies as appropriate
- Most patients will be referred to more than one of the above.
Vocal Rehabilitation Coaches
The Vocal Rehabilitation Coach (VRC) is agreed by vocal health experts to be a vital part of the rehabilitation team. This is a highly specialist singing coach who works with patients as part of a clinical team within a Voice Clinic and/or has a significant relationship with a Voice Clinic and receives referrals from a clinician. The generic term ‘Vocal Rehabilitation Coach’ is not protected by law, and anyone can call themselves a VRC: there are no legal requirements for any specific level of qualification or experience. There is also no professional body to oversee their practice, so, should it be necessary, patients will need to complain directly to the individual.
To provide some confidence in practitioners calling themselves VRCs, we have created competencies for the BAPAM VRC, and our senior clinicians will review applications from interested applicants. The BAPAM VRCs will have met BAPAM competencies and agreed BAPAM’s Code of Practice and will have clinical supervision from a voice specialist Laryngologist and SLT and, ideally, a psychosocial professional. A BAPAM VRC can only provide rehabilitation post diagnosis and under clinician supervision. They cannot provide laryngeal manipulations which must be carried out by a trained clinical professional. They should not operate as a BAPAM VRC outside this context.
All VRCs have signed the Educators Code of Practice.
We list all vocal health clinical practitioners on our Directory, and, to avoid confusion, we have listed our VRCs on this webpage.
Vocal Rehabilitation Coach list:
VRCs are listed in alphabetical order (by first name)
Besfort Williams
Profession
Vocal Rehabilitation Coaching
Regions Covered
London
Location
Westminster, London
Registration, insurance and DBS checks
Current insurance and DBS status unconfirmed – we advise you to check these details with this practitioner
besfort.williams@hotmail.co.uk
Mobile
07581052739
Besfort Williams is a Vocal Rehabilitation Coach (VRC) and an experienced singing teacher who has worked in professional Musical Theatre training institutions since 2013. As a VRC he has worked with the clinical voice clinic team at Guy’s Hospital, developing expertise in coaching singers rehabilitating from a range of voice disorders.
Carrie Birmingham
Profession
Vocal Rehabilitation Coaching
Regions Covered
North West
Location
Primarily across the Liverpool area for private 1 to 1 bookings. Also available for group bookings across the North of England and North Wales.
Qualifications/registration
Ba(Hons) Popular Music and Drama and Theatre Studies; Post-Graduate Certificate Vocal Pedagogy; Master of Arts Vocal Pedagogy; Level 4 Teaching Children and Young Adults; Level 4 Vocal Health First Aider; Level 6 Vocal Anatomy; 4th Year PGR Student, School of Music, University of Leeds
Registration, insurance and DBS checks
Current insurance and DBS confirmed
Website
Mobile
07708021327
Carrie is a hearing-impaired alt-rock singer-song writer, vocal teacher, voice and hearing sciences researcher, and BAPAM approved vocal rehabilitation coach. She runs a private singing school, Pro Vox based in Liverpool over-seeing a team of 4 singing teachers. Carrie began her private teaching career in 2009 alongside initial work with local education music services across primary, secondary and sixth form music and arts courses. She most recently joined the singing teaching team at the Arden School of Theatre Manchester as a Singing Lecturer, since recently being a Senior Pop Vocals Lecturer at Leeds Conservatoire for 5years.
Clients working with Carrie feature all ages, all contemporary genres including extreme vocals, songwriters, actors, public speakers, and artists involved in tours, cruise work, national and televised singing competitions.
Alongside teaching and assessing, Carrie is part of the multi-disciplinary voice clinic team at the Royal Liverpool and Broadgreen University Hospital Trust, ENT department, assisting professional voice users undergoing speech-language therapy and singing rehabilitation.
Since completing her MA in Vocal Pedagogy with Voice Study Centre she is now a 4th year part time PhD student at the School of Music, University of Leeds. Carrie originally studied Popular Music and Drama Theatre
As a performer she has fronted acoustic and rock band line-ups performing across the UK at diverse function events and receiving airplay on radio and underground festivals with original music written with her unsigned grunge-rock band between 2015-2020.
Roles: Director – Pro Vox Vocal Training Liverpool; Vocal Rehabilitation Coach – Liverpool Professional Voice Users Clinic; Singing Lecturer – Arden School of Theatre, Manchester; Vocal Health Assessor – Vocal Health Education; Conference Director – Association of Teachers of Singing
Dane Chalfin
Profession
Vocal Rehabilitation Coaching
Regions Covered
London, Central London, North West, Online/Telephone/Remote
Location
London/Manchester
Registration, insurance and DBS checks
Current insurance and DBS status unconfirmed – we advise you to check these details with this practitioner
Website
Dane Chalfin is a Vocal Rehabilitation Coach with over 20 years of Performer-Specialist Multidisciplinary Voice Clinic experience, who works exclusively with high-level professional performers (both singing and spoken voice) and complex voice disorders, His special interest areas include muscle tension dysphonia, vocal fold lesions, psychogenic voice disorders and pre/post-operative rehabilitation.
Dane’s clinical research into the endoscopic interpretation of vocal mechanics and Vocal Rehabilitation has been presented internationally and appears in numerous publications. He is currently the Vocal Rehabilitation Coach at the Performers Clinic at Guys Hospital in London.
Dane routinely works with West End and international theatre productions, TV/Film actors, recording artists, transgender performers, and other vocal coaches/singing teachers who want to begin working as part of a Voice Clinic.
Please note: Dane does not accept clients for Vocal Rehabilitation who have not been seen in a Specialist Voice Clinic for diagnosis first.
Consultations are available in London, Manchester and online.
Dr Jenevora Williams
Profession
Vocal Rehabilitation Coaching
Regions Covered
London, Central London, South East, Online/Telephone/Remote
Address
London / Guildford
Qualifications/registration
BAPAM VRC Competencies
Registration, insurance and DBS checks
Current insurance and DBS confirmed
All voice users suffer from ill health at some time. Jenevora works with singers who are recovering from injury, or just singers experiencing a problem with their voices. Her approach is always through the biopsychosocial lens; everything is connected and there is never one single cause for a voice issue. As a regular member of the team in an NHS multidisciplinary Voice Clinic, she has an ongoing understanding of vocal health and healing. Jenevora’s work is embedded within the multidisciplinary, holistic Voice Care Centre. The centre provides singers with joined-up treatment and care, working as a team to support the process of rehabilitation beyond just recovery. She is also a director of Vocal Health Education providing professional training internationally in vocal health and rehabilitation. Jenevora spent many years working as a professional opera singer, this lived experience combined with her years of research and training give her a unique insight into the demands of the professional voice user.
Linda Hutchison
Profession
Vocal Rehabilitation Coaching
Regions Covered
London, South London, South East, Online/Telephone/Remote
Address
London, Lewisham / Sidcup
Qualifications/registration
BAPAM VRC Competencies met
Registration, insurance and DBS checks
Current insurance status unconfirmed – we advise you to check these details with this practitioner
Telephone
020 8302 3778
Mobile
07425 160 031
Linda Hutchison is a specialist Vocal Rehabilitation Coach and singing teacher working privately and as part of the pioneering NHS Multidisciplinary Voice Clinic team at Lewisham Hospital. Her coaching work with singers addresses pre and post-operative voice problems, muscle tension imbalance, breathing problems, related emotional and psychological issues. Linda was a professional singer for many years before taking up teaching so she possesses a wealth of practical knowledge of the profession.
Michael Vickers
Profession
Vocal Rehabilitation Coaching
Regions Covered
London, East London, Online
Location
Tower Hamlets, London
Qualifications/registration
BMus in Vocal Studies; MMus in Opera; BAPAM VRC Competencies
Registration, insurance and DBS checks
Current insurance and DBS confirmed
Telephone
020 8167 4775 (via BAPAM)
Michael Vickers is an experienced singing teacher and Vocal Rehabilitation Coach (VRC), who works with many students and professionals in the performing arts. He works collaboratively with the specialist Voice Clinic team at Lewisham Hospital as a VRC, and privately. He is the Head Tutor of Singing at Italia Conti, and studied Vocal Studies and then Opera at the Guildhall School of Music & Drama.
Michael specialises in coaching support for adult professional singers and performing arts students in Higher Education who rely on singing for their studies. In terms of musical styles, he specialises in ‘theatre singing’, specifically, classical/operatic singing and musical theatre.
Michael helps singers with functional vocal disorders, typically after they have been seen in a multidisciplinary voice clinic and have been advised it is suitable to return to singing. The focus of his work is often translating the vocal coordination found in therapy into a singing-specific context. The coaching aims to help singers avoid further injury, optimise vocal function, and reduce inefficient behaviours in their singing. This typically involves; singing exercises, release techniques, and performance coaching.
Pippa Anderson
Profession
Vocal Rehabilitation Coaching
Regions Covered
North East
Location
Sedgefield / County Durham / Newcastle / Middlesbrough / Gateshead
Qualifications/registration
BAPAM VRC Competencies
Registration, insurance and DBS checks
Current insurance and DBS status unconfirmed – we advise you to check these details with this practitioner
Website
Mobile
07825301 873
Freelance Voice Coach and Singing Teacher with specialist skills in Vocal Health, Vocal Rehabilitation and Performance Anxiety. Pippa is the Vocal Rehabilitation Coach at the NHS Freeman Hospital Voice Clinic in Newcastle.
Sarah Wright-Owens
Profession
Vocal Rehabilitation Coaching
Regions Covered
Wales, West Midlands, Online/Telephone/Remote
Location
Birmingham, Shropshire and North Wales
Qualifications/registration
VRC, BSC(HONS)SLT
Registration, insurance and DBS checks
Current professional registration, insurance and DBS confirmed
Website
Mobile
07855 950 393
Sarah Wright-Owens works at the University Hospitals, Birmingham in the Professional Voice Users Clinic. She sang professionally for many years before qualifying as a Speech and Language Therapist. Sarah is currently a visiting specialist lecturer at the University of Birmingham and the Royal Birmingham Conservatoire. She works in a private practice in Birmingham city centre, Worcestershire and Shropshire. She has had many years experience teaching and rehabilitating singers.
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