Dear Dr. Jahn,
Every time I have a gig, I worry that I will get a cold, or that my rehearsals leading up to the gig will wear out my voice for the gig. A friend told me that all my worrying could be causing some of my vocal problems! Could this be true?
-Sienna
Dear Sienna,
You touched on two different issues (stress and excessive rehearsals), but they are related. In general, worrying and anxiety are not helpful. While a certain amount of anticipatory excitement adds to the quality of your performance and makes it more “in the moment”, excessive worry distracts and detracts from your work. Not only does anxiety impede proper focus, but it makes you sing with more tension.
From the laryngeal point of view, this causes excessive muscle contraction, decrease in the resonating spaces of the vocal tract, and a squeezed, harder and smaller voice. If this sort of singing is only occasional, you should not damage your larynx, although you may find you have a sore throat, sore neck and shoulder tension after performing.
If singing with tension becomes habitual, however, you may develop vocal fold nodules from overly squeezing the vocal folds together, causing trauma to the vibrating edges and callus formation. Once these nodules form, you enter a vicious cycle: to continue to approximate the folds for singing, you will have to squeeze harder and harder to get your voice. Eventually, even with maximal “muscling”, the voice will start to break up, you will lose notes off the top, and even your speaking voice might become husky.
There are many causes for phonating with excessive tension, but certainly stress and worry are right there near the top. On a more general level, stress can interfere with concentration, sleep, and even weaken your immune system, all of which can negatively impact on your performance.
Regarding excessive rehearsals: some of this behavior may also be driven by stress, and you need to figure out why you “need to rehearse” more than perhaps your vocal folds would like. If the reason is to learn the music, by all means learn it! The best antidote to performance anxiety is to know your part cold. But learn the music (and words) in a way that is consistent with solid technique and smarter-not-harder practices as may be recommended by a good vocal coach – check out some of the excellent entries here at Singdaptive from the many coaches who contribute regularly. Analysis and understanding of WHAT you are trying to accomplish with your rehearsal is important – you only have a limited amount of miles on your vocal folds before the gig, so do not burn out with rehearsals.
Rehearsals are like Goldilock’s porridge: you shouldn’t under rehearse, but over-rehearsal is also bad: it not only tires you vocally, it also takes away some of the fun and spontaneity of the performance. While mindless repetition has a numbing, reassuring routine-like therapeutic effect, it comes with a price that your larynx may have to pay.
-Anthony F. Jahn, MD, FACS, FRCS(C)
This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.

Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton. He is Medical Director at Jazz at Lincoln Center, and former Director of Medical Services at the Metropolitan Opera in New York. Dr. Jahn has published several books for vocalists, including “Vocal Heath for Singers” (Singdaptive) and “The Singer’s Guide to Complete Health” (Oxford University Press).