Dear Dr. Jahn: I am a 34-year-old light, lyric soprano. During the past two years, I’ve had continual problems with my voice. To begin with, I have a deviated septum from a bone spur caused by facial trauma, and a runny nose from allergies every day of my life. Approximately two years ago I began to have recurrent sinus infections about every three to four weeks. After about a year, my ENT was able to help me get these infections under control, so I no longer experience them on a monthly basis.
Even when I am well, I take mucus thinners and use saline, and Nasonex and Astelin prescription nasal sprays. For the past year, I have had recurrent hoarseness and a roughness to my voice somewhat reminiscent of a pop singer—which I am not. About nine months ago, my ENT diagnosed acid reflux that was irritating my throat behind my vocal cords. We’ve tried several prescriptions including Nexium and Previcid. I’ve adjusted my eating and drinking habits and sleep on an incline.
Two weeks ago, my ENT diagnosed a cyst on my vocal cords while I was experiencing extreme hoarseness. He increased the Previcid Solutabs to twice a day and added Tagamet and Mylanta Supreme at bedtime. I am very aware of (and practice) healthy vocal habits such as adequate water intake, limited caffeine, and rest. In addition, I have been reassured by my voice teacher that I am not singing in a manner that is harmful to my voice (although, I may have begun to try to compensate for my vocal difficulties from the cyst—before I was aware it was there—in ways that could eventually be harmful to my cords).
As soon as I learned of the cyst, I began vocal rest. The cyst did shrink considerably in about 10 days, but it was still present. I am, understandably, becoming increasingly frustrated with treatments that are not giving me the complete relief I need in order to continue pursuing professional, classical singing without fear of causing further damage. I appreciate any additional advice and insight you can provide.
Dr. Jahn responds: It sounds like you have been getting good medical care. The idea of a cyst is worrisome, since these do not normally shrink, even with good medical treatment. I would suggest that you get a second opinion, with videostroboscopy, to make sure this is a cyst and not a polyp. If you do have either of the two, you may very well be using your voice with excess muscle tension to compensate. It really should be treated more definitively.
—Dr. Jahn
Dear Dr. Jahn: One of my university voice students has been complaining of severe allergies all semester. She’s been too hoarse to sing, and even when her voice got better and her speaking voice was mostly clear, after a few vocalises it became apparent to me that she shouldn’t be singing right now. I sent her to an ENT who said her cords were OK and gave her the OK to sing, but [said] her tonsils need to come out and that’s why her throat and neck are so sore. She says she is no longer hoarse (I haven’t heard her, we’ve been e-mailing).
I’m wary as I don’t know her ENT or whether he knows much about singers. I’m concerned that even without hoarseness, she may develop some bad habits to compensate for the soreness, and possibly develop nodes. My instinct is to suggest that she drop the course, get her surgery ASAP, and we’ll continue next semester. Being a highly motivated student, she will of course be reluctant to do this. Are my fears well founded? Are there circumstances in which a singer with a sore throat can continue to sing?
Dr. Jahn responds: The real question here is, are her tonsils responsible for her hoarseness? The usual story with chronic tonsillitis (see “Your Tonsils: A Singer’s Primer,” October, 2006) is that patients get recurrent sore throats, especially when their immune systems are run down. So if your student gets sore throats, and then tries to sing using compensatory muscle positioning to get the voice out, leading to hoarseness, maybe having her tonsils out would be reasonable.
Is she hoarse when trying to sing with the sore throat? Or is the hoarseness unrelated to her sore throats? If hoarseness follows singing with a sore throat, and sore throats are a frequent occurrence, having the tonsils out may be a useful option. If the two are unrelated, a tonsillectomy might not help.
—Dr. Jahn
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
