Dear Dr. Jahn, I am a 27-year-old soprano and am now almost 4 months postpartum. My pregnancy and delivery were easy and uneventful. During my pregnancy I experienced perfect vocal health; I sang recitals, sang a show and did an opera workshop. I am breastfeeding and since the delivery I have run into a number of problems. I know there is a breastfeeding hormone that can effect the top notes—make the chords tight and not easily stretched, which I am experiencing. But the bigger problem is something else. Directly in my middle range, the B, C, C#, and D above middle C are rough, almost like radio static. I am wondering if you know anything about this and if I can blame the breastfeeding or the delivery on this problem. (I did groan like an animal during the delivery and was quite vocally tired and a bit hoarse for a couple of days.) My body has almost returned to normal, and I have been working diligently on my abdominal muscles to regain my support system. I have been offered a full scholarship to complete my Masters degree in vocal performance in the fall, and I am getting nervous about the condition of my voice. I did see an otolaryngologist about 6 weeks ago, and he could barely see down there but he saw a little inflammation and maybe a little bit of swelling. Could that be the breastfeeding? Is this a common problem? I am sure that other singing mothers would find it interesting.
—Name on file
Dr. Jahn: I don’t have a clear answer to your question, but do have some thoughts. Problems in the middle range may be due to swelling on the vocal folds. However, if your top is clear, the problem is more likely one of muscular incoordination. By this I don’t mean inadequate support, but more to do with the laryngeal muscle repositioning that is involved in the passaggio. My suggestion would be to undergo videostroboscopy with a good laryngologist to look for any incoordination in that range, and then you may need to work that part of the voice, even consider shifting your passaggio temporarily. Again, I am not a voice therapist, and these are just suggestions. The condition may improve significantly once you stop lactating.
Good luck!
Dear Dr. Jahn, I am a professional singer and voice teacher who has just moved to Arizona after living all my life (32 years) in the Southeast. Since coming to Arizona I have had problems with vocal fatigue and a bit of hoarseness that I have never experienced before. Flagstaff is at an elevation of 7000 feet and I am wondering if my problems have to do exclusively with the altitude, and how to combat them.
Last year I was diagnosed with Reflux, but was later told by a trusted ENT that the cords were dry but not refluxed. For this reason, he put me on Humibid and Vancenase. An ENT here in Flagstaff took me off those medications and back on Prilosec, and I’ve not sung very well since. Unless I’m missing something here with the altitude factor, I’ve almost decided to go back to the Vancenase/Humibid cocktail. Do you have any suggestions? I’m told that the folds are white and healthy. That is why I doubt the reflux idea. Any thoughts would be greatly appreciated.
—Name on file
Dr. Jahn: There are several vocal problems related to high altitude that you need to think about. First, there is generalized fatigue, related to the fact that there is less oxygen. Your heart has to pump harder to push the oxygen-carrying red blood cells around your body. Patients typically complain of fatigue and palpitations. After a few months, your body makes more red cells (increased hemoglobin), so this condition will get better. Secondly, it is difficult to sustain the voice, a problem which may be tied in with inadequate oxygen. Third, the air is often dryer than at sea level, and mucous membranes dry out. Based on what you have told me, I don’t think reflux is your main problem. Check your blood count, and start taking vitamins with iron if the count is low. Drink lots of water and try to stay humidified in your home. Good luck!
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.
