Dear Dr. Jahn: What effect do the tonsils—or the removal of the tonsils—have, if any, on the singing voice? I can feel my uvula when I sing, now that they are removed.
Dr. Jahn: The tonsils play an important and active role in young children—they help to acquire immunity for the body. In adults, however, they are inactive, usually rudimentary, and have no function. When these small and scarred tonsils are removed (hopefully for a good reason), there is usually no effect on the voice. When the tonsils are huge, however, often singers tell me they feel they have more room in the back of the throat.
Large tonsils, which are chronically infected, can encumber palate movement to a minor degree. When enormous, they can create a hyponasal, “hot potato” voice. Proper removal, in turn, can allow greater freedom and flexibility in the back of the throat. This removal must, however, preserve as much mucous membrane as possible, with minimal scarring of the base of the soft palate on either side. A surgeon who is familiar with the mechanics of singing should do it
Dear Dr. Jahn: I have a student who is a coloratura soprano and in her fifth month of pregnancy. She experienced severe vomiting and nausea during her first trimester and is presently demonstrating a huskiness much more apparent in her speaking voice than in her singing voice. She has been to see a laryngologist and has been diagnosed with GERD. The anterior portion of her vocal folds is clear but there is irritation and some swelling on the posterior portion. Her doctor prescribed Gaviscon but is understandably reluctant to prescribe any of the stronger prescription remedies. He has restricted her to one hour of singing a day and vocal rest as much as possible outside of that hour. She is entering the Masters Program in Vocal Performance at the university next week and I am wondering if you have any additional recommendations for her.
Is there any research out on the safety of Nexium or Prilosec for pregnant women? Should she be singing at all with irritated vocal folds? She is still able to sing clear, ringing unforced high E’s but has little stamina, especially in middle-voice singing. I very much appreciate your time and advice.
Dr. Jahn: I have several suggestions in response to your question. As you know, it is common to have reflux with pregnancy, and for your student it may actually increase into her seventh month, which is the time when the uterus presses up highest in the abdomen (after that, it starts to descend and protrude).
If she has had children previously, she may be more prone to reflux, due to previous stretching of the hiatus (the gap in the diaphragm between the abdomen and the chest).
She should certainly explore the use of one of the prescription anti-reflux medications, and information regarding their use in pregnancy should be available, either on the product insert, the doctor’s PDR book, or the pharmaceutical company’s website.
Your student should also consider singing in the morning, on an empty stomach, rather than after a meal.
Regarding her inability to sustain, this is not so much due to reflux as to decreased pulmonary function, due to the uterus pushing up on the diaphragm.
While many singers can sing through pregnancy, this depends not only on stage of pregnancy but body habitus (size of pelvis, size of uterus, how the baby is carried). The muscles and ligaments can also be more relaxed in late pregnancy (In rabbits, the ligament holding the two pubic bones together anteriorly actually becomes so loose that the bones separate to allow delivery!).
I would recommend continued singing, but within the limitations that her temporarily altered body allows. Please pass these suggestions on to your student, and have her discuss them with her obstetrician.
Dear Dr. Jahn: Inspired by the brief CS article about neti pots [August 2003, Suzanne Jackson], I trekked to my local health food store to buy a neti pot, brought it home, and followed the detailed instructions. Knocked over by a big wave while swimming as a child, I first felt the sensation of salt water in my nasal passages. With the neti pot, I rediscovered that sensation. It’s hard to imagine a more unpleasant daily cleansing ritual. Forcing salt water through my nose feels absolutely awful in every way. After the sordid ordeal is over, and the dust and impurities have been gently washed away, my mucous membranes protest at having been so impolitely violated, and react by producing more mucus. I actually end up more congested than before I began. It’s been over a month now, and I’m giving up. Some ancient yogi is having a good belly laugh at his practical joke.
Dr. Jahn: I’m sorry you have had problems with the neti pot. I have recommended it to my patients for years, and most of them find it very useful. A couple of suggestions for your next nasal adventure: Try to adjust the concentration of salt so it is neither too strong nor too weak. If in doubt, try buying physiologic or normal saline at the drug store. This has the same concentration of salt as your body fluids, and should not be irritating. Second, when you pour the solution into your nostril, tip your head both to the side and slightly forward. This will assure that the solution goes into the other nostril, and not into your throat or ears. Also, pour slowly! You control the flow with your hand. Your experience, while not unheard of, is not typical. Give it another try. If it doesn’t work for you, you may want to consult an otolaryngologist to see whether you might have a septal deviation, which misdirects the flow of the solution. And then, you can laugh back at the ancient yogi!
Dear Dr. Jahn: I think I’ve got a broken blood vessel in my vocal cord. I got it from working a 14-hour day, not eating dinner, coming home exhausted and then practicing for an hour. I noticed nothing strange except I didn’t sound very good. (Also, I was on my period and may have taken an aspirin that day.) I woke up hoarse and with a headache, kicking myself for being so dumb. Having been through this twice before, I know the remedy is vocal rest. I was hoarse for one day. I had sound the next but still did vocal rest. Today I tried the voice out very gently. It sounds fine but there is a little roughness on the E 10 notes above middle C. Obviously, I’m still doing vocal rest.
Dr. Jahn: Before you start singing again, you need to make sure that the blood has completely reabsorbed from the hemorrhaged vocal fold. This may take several weeks, so if you can’t see an ENT specialist, be sure you wait about a month before trying to sing. Also keep in mind that even if a doctor says your vocal folds look OK (i.e. no more visible blood), there is a period of persistent edema, which he cannot see, but you can feel and hear when singing.
That’s the short answer, I guess. The longer answer is, if you do have recurrent hemorrhage, especially in the same vocal fold, you may need to see a voice specialist ENT, and have the blood vessel treated with laser. This seals the blood vessels and will hopefully stop future hemorrhages.
Dear Dr. Jahn: I’m having a lot of depression and other symptoms, which are not being fixed with antidepressants. The doctor just tested my hormones because he told me this could cause depression. Result: estrogen was high. Progesterone and testosterone were so low, they were not detectable. He said this could be the reason depression is so resistant to therapy. He wants to supplement both the progesterone and testosterone. I remember reading that you said both testosterone and DHEA (which turns into testosterone) can lower the voice permanently even after discontinuing the hormone. My doctor told me he has women taking as much as 8 mg. a day of testosterone with terrific results and wants to start me on 1 mg. He claims this small amount could not possibly have an effect on my voice. I’m scared to take it. At what dosage does testosterone or DHEA become dangerous for a singer’s high notes? (I’m assuming progesterone is OK, since you haven’t mentioned it.)
Dr. Jahn: First, progesterone is fine, but synthetic progesterone apparently can metabolize down into testosterone analogs (one of the points in our “Pill and the Voice” article). The effects of both testosterone and synthetic progesterone are variable. Some of the variability has to do with your voice type (mezzos are less likely to be affected than high sopranos), and how receptive your larynx is to these hormones. The number of receptors varies, and there is no way of finding this out short of administering the drugs. It seems to me however that the change, if any, would be dose related, and thus a very low dose of testosterone might be safe, particularly in view of the positive effects that the treatment of your depression would have on your singing and your life.
The hormone story, incidentally, continues. A recent scientific article claims that most of the deleterious effects were due to older preparations with higher doses of hormones. It also suggests that a low-dose birth control pill is actually good for the voice, since it smoothes out and stabilizes vocal fluctuations due to the normal endogenous fluctuation of estrogen and testosterone during the menstrual cycle!
Disclaimer: The suggestions given by Dr. Jahn in these columns are for general information only, and are not to be construed as specific medical advice or advocating specific treatment that should be obtained only following a visit and consultation with your own physician.
