Question: I’m writing a paper on acid reflux because I have been diagnosed with GERD. What I don’t understand, though, is how the acid gets from the esophagus to the vocal folds to cause hoarseness and eventually even more vocal problems. Does the acid actually come all the way up the esophagus to the back of the throat and then actually drain down and reach the vocal folds?
Dr. Jahn: It is exactly as you say: the acid refluxes up the esophagus, past the upper sphincter of the esophagus, which is right behind the larynx. It is then believed to spill over into the posterior part of the larynx. This is why most reflux-related changes are posterior, over the arytenoids or between them. Acid can also pool in the pharynx, causing a sore throat, and even earache.
Question: I have enjoyed your articles in Classical Singer immensely. I am a 39-year old mother of six who has been singing since the age of 11. During my last pregnancy, I developed a hernia in my belly button and can really feel the separation of the abdominal muscles, which is worse than ever. Also, in the last four years or so, the asthma I had as an infant has returned. I am on Flovent, Ventolin, and Claritin, and take weekly allergy shots. I am wondering if the strength I had in my 20s will ever return, or am I simply too unwell physically to try to regain ground? I do notice near-pain when giving my diaphragm a workout, and I do not have the breath capacity that I used to have. (I have also lost E above high C and D also). Also, I do notice in the area of middle C to about F or so a kind of dry hoarseness that develops if I sing for more than an hour or so. Is any of this related to my physical deterioration? Thanks for your time.
Dr. Jahn: First of all, congratulations!! I am sure your children give you enough pleasure to make up for your vocal difficulties. Nonetheless, I would look into several areas. First, have a doctor (probably a general surgeon) check to see whether you have an abdominal (or umbilical) hernia. If you haven’t had any C-sections, this is less likely, and it may just be that the connective tissues have stretched a bit. If you do not need specific treatment (like repair of a hernia), consider wearing some kind of abdominal support when singing (like an elastic girdle), if this is not too restrictive. Secondly, you didn’t comment on whether you were overweight or not. If yes, try losing weight, and strengthening your abdominal muscles, using machines, crunches, etc. You should visit a health club or spend a few sessions with a personal trainer to give you an idea of which exercises would be most helpful. Third, the use of steroids long-term (Flovent has steroids) can weaken the muscles, although if you didn’t take them by mouth (like prednisone), this is unlikely. Do have a pulmonary function test done, however, since you may have a problem, which is not in the abdominal wall but the lungs themselves.
Question: I would like to say first that I have had a Classical Singer subscription for a little over a year now, and think your articles are an excellent addition to the magazine. You speak to every hypochondriac-singer’s heart! I am currently trying to collect some information about egg donation and the possible detrimental side effects it could inflict on my body and my voice. I’m a 22 year-old mezzo who’s pursuing a professional opera career. I am wondering if the treatments could darken my voice and if I would ever know if it was from the drugs or maturation. I don’t particularly want to put my body through this, even if it just means feeling ill for only a couple weeks or so, but my aunt is in need of an egg as a last ditch effort to get pregnant and I would like to help her out. Please let me know if you have any suggestions to articles, websites, etc. that AREN’T necessarily funded/hosted by egg donation centers. THANK YOU!
Dr. Jahn: I must say that, although I never pretended to be more than a laryngologist, most of the questions I get are in the Ob/Gyn area, which is clearly another part of the body. The short answer is, I don’t know. I would suspect that if they need to hormonally drive your ovaries to a greater degree than the normal ebb and flow of estrogen/progesterone during the menstrual cycle, there is a small chance of the voice becoming darker. Being a mezzo, you might notice this less than a light soprano would. A recent survey run on Classical Singer’s website, although not complete, suggests that even after taking oral contraceptives, not every singer’s voice darkens, and the change in voice is not always permanent. But that is not an answer to your question. I would suggest that you try to get on a website sponsored by the American College of Obstetrics and Gynecology, and follow the appropriate links.
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.
Anthony Jahn M.D., noted author and professor of clinical otolaryngology at Columbia University College of Physicians and Surgeons, has offices in New York and New Jersey. You can email him at Jahn@classicalsinger.net, or write him at Dr. Jahn, Classical Singer Magazine, P.O. Box 95490, S. Jordan, UT 84095.
