Dear Dr. Jahn,
I read your recent article in Classical Singer titled “Asthma: What Singers Need to Know.” My patient has moderate asthma and requires inhaled cortisone. She notes her vocal cords feel heavy and less flexible. She is a high soprano and notes her vibrato is slow. What suggestions do you have for her? I appreciate your comments.
I’m assuming that you can’t control her asthma with oral medications or non-steroidal inhalers. I’m also assuming that this is intrinsic asthma, and not one where allergic triggers can be identified and eliminated.
I would use QVAR rather than Advair. I would also use a steroid (if possible) that does not have any powder or chemical propellant, and I would ask her to use the inhaler only when absolutely necessary.
If she absolutely cannot avoid inhaled steroids, and you are convinced that this is the cause of her hoarseness, make sure she is well hydrated (8-10 glasses of water a day). She may also need to rework her technique using a bit more laryngeal pressure (vs. an open larynx and supporting the voice from below only). This kind of voice is more acceptable for musical theatre or popular music than it is for opera, however.
Also make sure that she doesn’t develop haryngolaryngeal candidiasis.
Dr. Jahn
Dear Dr. Jahn:
I have enjoyed your articles in Classical Singer and find some of them very helpful. However, in addition to how to avoid colds, we need to know what to do about the cold we’ve already caught.
I have had a cold for nearly a week: four days of sore throat, three days (and possibly more) of streaming nose, to be followed by up to two or three weeks of heavy chest congestion. Most of my colds last six weeks.
I have a gig in a month and there is no cover, no substitute singer.
How does one cope with a cold once it starts to run its normal course, which can take several weeks?
A few suggestions: Zinc gluconate (oral tablets or Zicam nasal spray) can shorten a cold and make it less severe. High doses of vitamin C (4 to 8 grams in divided doses) also help. Don’t exercise or try to “work through” your cold—let your body deal with it. Drink lots of water. Assuming your immune system works normally, you should be fine within a month. Don’t sing too much with your cold, since you may get into bad posturing habits that you will have to learn to undo later.
Dr. Jahn
Dear Dr. Jahn,
I have enjoyed your articles and would appreciate it if you could share some advice about orthodontics and singing, or suggest where I can find more information.
When I was a child, my orthodontic treatment included a palate spreader and then braces. I am now in my mid-twenties and faced with the possibility of additional treatment because my back upper molars (my wisdom teeth were removed) are tilting outwards towards my cheeks and do not make any contact with my lower molars.
My questions are threefold: How will orthodontics affect my singing (braces and wires across my palate between the molars)? If orthodontics are not successful, which is a distinct possibility, the teeth will eventually need to be pulled. How will that change the acoustics of my voice? And finally, does my childhood orthodontist have any ethical responsibility to fix this problem, since it was created by his initial treatment with a palate spreader?
Thanks for your help. My dental professionals have no experience with professional singers and are unable to provide adequate information.
Reading your letter, I would direct your questions about initial treatment not to your orthodontist, but your pediatrician. Many children have enlarged adenoids and are unable to breathe properly through their noses. These kids do not develop a normal hard palate, since the palate (which forms the floor of the nasal passages) fails to descend. The palate stays high and arched, requiring orthodontia and palate spreaders later on. Often, pediatricians will not refer these kids for adenoidectomy, telling parents that the child will outgrow the problem. By the time the adenoids have finally atrophied (often into the late teens, sometimes never), the palate is fully formed, and in a shape that requires orthodontic correction.
I don’t have the specialty expertise to specifically answer all of your concerns, and you might want to find an orthodontist or oral surgeon who has dealt with singers. It would seem logical however that if you have an appliance in your mouth, it will affect the resonance and possibly the articulation, depending on its size and its location within the oral cavity. If there is some discomfort associated with the orthodontia, it may also cause tension, and some TMJ dysfunction. Any muscle tension in the area can have a secondary effect on laryngeal position (the larynx may assume a higher resting position). This can be overcome with voice therapy. Having molar teeth pulled should have no effect.
Dr. Jahn
