Hello Dr. Jahn,
I have been a longtime subscriber and reader of Classical Singer magazine, and have really appreciated all of your health articles every month. I am coming to you now with a specific question [because] I thought [that] of any doctor in the United States, you might know the most information.
My father, [who is] not a classical singer but loves singing Brooks & Dunn music on the boat, recently developed shingles. The nerve that the shingles affected not only gave him temporary paralysis of his left arm, but his left vocal cord. His voice is terribly raspy, as expected with only one cord being used during speech, and the doctors have informed him that it may take six months to a year to get his voice back to normal, if ever. As you can imagine, it has been terribly disheartening and discouraging news for him.
With your expertise, is there any piece of knowledge you might have on this subject? Is there a type of procedure to restore the use of his left vocal cord in a more timely manner? And since he is a successful businessman, and talks with clients every day on one vocal cord, is that healthy, or is he doing more harm in the meantime?
Shingles is caused by the chickenpox virus, and usually affects nerves to the body surface (cutaneous or sensory nerves). It doesn’t normally affect the cranial nerves, such as the one that moves the vocal cords.
My recommendation is that your father be examined to look at the status of his vocal cords. If one side is completely paralyzed, i.e. no movement at all, he could have an electric study (laryngeal EMG) to see whether the function might return. If there is no evidence of return, he could have some material temporarily injected into the vocal cord (such as a tiny bit of fat) to plump it up, and allow the mobile cord on the other side to make better contact. This would improve his voice. Longer-term treatments are available in cases of permanent paralysis, but this might be a good start.
I don’t know where your father lives, but he would do best to see an otolaryngologist who specializes in neurolaryngology (movement problems of the larynx). I can make recommendations in several states, if you like.
Dr. Jahn
Dear Dr. Jahn,
I enjoy your segments in Classical Singer and the vocal health-related advice you give to singers. Now I am writing you to ask for some advice, but not health-related. I would like to know what path—in terms of education, clinical experience, etc.—is to be pursued to become a laryngologist, one with an emphasis on helping singers.
After starting as a physics major, I graduated summa cum laude with a B.M. in vocal performance. Recently, I graduated with a master’s in voice.
All throughout my studies, I have been very active in the schools’ performances. I was always quite successful dramatically, but vocally, I never quite blossomed. During my master’s studies I switched from high baritone to tenor, and the change hasn’t been easy. For a while, I’ve been seriously thinking [about] how I might serve opera in a different way.
What advice would you give? Is there a need for laryngologists who were/are singers and have performing experience?
I realize this would involve many more years of study, but I love being a student and I’m not afraid of a lot of hard work. At 29, I am a little older than most medical school students, but being single with no kids, I don’t have the burden of providing for a family. And I do have the support of my parents.
Thank you very much for all your help.
Your question is unusual, but I am happy to outline what you would need to do to become a laryngologist. First, you need to complete four years of medical school, followed by an internship. Then, you need to continue into a residency in otolaryngology—the area that generally deals with problems in the head and neck area. After that, you could start to develop a subspecialty interest in laryngology. Most physicians at this stage opt for a one- or two-year additional fellowship in laryngology.
Some physicians who are not otolaryngologists specialize in “performing arts medicine.” Despite its catchy name, this is not really a specialty, since it deals with areas as diverse as the pianist’s hands, the ballerina’s feet, and the singer’s throat. Most “performing arts medicine” specialists are physiatrists, specialists in physical medicine and rehabilitation.
A shorter and possibly effective approach might be a career in speech pathology. A number of speech pathologists specialize in the singing voice. This would require a graduate degree, followed by some additional training in working with singers. Yet another direction would be to teach voice, but get additional training in “vocology,” a recently established course of study for voice teachers that gives additional training in vocal anatomy and physiology. The NATS website may be able to direct you with this.
Dr. Jahn
Dear Dr. Jahn,
Your column is so detailed and helpful. Thank you so much for that.
Have you ever heard of a singer having what seems to be muscular pain in the back/top of the throat after singing? It’s as if the soft palate itself (or the back of the tongue, or both) has somehow been strained. Is that even possible?
ENTs have assured [me] that there are no laryngitis, reflux, or pathological considerations present. Also, I am not a belter. A stroboscopy looks normal.
I’d be very grateful for your insight, even your guesses and possibilities!
Since your ENT exam was normal, I would assume that the palate is moving symmetrically and well, and that you have no problems with changes in the nasality of your voice (either more nasal or less nasal). So, it sounds like muscle strain. The areas I would look at are: new repertoire, a change of Fach, a new teacher or new technique. Also, are you singing more now, or in a venue where you need to push the voice more (longer performances, louder accompaniment, etc.)? A neuromuscular problem is much less likely, but if you get other muscle pains or fatigue, you should see a neurologist.
I can refer you to someone in New York, if you are in this area.
Dr. Jahn
Dear Dr. Jahn,
I have lost my top for the past two weeks. I have no throat pain, but if I try to sing in my upper range, I cannot get a single sound out (except for wheezy air). Surprisingly, this has happened to me several times before, but it only lasted a week. I was worried when the week deadline passed, and so I went to a doctor on Wednesday. He diagnosed me with chronic rhinitis (chronic postnasal drip). He prescribed me a nasal spray called Nasacourt (some kind of steroid).
He also told me it would probably take another two weeks before I can get my voice back. I looked up chronic rhinitis and found out that it can last as long as a few months. I was wondering, how many other singers suffer from this, and what they do about it.
Can you give me a few pointers on how to take care of my voice right now, as well as some pointers on how to try to avoid the rhinitis from happening again?
Rhinitis and postnasal drip are common, and normally do not cause the symptoms you have described. Did the doctor look at your vocal folds? It sounds to me like you have some swelling that prevents the folds from approximating and thinning out (i.e. loss of flexibility) at the high range. Other possibilities, such as a hemorrhage, can only be ruled out by laryngoscopy. It is also possible that you have strained the muscles (muscle tension dysphonia).
While treating the drip is great (I normally recommend a Neti pot to wash out the nose, and a nasal spray such as Flonase), you also need to treat the larynx. I suggest you see a doctor who deals with singers (a laryngologist), and try to figure out why you lost your top notes. It would be unusual for this to result just from a drip.
Good luck!
Dr. Jahn
