Dear Dr. Jahn: Last summer I was in a bicycling accident and pulled muscles in my upper back and neck. Additionally, 12 years ago, I fractured my left collarbone. Since the accident, I have had very significant back, neck, and shoulder pain. Additionally, at times I seem to pull or strain muscles around my larynx, all of which make it difficult to maintain good posture. More importantly, when the pulled neck muscles flare up, I tend to become a bit hoarse, and it becomes painful to speak and sing, all of which are reminiscent of the symptoms I had when I broke my collarbone.
I have had x-rays that show no broken or re-broken bones, although the x-rays do show that the clavicle fracture healed off alignment. Laryngoscopy shows that the vocal cords are fine. Despite all these “normal” findings, I’m in a lot of pain, and can’t really count on my voice. I’ve seen a shoulder doctor, as well as an otolaryngologist, but neither was able to give a definitive reason for these flare-ups, and the physical therapy I had over the summer seemed to exacerbate the muscle pain around my larynx as well as the hoarseness. Any thoughts about how I can proceed to get these symptoms under control? Any feedback would be much appreciated.
Certainly, a physiatrist would be helpful to work on the muscles. [Ed.: “Physiatry” is a medical specialty governing disease or injury caused by exercise, manipulation, or other physical agents.] The problem is, muscle tension often involves adjacent (even distant) muscles, so pain around the collarbone can cause splinting (a guarding-type contraction) of the muscles in the neck, and some of these muscles elevate and depress the larynx. The answer, assuming you have good vocal technique otherwise, is to get intensive physical therapy to the area of the original injury, the source of referred tension. This may involve physical manipulation, heat, or injections. As far as the neck goes, concentrate on relaxation. Alexander method may be helpful, as also frequent massage to the upper back and shoulder area. Keep in mind, there is nothing intrinsically wrong with the larynx, and this is a secondary problem, “referred” to the laryngeal muscles by adjacent muscles in the upper shoulder girdle area. Good luck to you!
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Dear Dr. Jahn: If a 30-year-old opera singer is diagnosed with otosclerosis and has a stapedectomy which results in loud tinnitus and worse hearing, how would you advise this person?
Hearing loss from otosclerosis can be managed in three ways. No treatment (observation) is an option if the hearing loss is not too great. If the hearing loss is on one side, you will probably hear your voice in your head on that side though. You could also try a hearing aid. These are quite tiny now, and they avoid any risk from surgery. The main problem with a hearing aid for singers is that it can shift its position if you open your mouth wide, as in singing. There is also a significant expense. It may, however, be still worth trying. Stapedectomy is also a very good option. In my experience, most patients do not develop loud tinnitus or a hearing loss after this procedure, although this is always possible. I have done stapedectomies on several singers; one singer (also a voice teacher) complained that when one of his students hit a particular note, the ear would resonate–this persisted for several months. If the stapedectomy is successful it gives the most natural quality of hearing. If you are considering this, ask the surgeon how many stapedectomies he has done and how many he does a year; try to find someone with a subspecialty interest in ear surgery.
If you have already undergone surgery and have been left with tinnitus (ringing in the ear), this is more difficult to manage. Normally, this improves by itself over time. Background masking sounds can be soothing and helpful. The best current treatment, however, is tinnitus habituation therapy, developed by Dr. Jastreboff at the University of Maryland. You can contact him in Baltimore for further information and a referral to someone in your area who can help you.
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Dear Dr. Jahn: I often lose my voice completely when I get a viral or bacterial sinus infection. I suppose my sinuses are draining down my throat. What can I do to prevent and/or minimize the effects of these infections? I simply CANNOT “sing over” my colds.
You may try to read a column I did on colds last year in one of the back issues of TNYON. Specifically, minimize catching the cold by drinking lots of water (all the time), taking Vitamin C (2000 mg a day, increase to 1000 mg per hour when a cold starts), and washing your hands frequently during cold season. Consider getting a flu shot. You can reduce postnasal drip by flushing your nose with lukewarm salt water 2-3 times a day, using extra nasal irrigator system. I recommend the “neti pot”, which you should be able to buy through any company which offers yoga-related supplies.
