It has been a number of years since I discussed acupuncture in this column. During those years, I have successfully incorporated acupuncture in my ENT practice. I have found that acupuncture is particularly beneficial for singers, and I often use it in conjunction with conventional medical treatment.
It is not easy to summarize how acupuncture works in just a few lines, since it is based on the philosophy of Traditional Chinese Medicine (TCM), which is quite different from our Western approach to patients with illness. In the West, we look at the illness as an invading entity that must be isolated, attacked directly, and eradicated. By contrast, the Chinese consider that the human body is generally capable of ridding itself of disease, provided it is strong enough and that the energy which animates the body can flow freely. The purpose of acupuncture, then, is to open the channels through which the body’s energy flows, strengthen the flow of energy and, in some cases, reduce excessive energy which might upset the balance of the body’s physiology.
There are many other forms of treatment in TCM, including herbs, diet, medical massage (called Tui Na), and exercise (Qi Gong and Ti Chi), and they all share the same fundamental goal: maintaining and restoring the balance and assuring that the energy flows freely to all parts of the body.
There are many reasons why acupuncture is still not generally used and accepted by Western doctors. Fundamentally, we don’t exactly know how it works. There have been hundreds of studies that try to link the effects of acupuncture to findings that we can measure: blood flow, increased immune defenses, electric changes in skin resistance, and visible changes on brain scans. But even as we continue to struggle with the “why,” the reality remains: understood or not, acupuncture simply works, and it does so for many conditions that we Western doctors either can’t treat or don’t treat effectively. I suspect our attitude has been a combination of intellectual frustration, defensiveness of what we know, and an unwillingness to admit that just because we don’t understand a phenomenon does not take away from the validity and effectiveness of that phenomenon. “I don’t believe in acupuncture,” says more about the speaker than about acupuncture.
Acupuncture is a particularly good treatment modality for singers, and for several reasons. First, the majority of problems in singers have to do with function rather than structure. Even some structural problems, such as vocal nodules, originate in abnormal function (excessive muscling). Excessive muscle tension in producing the voice (muscle tension dysphonia) is a technical dysfunction with multiple possible causes but is prevalent among even well trained vocalists. While the definitive cure lies in identifying the cause and reworking how the voice is produced, frequently a short-term and immediate treatment is also needed. Acupuncture is very helpful in this regard. Moreover, it doesn’t cause any side effects, such as dryness or drowsiness, which oral medications might. Acupuncture can also generally reduce excess muscle tension elsewhere in the body and, in this way, reduce or eliminate tension in the neck, jaw, tongue, and larynx.
Localized pain, such as in the neck and back, also has a way of increasing stress and neuromuscular tone, with negative effects on the singing voice. Abdominal muscle spasms interfere with support and smooth contraction during exhalation and voice production. I recall once being urgently called backstage to treat a singer who “couldn’t breathe.” I ran to the dressing room, expecting an airway emergency: instead, I found a healthy young woman bent over with menstrual cramps. Acupuncture can often relieve these symptoms without the need for analgesics and muscle relaxants. In a situation where a singer should not take NSAIDs such as aspirin or ibuprofen, acupuncture can be a fast-acting and simple alternative.
Stress is common among singers. Whether externally triggered (family issues, financial worries, job problems) or internally generated (performance anxiety, lack of self-esteem), stress can have a negative effect on focus, voice production, and general quality of life. Once again, medications, while often effective, can produce side effects, such as dryness and dulling of the affect.
Acupuncture is again a viable alternative, especially for specific episodes. It often has an immediate effect of relaxation: I have had many patients who go into a meditative, almost trance-like, state during treatment and feel relaxed and refreshed afterwards.
Psychosomatic conditions are also common among singers. There are many fascinating theories about why we somaticize stress, but the presentation to the doctor is frequently one of a physical illness with no apparent cause. As an example, I have over the years treated a number of patients (often singers) with difficulty swallowing. This condition, described as feeling a lump in the throat, is called “globus syndrome.” One such patient actually experienced food getting stuck in her throat and at times needed to regurgitate what she had just swallowed. Multiple examinations by GI specialists, X-rays, endoscopies, and aggressive reflux treatment were unproductive. To my surprise and the patient’s relief, after a single acupuncture treatment, the condition completely resolved. The patient was asymptomatic for several months and now returns periodically for a 20-minute acupuncture “tune-up.”
Finally, there are groups of patients who cannot take medications, for a variety of reasons. A common one is pregnancy and concern that the medication can cross the placenta and harm the baby. Or there may be an issue of allergies or interaction with medications the patient is already taking. Acupuncture can be useful in this group also, since it approaches the problem in a different way, and the therapeutic effect may be achieved without increasing the pharmacologic burden to the body.
I need to end this article with a couple of caveats. I am by no means suggesting an “either-or” approach to treating your health problems. Eastern and Western medicine are not alternative but complementary. No symptomatic treatment should be offered unless a reasonable diagnosis is first made. And for serious illnesses—whether progressive, multisystem, or potentially life threatening—Western medicine needs, at least for me, to be in the driver’s seat. But when your problem has been plausibly identified and has not responded well to Western medications, consider adding acupuncture to your treatment. Just remember: like Western medicine, acupuncture is only as good as your provider. Acupuncture therapists vary greatly in experience, training, and orientation—so if you have no success with one practitioner, consider a second opinion before abandoning this form of treatment.
