Dear Dr. Jahn: I always enjoy your column “The Doctor Is In,” but I was particularly interested in two comments you made in the January 2010 column.
1. You wrote to “Fish”: “We do know that breathing through an open nose increases the compliance of the lungs—i.e., makes them more flexible and effective.”
2. You wrote to “Impatient”: “Typically the larynx elevates when there is reflux disease . . . ”
Could you point me in the direction of references for these? I would be very interested to read further on both these points.
—Sally Collyer, Melbourne, Australia
Dear Ms. Collyer: Thank you for your kind comments and your interest. Regarding the nasal breathing, this was described by Drs. Joseph H. Ogura and Theodore E. Walsh in St. Louis, I believe in the 1960s or ’70s. Ogura called it the “nasopulmonary reflex.” He found that, most likely through a nervous connection, breathing through the nose increases the compliance of the lungs. I don’t have the specific article reference for you, but there were several articles written on it, and you should be able to find them.
Now, the elevated larynx: This is based on my own personal clinical experience, which is yet to be written up. I consider reflux to be one of the many factors (along with other causes of pharyngeal irritation, such as bacterial pharyngitis) which cause the larynx to rise. The mechanism, I believe, is one of irritations of the mucosa and the underlying muscles, which causes the supralaryngeal muscles to contract. You can check this yourself by palpating the thyrohyoid area in refluxing patients.
It is of course only one mechanism causing a high larynx. Passive elevation can occur after prolonged voice rest and, of course, active elevation occurs with inappropriate vocal strain.
—Dr. Jahn
Dear Dr. Jahn: My mother recently got a scan of her skull to determine the cause of her frequent sinus headaches. Her doctor told her that she is actually missing a pair of sinus cavities and that this condition, although rare, is not unheard of. My question is could this condition be hereditary? If so, what (if any) health problems could this cause for a classical singer? Thank you very much for your answer.
—Curious Soprano
Dear Curious: The sinuses are basically air-filled cavities in your skull. They are connected to the inside of your nose, often by rather narrow passages. For sinuses to develop properly, these passages must be open to allow the flow of air into the sinus.
Different sinuses develop at different times during childhood. The frontal sinuses (in your forehead) are often not fully formed until you are 18. Also, the sinuses, although they are paired, are frequently of different size and shape on the two sides. If you have had a lot of nasal infections, or the passage from the nose is blocked, a sinus may be smaller or (in the case of the frontal sinuses) never form at all.
None of this has any effect on your voice. How your sinuses develop is “inherited” only in one sense: if you have inherited a lot of allergies or are prone to chronic nasal infections as a child, your sinuses simply may not fully form. But the actual size and shape of these cavities is not inherited and, again, has no bearing on your voice.
—Dr. Jahn
Dear Dr. Jahn: How long will a young woman’s voice continue to grow? What are the factors affecting how big a voice will get? My daughter is just a few months shy of 15. She has a fairly large and well developed voice for a 15-year-old. But we have been told that because of her petite, slender 5’1” frame that her voice will probably not get large enough to be very competitive after the age of 18.
What are your thoughts on this?
—Concerned Mother
Dear Concerned: A number of factors can affect how long a young woman’s voice continues to grow, some developmental and some technical. Developmentally, the voice will continue to grow for some time after menarche, and the best rough guide to whether she is “fully grown” would likely be bone age, which can be checked with a simple X-ray to look at the epiphyses (the ends of the bones). Of course, a fully grown young woman can be petite and slim, or tall, or more robust in size. The best indicator would be to look at the parents.
Typically, teenagers grow in their trunk and extremities first, and the head assumes its adult dimensions last.
Since the size and resonance of the voice relates not only to the size of the thorax (trunk) but also to the length of the vocal folds and the size of the resonating cavities above them, full growth can take several years.
Now, the technical side. While the voice may be fully developed in terms of sheer power (i.e., lungs and vocal folds), it can continue to change in color and even Fach for many years during a singer’s development. It is, for example, not unusual for mezzos to start with lighter roles, such as Cherubino and then, over time, move to the heavier mezzo roles. The lighter soprano voices (like the soubrettes), in my opinion, do reach their full adult voice earlier than the more complex or dramatic ones. Like wine, voices can be fresh and fully developed early, or can take many years to mature and unfold.
I hope this helps to answer your question.
—Dr. Jahn
