Hello Dr. Jahn: I’ll be having stomach surgery in the coming months, and my surgeon has offered, while she’s at it, to repair my “very small” (they tell me) hiatal hernia, apparently by simply attaching my stomach to the underside of my diaphragm so it no longer can push up through. Is there any reason to be concerned about this affecting my voice or vocal production/support system? Do I need to worry that such a surgery will somehow change the way my diaphragm functions?
—Seeking Support
Dear Seeking: From your description, it sounds like your surgeon would just attach with a suture the side of the stomach near the esophagus to the diaphragm. I am not an abdominal surgeon, but the way I visualize this, it should not affect how your diaphragm moves. But I would ask her your question, and also ask her whether she thinks your small hiatal hernia is contributing to your symptoms—is it being repaired to improve how things work, or just incidentally? I suspect you will have some postoperative problems with support until things heal, which may take several months. —Dr. Jahn
Dr. Jahn: I’m a soprano living and singing in Los Angeles. I’m sure you know about the several wildfires burning in Southern California [letter of Oct. 2007 – ed.]. I’ve been very lucky so far; my town is far enough away from the various fires that I haven’t been evacuated, nor have any roads near my home been closed. However, the air quality has been bad. Because of the Angeles National Forest fire (the one closest to my house) the air has been thick and smoky.
I’ve followed the air quality warnings and stayed inside on the worst days. However, just from small excursions outside, my nostrils are burning and my throat is itchy.
Besides the obvious (staying hydrated, following instructions. and staying inside on bad days) what else can singers do to ensure vocal health during the wildfires? Thanks so much for addressing this issue. —Smoky Soprano
Dear Smoky: You are doing the most important thing, which is staying indoors as much as you can. If you do need to go out, you could consider several preventive measures. First, spray your nose with saline before heading out. The best would be Ayr saline gel spray, an aqueous saline that is more viscous than just salt water and would protect your nasal lining better. If the air is particularly bad, consider wearing a mask—a cloth mask made damp with water would be the best way to catch any particulate matter in the air. On returning indoors, you should irrigate your nose with more saline, using a commercial nasal wash or a neti pot.
Regarding your throat, try to breathe through your nose as much as possible, to filter the air that reaches your vocal cords. If you feel tightness or even wheezing, consider an asthma spray such as Albuterol. If you are prone to asthma, you may want to try Singulair tablets, although these take a bit longer to kick in than the inhalers.
Don’t forget to drink lots of water. This is converted into a protective film of moisture that covers your respiratory lining. —Dr. Jahn
Dear Dr. Jahn: I have read your articles in Classical Singer and appreciate your advice. I am preparing for graduate school auditions and scheduling the removal of my wisdom teeth. First, will having all four teeth removed have any effect on my vocal production? Secondly, the oral surgeon mentioned that after the surgery I am not supposed to put any excess pressure on my sinuses, such as blowing my nose too hard. For most people this would not be a problem, but does it mean that I will not be able to sing? If so, for how long? My teeth are not causing me pain now, but I don’t have much room and would rather have them removed sooner than later.
—Soon to Be Toothless
Dear Toothless: Removal of the wisdom teeth is usually done electively (rather than as an emergency), so if your oral surgeon thinks this may be useful, I would go along with that. Just ask why he recommends this: for crowding, potential infection, etc.
There are a number of potential complications for singers with this type of surgery that you should know about, and discuss with your doctor. They include (1) injury to the lower jaw nerve either from injection or from the extraction, (2) an abnormal opening into the maxillary sinus when the upper wisdom teeth are removed, and (3) prolonged TMJ dysfunction, either from the surgery or from keeping your mouth open during the procedure. The nerve injury specifically can leave you with prolonged or permanent numbness to the chin or lower lip. Of course, most of the time these things do not happen, but you need to be aware that any “routine” surgery can occasionally lead to difficulties. —Dr. Jahn
Dr. Jahn: I have a student in a group voice class who just revealed to me she is bulimic, wanting to know what effect that might have on her voice. Has there been any research on this? —Concerned Teacher
Dear Concerned: I have seen several singers with bulimia. I would first suggest that your patient seek the appropriate therapy for the bulimia, i.e. the psychological issues. In terms of the voice, the only concern I would have is the effect of the recurrent vomiting of stomach contents. There might be an issue with damage to the vocal folds if the acidic gastric contents are regurgitated over the back of the larynx, with resulting hoarseness. Acid irritation to the pharynx, with reactive contraction of the pharyngeal muscles, might also elevate the vocal apparatus and result in an abnormally high laryngeal position with all of its attendant vocal problems.
Damage to the teeth has also been described, I believe by Dr. Bob Sataloff. The acid can damage the enamel, and discolor and mar the frontal incisors. If your student has any other problems, I would be interested in hearing
about them. —Dr. Jahn
DISCLAIMER: The suggestions Dr. Jahn provides in these columns are for general information only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
