Q: I am a Young Artist at the Metropolitan Opera. I have just finished my third year. I have had severe allergies for the last week, resulting in a slightly swollen left vocal cord. My doctor prescribed three tablets of Prednisone (20 mg. each) to be taken once a day for three days. I am on vocal rest for two days in the hope of singing an audition on Friday and Saturday. I have canceled all other auditions and lessons this week.
Is it dangerous to sing while taking this drug? I will warm up and sing two to three arias on both Friday and Saturday. My last dose of Prednisone will be taken on Friday afternoon. My doctor seemed unconcerned.
A: It shouldn’t be a problem for you to sing on Prednisone, especially since you are not singing a “run” of many shows. If you do have recurrent allergies, however, I would recommend an allergy evaluation and more consistent management. If the allergies are rare and really only an issue at times like this, you should be fine with a couple of Prednisone pills.
Q: I am a singer living in the New York City area. I enjoy your column in Classical Singer very much and have gleaned lots of useful information from it over the years.
I am wondering if you can give me some advice regarding dentists. I have a very real phobia of the dentist and need to have some work done. I can’t find a dentist who understands both the fear and my being a singer.
Are there any dentists who specialize in performers and understand the voice? I find the whole dental experience frightening because it is so closely linked to my voice. I am afraid of having my face, throat, or jaw permanently affected.
My current dentist, I am sure, is a fine dentist for the general population, but he has no understanding of singing or why this is so scary to me, and so dismisses my fears.
I greatly appreciate any recommendations or advice you can give.
A: Many people have phobias about dentists—you’re not alone! As far as specific issues related to singing, routine dentistry doesn’t pose any risks to the voice. The one thing you should be aware of is that holding your mouth open for a prolonged period of time for some dental procedures can put a temporary strain on the temporomandibular joint. The issues are actually more significant for some wind players, such as flutists, where changing the orientation of the front teeth can affect the embouchure.
If your phobia is about dental surgery, you should consider taking a mild tranquilizer before the procedure. It really should have no effect on your voice.
Q: You mentioned in the [August] issue of Classical Singer that laryngeal muscle tension can result from inflammation of the mucous membranes. This is interesting to me because I believe damaged laryngeal tissue due to LPR [Laryngopharyngeal Reflux] has interfered with my vocal production for quite some time. Although the LPR was brought under control long ago, the healing of damaged tissue seems to be a very slow process. I have actually been able to feel the difference over the course of many months as “patches” of damaged tissue are restored.
This is the first time I have heard a laryngologist address this particular phenomenon and I would like to know more specifics. For example, is it the stiffness or swelling in the tissue that affects muscle movement, or do other factors come into play? Has anything been published about this particular topic, and do you have any suggestions for further reading?
A: I am not aware of anything that has been published, although I may have missed some of the literature—but this has been my personal observation (so it’s possibly an unpublished and new theory): LPR, which causes inflammation of the pharyngeal mucous membranes, seems to create a reflexive irritation of the underlying muscles. I would not, however, extrapolate from that observation that it can cause permanent structural changes, such as scarring of these muscles.
I am glad you are getting better. In addition to careful vocalizing, you may wish to consider laryngeal massage to relax the muscles, especially those that elevate the larynx: above the hyoid and along the floor of the mouth.
Q: I am a 49-year-old tenor (spinto, I would say) and I have recently been put on injectable testosterone therapy (testosterone enanthate) for very low testosterone levels due to “andropause.” I must confess, I had not the faintest clue what andropause was, and my internist explained it was essentially the male version of menopause. In all events, I have noticed, since being on testosterone therapy, that my voice is at times unpredictable, unmanageable, and what I can only describe as not the voice I know.
I have tried to do extensive research into the effects of testosterone therapy and the male voice, and the closest I could come was a note in the medication monograph stating that side effects (for women) can be a thickening of the larynx and thickening of the vocal folds.
Would this “side effect” hold true for men as well? Do I have any recourse?
It is extremely difficult to sing through the passaggio—a problem I never had before—and sometimes I simply cannot turn the tone over at all. Any thoughts you may have would be welcome and very much appreciated.
A: Testosterone therapy is normally more a problem for higher female voices, but if you have a higher lyric tenor, I can understand why testosterone therapy might cause problems. One effect of testosterone is to bulk up the muscles—this is why athletes take such drugs. So if your muscles are increasing in bulk, you may have a problem with the larynx at the point where muscle activity is highest: just below the passaggio. Also, going into head voice involves thinning and stretching the vocalis muscle, which may also have changed in bulk.
Have your doctor check your testosterone levels now to see if you are in the normal range or above. Other side effects of testosterone you might notice are increased body hair, increased perspiration and underarm wetness, and increased libido.
I think the problem with the larynx most likely is related to changed muscle mass and not to thickening of the vocal fold epithelium. Your choices would be to cut back on the testosterone or to re-work your passaggio to accommodate to the increased bulk of the laryngeal muscles.
Q: One of my very enthusiastic college freshman students has been diagnosed with mononucleosis. I know that the symptoms include sore throat, fatigue, fever, and swollen, tender lymph nodes. I also know that it is contagious and that it takes about six weeks to be completely over it.
As her teacher, I am wondering whether it’s OK for her to proceed with lessons if her throat doesn’t hurt at the time, or if it would be better for her to just drop lessons this semester (which would be very upsetting to her). Also, as a professional singer with engagements coming up soon, I am always concerned about my own health. Should I be concerned about teaching her (assuming I am not up in her face or touching her, but merely spending time in the same small studio)?
A: Infectious mono is contagious, and is spread through physical contact, saliva, etc. First, for yourself, I would just get a blood test for Epstein-Barr virus titres. Most likely you have had it already and should be immune. If the titre is negative for you, I would be careful. For your student, if she feels OK she can continue lessons, but don’t push—some cases go on to Chronic Fatigue Syndrome.
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.
