Dear Dr. Jahn: My daughter, a musical theatre major and beautiful vocalist, is scheduled for submucous resection of the inferior turbinate and possible septoplasty soon due to turbinate hypertrophy. Her ENT surgeon suggested a laryngeal mask as we raised concern over intubation and her vocal cords. He said she would not need packing. I am still petrified that she will end up with empty nose syndrome or her voice will be altered negatively.
She will start rehearsal for a show 12 days post-op. Is that enough time for her nose to be clear enough to sing? She feels that this will give her better nasal resonance. I would appreciate any advice you could offer. Reading posts from other patients’ experiences is making me want to have her call the whole thing off.
Dear Reader: I appreciate your concern but, based on the information you sent me, you need not worry. A submucous resection of the turbinates does not remove them, it just reduces them in size. Empty nose syndrome usually occurs after the inferior turbinates are removed completely, which is not what your surgeon is proposing. You didn’t tell me how old your daughter is—I’m assuming she is a young adult. In children or young teens, I tend to be more conservative, since the nose is still growing and changing in shape. But once the nose has reached its adult dimensions, any correction of nasal blockage such as your doctor is proposing should not adversely affect the voice. In fact, as I wrote recently, it may improve her ability to place the voice into the mask and improve both the proprioception and sound of the voice.
—Dr. Jahn
Dear Dr. Jahn: I saw your article in Classical Singer and thought I would contact you about my daughter. She is quite accomplished in her classical singing and hopes to pursue vocal studies at boarding arts school, college, and beyond. She has struggled with strep throat infections over the last two years, as many as 8 to 10 in the last 18 months. We have been told that a tonsillectomy would be helpful for her overall health. We are all worried how this may impact her singing. Everything from the risk of injuries from the endotracheal tube, the effect the removal of the tonsils will have on her tone (which is very nice and distinctive), and the ability to heal and return to her previous vocal strength, among other things, has been deliberated. I am sure there are other risks that we haven’t even considered. Your expert advice and input would be most appreciated. Thank you so much.
Dear Reader: Based on the information you gave, I agree that your daughter would benefit from a tonsillectomy. Providing that this is done by a surgeon who understands the singer’s anatomy, she should have no problems. Intubation for anesthesia is important for this kind of surgery to protect the airway. In this regard, you should have a look at the chapter “Anesthesia for Singers” in my book The Singer’s Guide to Complete Health.
In terms of your daughter’s general health, chronically infected tonsils represent an ongoing burden on her immune system, one that may continue for years—recurrent infections and other morbidities that impact negatively on school attendance as well as vocal performance.
—Dr. Jahn
Dear Dr. Jahn: What is the procedure for using GORE-TEX in replacing a vocal fold? Successes and failures?
Dear Reader: GORE-TEX is a plastic mesh material. It is used to medialize the vocal fold in cases of vocal fold paralysis, where the fold cannot move and the patient had an incompetent glottis.
The GORE-TEX sponge is inserted through a window made in the thyroid cartilage. It is then used to push the paralyzed vocal fold in toward the middle, so the opposite fold can contact it on adduction. In this way, glottic competence is restored. The usual indications for such surgery are hoarseness and aspiration of food or liquids, where the vocal folds had failed to recover with time and therapy.
GORE-TEX is one of several implant materials that are used for vocal fold medialization. It is quite successful when used correctly and for the right indication. I cannot, however, comment on whether the singing voice can be restored by this procedure.
—Dr. Jahn
