All singers can name something about their voice that took hard work to master. What makes me different, however, is that for years my vocal challenges were unresponsive to such work, which puzzled my teachers and frustrated me. These problems, and other symptoms, were signs of something much more sinister: Chiari Malformation, a disorder that could have caused paralysis or even death. This potentially dangerous condition impacted both my life and my voice, and the journey of discovery and treatment has molded me into the singer I am today.1
Symptoms
Signs that something was not right began in my childhood. I ran into things for no apparent reason, which earned me the title of “klutz.” I was hopeless at activities like baseball and tennis—I could never hit the ball, no matter how hard I tried. I began ballet lessons at the age of four, and I stood out because I was so stiff in comparison to the other students.
Around the age of 14, I developed back pain. This problem is not uncommon in teenagers, particularly in those who, like myself, go through a sudden growth spurt. My spine was X-rayed, and everything appeared to be normal. I began chiropractic treatments, which seemed to help. When I went to college, however, not only did my back pain increase, but I also began to have frequent headaches.
The nagging problem during both my undergraduate and graduate work in vocal performance was tongue tension. Teachers gave me exercises to help the tongue release, but the muscle resisted. I went on a mission to roll the letter “r,” but it was futile. I recall one of my exasperated vocal coaches saying, “I don’t understand why you can’t just relax and sing!” I was particularly inspired to dig in my heels when a teacher told me, “You had better think about doing something else, because you don’t have the voice to make it. It has too many problems.”
Breathing was also challenging, because my back muscles were tight—they felt more like bones than muscles. To make matters worse, my left shoulder developed a posture that was lower and farther forward than my right. Heeding the advice of my voice teacher, I went to a therapist who administered massage and ultrasound treatments. She was puzzled why the muscles in my neck and in between my shoulder blades were so combative. These muscles had never experienced any type of trauma, and yet they were bundled into tight knots, as if they were protecting an injury. I took this information to a medical doctor who prescribed muscle relaxants, which did not help.
Singing through my upper passaggio and head voice register was infuriating; if I got through the second F above middle C with decent tone, it was a miracle. I was told, “You’re probably a contralto. Don’t worry if your top doesn’t come in right away.” But the problem was more than vocal immaturity. When I sang through the passaggio to the second G above middle C, the voice simply would not continue. Even a laryngeal scope could not solve the mystery.
Due to increasing and persistent back pain, my spine was X-rayed again at age 22, at which time scoliosis was discovered in my lower back. There had been no evidence of scoliosis on previous X-rays, and it is highly unusual for adults to suddenly develop this condition. I was told that my previous X-rays must not have been done properly or were not of the same area where the scoliosis had now been found.
As I began my doctoral degree at age 27, I continued to go to medical doctors with the same complaints and was told the same thing over and over again: my pain could not be as bad as I described, it was likely caused by too much stress, and I simply needed some muscle relaxants and anti-inflammatories (which never helped my symptoms).
My vocal shortcomings also remained. Like a typical “type-A” personality, I adopted a “this must just be the way that I am” attitude and worked harder and refused to give up. I was diagnosed with fibromyalgia at the age of 29 and sent to physical therapy. I worked with a wonderful massage therapist who insisted, “I cannot tell you what it is exactly, but there is something wrong with your thoracic spine. It doesn’t feel right.” Other bewildering symptoms also developed. At a routine eye exam, the doctor discovered unusually high pressure in my eyes. I was tested for glaucoma and other possible causes, but all results were negative.
At age 34, I arrived at my breaking point. During a grueling rehearsal schedule, I began to lose the ability to feel hunger and suffered frequent bouts of nausea. Debilitating back spasms literally brought me to my knees, and I began to lose feeling in my hands. I knew then that something was seriously wrong and that my body was begging for me to listen, and I did. I called a neurosurgeon, who sent me for an MRI. The morning of the procedure, I said to my husband, “I really hope they find something. Then maybe people will stop telling me there’s nothing wrong with me and that it’s all in my head.” I never imagined that I would need brain and spinal surgery immediately.2
What Is Chiari Malformation?
Chiari Malformation is essentially a deformity in the cerebellum (the base of the brain). Most people with this condition are born with it. The cerebellum, responsible for motor function, descends or “herniates” into the spinal cord and disrupts the flow of cerebrospinal fluid between it and the brain.3 Symptoms are vast and can include headaches, laryngeal problems (like unexplained hoarseness or vocal cord paralysis), dizziness, and tongue paralysis. 4 Chiari Malformation can be properly diagnosed only with an MRI.
Another serious consequence of Chiari Malformation is its effect on the cranial nerves. Most of these nerves exit the brain through the cerebellum; they service many parts of the body, including the tongue, soft palate, pharynx, trapezius muscles, and respiratory muscles.5 My laryngeal and tongue problems were most likely caused by the pressure my brain herniation placed on my cranial nerves.
Many people with advanced Chiari Malformation like myself also develop a syrinx within the spinal cord. My syrinx was enormous—it stretched from the base of my skull to the base of my shoulder blades. A syrinx forms when cerebrospinal fluid becomes trapped within the spinal cord.6 As it expands over time, it begins to damage the cord and the surrounding nerves, which can result in anything from back stiffness, back pain, and tingling and clumsiness in the appendages to paralysis and death.7 The tremendous pressure exerted by the syrinx on the vertebrae frequently causes other spinal conditions, such as herniated discs (of which I had two) and scoliosis.8
A Voice Reborn
Following surgery to correct my condition, life has been very different— especially in regard to my voice.9 I liken this difference to driving an old Volkswagen Beetle your entire life, and then getting behind the wheel of a Ferrari. The first time I vocalized after my surgery, I sang a high B-flat with ease. I immediately burst into tears. My chest voice is now fuller and more extensive, and the newfound elasticity in my tongue and soft palate is nothing short of miraculous.
There have been unexpected vocal challenges as well. I began performing seven weeks after my surgery which, in retrospect, was far too soon. I grossly underestimated the effects my surgery would have on my vocal and respiratory function, as did my neurosurgeon. Before the surgery, I asked him if I should hold off singing for a while, and he said, “Oh, no. You’ll be just fine within six weeks.” I should not have gone straight to the race track with the new Ferrari—it needed time to be “broken in,” and I needed time to develop a feel for it.
In other words, I had a lot of adjusting to do. My body was not accustomed to the new flexibility in my laryngeal muscles, so I tended to sing sharp. I had to relearn how to sing through the passaggio and head register. Trust me—a Ferrari goes uphill much faster and much more efficiently. I also had to adjust my breathing technique because, again, I was not accustomed to muscular flexibility. When I engaged my breath the “old way,” I created too much breath pressure—which, in turn, caused pitch problems. As I adjusted to how the “Ferrari” worked, however, the problems gradually disappeared. I learned that less was more. I no longer had to force the muscles to engage.
Although concerned with my sudden pitch problems, the conductor whom I sang with so shortly after my surgery remarked, “Wow, this is not the same voice I heard a few months ago.” He complimented my rounder tone and how my instrument seemed to be “much bigger.” It took a year of hard work and rediscovery before I truly got to know this reborn voice.
If there is one lesson to be learned from my ordeal, it is to listen to your body, even when medical experts dispute what you tell them and dismiss your symptoms. The body has its ways of letting you know when it is in distress, and it will keep intensifying the way it communicates until you listen. Additionally, my experience is proof that vocal problems can be symptoms of other malfunctions in the body. If you or a dedicated student has vocal challenges that do not seem to improve, further investigation may be necessary. As in my case, a singer may also be experiencing symptoms that are not vocal but are pieces of the same puzzle.
Another lesson is that sometimes a singer’s will to sing can be extremely powerful. My neurosurgeon was aghast that I was able to have a singing career despite the handicaps caused by my condition. Although my body resisted what I asked of it, I refused to make excuses for myself. If you want something badly enough, you will find a way to get it.
I came very close to losing a lot—the ability to sing and the use of my arms—and perhaps even my life. And yet, in many ways, I am thankful for what I went through. I am grateful for every note that comes out of my mouth. As a teacher, I can stand behind statements like “Determination will get you places” and “Don’t let your challenges become excuses.” Indeed, I am living proof that there can be a wonderful life after Chiari Malformation—and beautiful singing too.
1 A portion of this testimony is derived from Bonnie Cutsforth-Huber, “Chiari Malformation: What Singers Should Know,” Journal of Singing, 65/5 (May/June 2009), 567-571.
2 For more information on the surgery to correct Chiari Malformation and the different types and symptoms of Chiari Malformation, see ibid.
3 National Institute of Neurological Disorders and Stroke. “Chiari Malformation.” www.ninds.gov/disorders/chiari/ detail_chiari.htm. Accessed 5/23/08.
4 UW Medicine Neurological Surgery. “Chiari Malformation.” uwmedicine.washington.edu/PatientCare/LOC/Neurosurgery/conditions/ ChiariMalformation/index.htm. Accessed 5/23/08.
5 David G. McClone. “The Chiari II Malformation and the Hindbrain of the Associated Hydromyelia.” Neurosurgical Topics: Syringomyelia and the Chiari Malformations, ed. by John A. Anson et. al. (1997): 73.
6 UW Medicine.
7 “Welcome to Chiari One! In Plain English.” ChiariOne.org.chiarione.org/plainEnglish.html. Accessed 5/23/08.
8 Ibid.
9 Nonvocal outcomes of the author’s surgery are discussed on p. 570 of Cutsforth-Huber’s “Chiari Malformation: What Singers Should Know.”
