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Geriatrics Expert Named
otolaryngology
| The Voice Doctor Will Hear You Now singers, teachers, even presidential candidates often need specialized care to improve their sound |
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Just like athletes who see orthopedic surgeons for torn ligaments, singers with voice problems often seek medical help. So Katie turned to Hector Rodriguez, M.D., assistant professor of clinical otolaryngology/head and neck surgery at P&S. Dr. Rodriguez examined Katie to rule out a malignancy, since patients with throat cancer initially complain of voice problems, especially persistent hoarseness.
When he found no medical problem, Dr. Rodriguez referred Katie to Thomas Murry, Ph.D., for a videostroboscopic examination of her vocal folds. Dr. Murry is a professor of speech-language pathology in the department and one of a small group of voice clinicians in the country who specialize in caring for singers.
As a former singer in both church choirs and rock bands, Dr. Murry knows first-hand the demands singers place on their voices. “To work with singers, you need to speak the language of the singer, understand differences in musical styles, and the complex relationships the singer has with teachers, audiences and agents,” he says. “Most importantly, you need to know how the voice works.” Dr. Murry has published more than 100 scientific papers on vocal function and voice care.
The human voice emanates from the two vocal folds in the larynx. Sound is produced when a singer exhales and air flows between the two vocal folds. The rush of air vibrates the folds and generates a buzz-like sound that is shaped by the resonating cavities – the mouth, nose and sinuses.
The vocal folds are often injured when a singer has a voice problem, Dr. Murry says, and he checks them first when examining a singer. “The vocal folds are muscles, and just like other muscles, they are subject to fatigue, soreness and injury.”
Analyzing Vocal Cords
Vocal folds can vibrate up to 1,200 times a second – as fast as a butterfly flaps wings – so Dr. Murry uses the camera with a strobe light to make the rapidly vibrating vocal folds appear slower as the patient sings or speaks.
Dr. Murry spotted two “kissing” nodules, one on each of Katie’s vocal folds. The masses are benign, but they are one of the most common sources of voice problems. The word “kissing” is a bit misleading. Though the nodules contact each other as the vocal folds vibrate, they do not do so gently. The nodules grow when the vocal cords crash into each other.
“The nodules form when the singer strains while performing, yelling or crying, and is not using the muscles the right way,” Dr. Murry says. “It’s like when you try to lift a big weight off the floor but you strain your back muscles doing it. In singing, as in lifting, you need the support of whole body.”
Fortunately, most singers with nodules and other masses need only non-surgical therapies. Voice therapy helps the singer reorient other muscles that engage the vocal folds, so he or she
doesn’t strain the folds themselves.
Part of Katie’s therapy also aims to correct her “glottal attack,” a speech habit in which the space between the vocal cords (the glottis) is abruptly closed. Instead of relaxing her vocal cords before certain words, she bashes them together, which produces a noticeable “click” when she speaks and also leads to nodules.
Rehabilitation can take a few months. Katie’s nodules have nearly disappeared and she already notices a dramatic improvement. “During the singing gigs I’ve had lately, the improvement in my tone has been like night and day. People come up to tell me how great I sound.”
Professional singers are not the only people who can benefit from voice therapy. Much of Dr. Murry’s practice is made up of teachers, telephone operators and women in male-dominated professions.
“Interestingly, women who work around a lot of men, tend to speak in a lower tone of voice as a way of sounding more authoritative, because men talk lower,” Dr. Murry says. “But that effort can strain the vocal folds. We teach women to speak in a business-like manner that projects, but in a way that is more natural to them and does not injure the vocal folds.”
For all patients, Dr. Murry has drawn up a list of tips for good voice hygiene. Smoking is out (it thickens the vocal folds and causes throat cancer), as is alcohol the day before a performance or presentation (it dehydrates the folds). Many of Dr. Murry’s patients also benefit from medicine to control the amount of acid from the stomach that can reach the vocal folds and increase hoarseness.
One piece of advice Dr. Murry offers to preserve the voice might also help relationships. “Try not to yell,” he says. “It’s bad for the vocal cords.”
—Susan Conova
