Last Thursday was my 25th birthday, and I had a very exciting experience – I went with one of my singing students to her appointment with an ENT (Ear, Nose, & Throat specialist).
This student has been taking lessons with me since February, and is similar to me in that she is an energetic, outgoing, and outspoken young lady (she is about 14 years old). Previously she had never done any singing training, but enjoys singing and has a lovely strong voice, particularly in her lower range (thick folds).
However, I did note that she found it quite difficult to go up into her higher range (thin folds/stiff folds); she has improved somewhat with exercises designed to help tilt the thyroid cartilage and go into “thin folds”, however still often had a breathy or croaky/crackly sound in her higher range and definitely found it challenging.
She also had the kind of speaking voice and vocal habits in speech that reminded me of other people I have known who have regularly lost their voice or had voice issues; outgoing people who talk loudly around their friends or when they get excited, tend to shout a lot or have to talk in loud environments; I could hear from her speaking voice that she could easily lose her voice if she pushed it too much. While I have worked with her on retracting the false vocal folds to avoid vocal trauma, I felt there was potentially something going on which I didn’t have a solution for.
I am not a speech pathologist, so I do not have sufficient knowledge/qualification to diagnose a student with any kind of vocal pathology; but if I hear something in a student’s voice that seems to be something other than just lack of control, I will always recommend that the student see a speech pathologist or ENT to check that there is nothing potentially dangerous going on (like vocal nodes or nodules) or any other kind of vocal pathology or speech habit that needs special training.
My student has had some sinus issues as well, so when she went to her GP to get a referral, they recommended that she see an ENT.
There are only two ENT’s in Hobart, so there was quite a long wait, but finally we went in to see Dr. Nusa Naiman.
I was like a kid in a candy store – nerding out about voice stuff gets me very excited, and while my student and her mum were happy to have me there to help describe the issue to Dr. Naiman, I was also extremely happy to have the chance to learn what was going on with my student’s voice (for future reference) and potentially see her vocal folds!
Luckily for me, after asking some questions, Dr. Naiman went straight to getting an endoscope in to see what was going on. It’s a painless but apparently slightly uncomfortable procedure; my student first had a couple sprays up her nose from a bottle of local anaesthetic spray, waited a few minutes, and then Dr. Naiman inserted a very thin tube with a tiny camera on the end. The camera tube goes up the nose and down the back of the throat, into the airway just above the larynx (voice box) so we could see her vocal folds.
What we saw, and Dr. Naiman pointed out, was some irritation/reddening around the arytenoids (cartilages at the posterior end of the vocal folds) and the end of the vocal folds themselves (probably, I am guessing, due to some pushing/constriction of the false vocal folds when shouting/singing/speaking too loud). And when the student attempted to demonstrate what I had noticed – the breathiness/crackling/difficulty in the higher register – Dr. Naiman pointed out that the vocal folds did not close completely in this higher register – the technical term for this is “incomplete adduction of the vocal folds” which creates a breathy sound as air escapes through the gap or “chink” where the vocal folds are not closing completely.
I was pleased to know that there were no vocal nodes/nodules or anything that serious going on with my student’s voice. Dr. Naiman recommended 2 weeks of vocal rest (no shouting, whispering, or singing; just minimal speaking) to allow the redness to subside, followed by some sessions on some exercises to help with the incomplete adduction, from a speech pathologist who specialises in voice. Luckily, I had just recently met one: Helen Sjardin, who has moved back to Tasmania in the last couple of years and knows Dr. Naiman. There aren’t a lot of speech pathologists in Tasmania (or, apparently, elsewhere either) who specialise in voice, so this is lucky for us!
I’m looking forward to attending some sessions with Helen and my student, and learning some more about incomplete adduction and exercises that can help with fixing it. I had a very enjoyable lunch conversation with Helen the week before, and hope to maintain regular contact with her and work together to best serve our various clients and expand my knowledge about the voice!
My next post will be about the relationship between the different kinds of voice specialists – from voice coaches, to speech pathologists, to ENTs – so stay tuned!