A Singer Diagnosed With “Vocal Cord Dysfunction”

Recently a singing student of a colleague received a diagnosis of “Vocal Cord Dysfunction” from an ENT. The voice teacher asked on a forum what that meant. Those of us who work with injured singing voices responded that Vocal Cord Dysfunction wasn’t a diagnosis.

Any vocal fold injury or pathology creates “vocal cord dysfunction.” Right?? That is perfectly logical.

Evidently, in the medical community “Vocal Fold Dysfunction” is another name for “PDFM”–Paradoxical Vocal Fold Movement.

And, evidently, ‘Vocal Cord Dysfunction’ is not categorized the same as ‘Vocal Fold Injury.’ However, both affect movements of the vocal folds and the larynx.

PVFM doesn’t refer to one specific vocal fold injury diagnosis. It’s anything that causes “an episodic unintentional adduction of the vocal folds on inspiration.”  Which means the vocal folds are working backwards—they close when the patient tries to inhale. Normally the vocal folds open upon inhalation.

Can you imagine how awful that would feel? However, Kerrie Obert, a Clinical Voice Specialist at The Ohio State University and Dept. of Otolayrngology and co-author of The Owner’s Manual to the Voice: A Guide for Singer’s and Other Professional Voice Users, says

While scary, one of the things to know is that oxygen levels remain normal during an attack. People with this disorder feel they are not getting enough air but they actually are. It is one of the things that distinguishes it from asthma or other respiratory disease. It is basically a behavioral problem and generally remedied with just a few sessions with an SLP.

This voice disorder ALSO has other alias’, such as laryngeal dyskinesia, inspiratory adduction, periodic occurrence of laryngeal obstruction, Munchausen’s stridor, hysterical croup and irritable larynx syndrome….just to name a few!

Kristine Pietch, SLP at Johns’ Hopkins’ Dept. of Neck and Head in Baltimore and Bethesda, Maryland and a fine singer, noted that

We don’t like the term ‘vocal cord dysfunction’ in our clinic for the reasons you describe (very non specific!) but it is the one that most pulmonologists use and that our patients hear first! I see a number of these patients every week and on my handout have to write “vocal cord dysfunction AKA paradoxical vocal fold motion” and NOW I’m probably going to have to add yet another…ILO aka inducible laryngeal obstruction which has been taking off (especially outside of the US). Too many terms…..very very confusing….

Paradoxical Vocal Fold Movement is misdiagnosed frequently as asthma because the symptoms are:

  • Noisy or wheezy inhale
  • A feeling of not inhaling enough air when playing sports or singing but recovers quickly, within 5 minutes.
  • Asthma or allergy medications don’t help with breathing problems
  • Has a history or symptoms of acid reflux
  • Patient points to the throat more than the chest to indicate the area of tension

This condition seems to be most common in young females 11-13 who are competitive athletes and quite driven academically. It occurs more in females than in males. It’s really imperative that the student get a correct diagnosis (asthma or PVFM) and specialized therapy from a voice care clinic and an experienced Speech-Language-Pathologist.

Sometimes asthma and PVFM occur at the same time too.

The speaking and breathing need to be addressed before the singing voice.

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Please view my services as an Independent Singing Voice Rehabilitation Specialist and my qualifications:

I. Individual Singing Voice Rehabilitation

For individual singers after diagnosis from your doctor.

II. Cate’s Collegial Consults

For experienced voice teachers and their student together, for those who live in areas without access to the resources they need.

A Singer Diagnosed with Bi-Lateral Vocal Fold Paresis

It’s time to SHATTER the imbedded pedagogical view that “singing with the wrong vocal technique” causes vocal fold injury. That is true in many cases, but in equally as many cases it is not.

Please listen to my interview on the VocalFri podcast. We get into cool stuff every singer and voice teacher needs to hear.

Thanks for your precious attention and time!

Robert Mueller’s Voice and a Perceived “Doddering” in His Testimony

A colleague was recently consulted for Mel Beta, an online commentary and pop culture source, on Robert Mueller’s voice during the recent hearings here in the US.

The article combines a sincere inquiry about the quality of Mueller’s voice and hesitations in his performance, with evidence that often any message not delivered quickly, loudly and confidently is not to be tolerated as “informed.” Hesitation is seen as weak and an opportunity to move in for a kill. The media has gleefully spread this around as “news.”

And it shows that our voices factor hugely in how our verbal messages are heard and understood.

Liz Jackson Hearns‘ work as a voice teacher whose speciality is transgender voices, makes her a natural to speak on “Why a nervous voice happens.” She also said that people who aren’t used to being on camera may not have the delivery skills for that medium. It has nothing to do with their manner of working, intelligence or skill. Thank goodness, Liz was interviewed for this!

The Mel Beta article also interviewed Steven Camarata, an SLP and professor at Vanderbilt University, who said that Mueller is just a breathy talker.

My opinion is that Mueller’s voice issues may be partially due to Liz’s observations, but also reflect what can happen to an aging voice: Presbyphonia, or vocal fold atrophy and bowing, is common in those of Mueller’s age.

Voice changes due to vocal cord atrophy are common in people over the age of 60 years. The most common symptoms include:

  • Reduced vocal volume
  • Higher pitched voice
  • Breathy, “thin” sound
  • Increased speaking effort
  • Vocal fatigue
  • Difficulty communicating with friends and family (especially with noise in the background or on the telephone)

This is why Mueller’s voice may have been perceived as breathy by Camarata, but it is also why his breath usage is “off.” If the vocal folds are not able to come together, natural robust support will falter and the speaker has to make more effort to speak, which is very fatiguing on all levels.

Targeted vocal function exercises done with recommended pacing do help aging voices. And just for the record, there are much younger speakers and singers who are diagnosed with this condition early in their lives. And it has nothing to do with poor technique or vocal abuse.

Also, if brain function as we age contributes to any of Mueller’s perceived “doddering,” ‘white matter’ can change in the elderly. ‘White matter’ is brain tissue composed of nerve fibers that connect nerve cells.This correlates with the speed of their mental processing.

The speed in mental processing is what is perceived as doddering. But it has nothing to do with ‘failing’ as a leader or expert.

“America champions the loud and the garish” –Wynton Marsalis

The Alchemy of Teaching Singing

Singing Voice Rehabilitation

Cate’s Collegial Consults

Vocal Conditioning

Changing Your Story: Private Lesson Fees, Part I

Most private music teachers will price their one to one lessons based on the average cost of lessons in their city or town. While this may be a good place to start, it is something that is in your best interest and the best interests of our communities to outgrow.

I am sharing this post, verbatim, from Cara Transtrom, an Independent private voice studio owner. We met through The SpeakEasy Cooperative founded by Michelle Markwart Deveaux.

Raising rates doesn’t work when you randomly decide to do so without doing the work of understanding yourself, your abilities, your path, your passions, and how that LEADS to rate raises.

Cara’s Words

“Colleagues, I want to share a thought about pricing that has helped me over this last year or two. As is true of many of us, I’m sure, the prices I need to charge for my services in my particular region of the U.S. means that I could never have afforded me (nor could my family) in my growing-up years, college years, or grad-school years.

As you can imagine, I’ve had mixed feelings about this.

So it has often been a struggle to continue to define what it means to take care of myself and my family financially while also fulfilling the passion I have for seeing that vocal education is accessible to those whose limited family resources don’t permit it.

These two things often appear to be in conflict, even though both realities are fully, 100% true simultaneously.

So over the last few years, I’ve been thinking hard about pricing as social justice. I kid you not: if we (mostly female) voice teachers continue to price our services at hobby rates, we help to ensure that the next generation of voice teachers will largely be privileged women who are partnered with someone who can pay all their bills.

So a choice to charge “hobby” rates (which will differ significantly from area to area within the United States, let alone internationally) is actually a choice that will eliminate the following folks from the next generation of voice teachers: large swaths of people of color, first-generation immigrants, some segments of the LGBTQIA+ communities, socio-economically-disenfranchised folks, and others who do not have the luxury of being entirely or almost-entirely supported by family wealth or by a wealthy partner. ”

Cate’s Comment

This may seem like a slap-in-the-face comment to those who keep their rates low to serve a certain demographic. But consider how this can affect anyone who wants to go on in the arts or arts’ education work. They need to work with someone who models both charging a livable wage AND passing it forward to those who can not afford them. After all, your wage has to allow for the on-going bare minimum expenses of self-employment taxes, business expenses, practice and research time and continuing education for the teacher. Otherwise, it is a hobby and you are undercutting those who don’t have a partner who supports them financially.

Cara’s Words

“My choice to charge rates that allow for a basic standard of human needs for me and my family being met, is a choice to help ensure economic justice for the next generation of voice teachers, artists, and teaching artists.

Grit, determination, passion, insatiable curiosity, talent, artistry, creativity, and a relentless desire to grow IS NOT LIMITED only to those with enough privilege to pay for the development of these things: it is instead our human birthright.

I cannot individually change all the world’s economic systems of (in)justice, but I CAN see that the legacy I leave behind for the next generation seeks to ensure that they will have a living wage as artists, teaching artists, or teachers.

We often speak within The Speakeasy Cooperative of pricing for generosity, (pricing in a way that allows us to quietly offer lessons and other services to certain clients in need on a sliding scale different from our published or “usual” rates).

But do we often stop to think of the fact that the way in which we price our services MAY BE ONE OF THE MOST POTENT, EFFECTIVE, AND VALUABLE WAYS THAT WE INSIST UPON ECONOMIC, RACIAL, AND CULTURAL JUSTICE in the communities, countries, and the globe in which we live?

We can and we do touch & change the hearts and minds of people with our performances and our teaching: this we take for granted.

But let’s also embrace the reality that we can and we will change the economic (in)justice that surrounds artists and teaching artists of almost every culture by the ripple effects of our own pricing and money-value choices.

Michelle Markwart Deveaux’s words:

Income + Intention + Impact = BeastyBoss. 

Our money does MORE than help us. 
Our rates are about impact in the world. 

Greed is an insatiable, excessive, selfish craving for more more more. (Jen Sincero) 

Let’s not confuse Greed and Money.

Comments? Thoughts?

Singing Through Change: Who We are Writing For

If menopause symptoms were due solely to hormonal changes then the menopausal experience would be more homogenous.

In “Singing Through Change: Women’s Voices in Midlife, Menopause and Beyond, Nancy Bos, Joanne Bozeman and I are writing for a wide variety of singers who:

–Have sung all their lives but don’t understand that singing through the lifespan is like being active in sports. You need to tend things along the way or you can’t play.

Don’t know much about their bodies or biological cycles other than what they hear in media or what their doctors tell them.

–Work with singers through midlife and aging: coaches, teachers, performers, choral conductors, music directors and medical personal.

–Are colleagues, students and medical professionals. We are writing the book we wish we’d had as we moved through our changes.

A very T-A-L-L order? Yes.

That’s why there are three of us writing in collaboration. We are really excited about the very unique way of co-authoring we’ve created! It takes longer than if we each write a chapter, but it’ll be worth it!

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Singing and Teaching From an Undivided Self

We have more academically-educated singers and voice teachers now than at any time in the history of vocal expression, and dare I say it? Very little teaching from an Undivided Self, which means very little useful and true wisdom.

Learning to get to this place this requires TIME.

It’s a sort of alchemical process to find personal, musical and pedagogical ah ha’s! amid the deafening noise of information, data, and a cult of personality. These things don’t work well with singing. Because singing is about first finding silence of stillness and then becoming a channel for bio-electric energy, all human expression and divine connection.

I think many teachers ‘head’ know this–but they don’t FEEL it or EMBODY it.

There is a crying need for a 1:1 Experiential Learning Program outside of academia to allow teachers and singers the time they need to create this alchemical process. To learn to teach WHO they ARE as well as WHAT they KNOW.

I’ve put together what may be the first program of its kind, “The Alchemy of Teaching Singing,” to fill a hole in the Continuing Education of Singing Teachers.

We’ll work with practical and useful steps towards integrating your singing, passions, pedagogical foundations, teaching interests and needs to create your undivided Self.

I’ll also help you honor every facet of your life experience, which creates a space of immense coherence and strength to hold student, learning, and your Self.

THAT’s where the magic happens.

Special thanks to Palmer Parker and his brilliant book “The Courage to Teach.”

Book Titles and Search Engines…

Who knew it would take so long to come up with a title for our upcoming book on Singing and Menopause, to be published by StudioBos Media???

We started out months ago by brain-storming every idea we could think of to see what would stick. We ran titles by some of our interviewees, colleagues and friends and our editor. We had to have certain words in the title for the Search Engine. We didn’t want it to be too academic-y or cartoonish.

“Aunt Flo’s Not in the House Anymore” was the first of the spaghetti thrown against the wall. It didn’t stick. (Evidently people in the midwest “get” that but as an East Coaster I was ‘Huh?’)

Let me know if you don’t get it too….

Today we finally decided on

Singing Through Change: Women’s Voices in Midlife, Menopause, and Beyond

A quote from co-author Joanne Hayes Bozeman:

Through researching and writing this book, I have come to appreciate that the menopausal transition is far more than a set of symptoms attached to a shift in hormones. It’s a unique, sometimes untidy socio-physiological-psychological metamorphosis for women. For singers, the voice is often a crucial part of that metamorphosis.

Sign up for our mailing list and read about the authors here.