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.

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.”

Update on Women, Menopause, Singing

To receive publication updates on the new book “Women Singing Through Menopause, Midlife and Beyond,” please sign up at Studio Bos Media

We are still wooing the right title.

Writing with coauthors Nancy Bos and Joanne Hayes Bozeman has been one of the most rewarding collaborative experiences of a long life spent in collaboration. Combining the voices of three powerhouse artist/educators who are researchers has taken a huge investment of T-I-M-E. But building a solid infrastructure for the book and becoming vulnerable to each other (check out Brene Brown’s The Call to Courage) are birthing our idea into reality.

We are writing a book for Great Aunt Betsy who sings in her church choir, for the college voice professor who has always sung well and then, well, doesn’t. For the community musical theater singer, to the elite classical and popular music singer. For the voice teacher or singer who’s own voice has gotten better and better and may not understand what is happening with others who have a different experience. For the medical community that knows nothing about menopause and voice changes because it is outside of their health model. For the used-to-sing woman who is just fine with how her voice is as she gets older and doesn’t think much about it.

So the challenge has been how to combine our three author-voices, our interviewees’ individual stories AND a curated list of reliable information into one voice–

–to reach all these singers.

It’s happening and we can’t wait to share it with you!

Evidence-Based Vocal Pedagogy and Other Mystifications, Part II

If you haven’t read Part I, head over for a quick read.

My husband is an Instructional Designer. We have long, sexy talks about Andragogy, which is the art and science of teaching Adult Learners. In his field, (and many others) Pedagogy means the art and science of teaching children.

These conversations have got my WHEELS TURNING and I am thinking that “Evidence-Based Vocal Pedagogy,” when working with adult singers, would be enhanced by using a few principles from Evidence-based Adult Learning.

So If you work with adult singers or voice teachers, here’s a short quiz to find out if your teaching might be more effective with a few of these basic principles of Adult Learning. (and maybe you already do this–BRAVA if that is the case.)

I. Adults learn better when the instruction they receive is tailored to their learning styles (e.g, Visual, Aural, and Kinesthetic)

DRAMATIC PAUSE

The answer, according to Evidence-Based Adult Learning is, no. Most of us were taught otherwise. But here are some interesting articles that explain more:

Debunking Learning Myths

The Atlantic “Are Learning Styles” Real?

II. The more you give your students, the more they will learn.

TAKES A SIP OF TEA

Once again, the answer is no. A colleague asked what is meant by “the more you give.” In this case, they are referring to the amount of information or ideas presented in one training session, whether that is one class or 10 classes, or in a private lesson or coaching.

To get how this might apply to both private lessons for adults and courses, here are three sources to jump start your thinking:

Compulsory Teaching, by Dr. Shannon Coates

Shut Up and Let the Student Sing, by Cate Frazier-Neely

Giving Students ‘Think Time

III. Making mistakes is useful for learning

STARES OUT WINDOW AT DAFFODILS

Here, the answer is yes. The enemy of learning, creativity and authentic vocal expression is Perfectionism.

There’s a fine line between expecting a student’s best and demanding perfection.

However, my colleague, Jennifer Cooper, says that in teaching adult singers, making repeated mistakes at the fundamental level (pitches, rhythmic accuracy etc.) can create a reinforcement of inaccuracy (i.e. once that pitch is learned “wrong”, it takes dozens of accurate repetitions to correct it).

And I would add that the educating the ear and physical coordination, to make music, is harder as an adult that it is for a child–just like languages and sports. Making mistakes is only useful for people who do the work of learning from them.

The Secret of Creativity: Make Mistakes

IV. Students who express satisfaction with a training course are more likely to have learned more than students who say they were dissatisfied with the training course.

WATCHES CAT LICKING HIS PRIVATES

This one may surprise you. The answer here is no, too!

Expressing satisfaction with a teacher or training course may not be the same as learning what is being taught by the teacher or in that training program. The five-star, ‘rate your professor’ nonsense that has taken root does not measure anything accurately or well. I have seen amazing teachers given one star because the student thought the homework was too hard, and charismatic teachers given 5 stars because they acted like buddies with their students. Expressing satisfaction, or no satisfaction, has little to do with what has been learned in many cases. To read more:

Alliger, G.M. Tannenbaum, Bennett, Traver, & Shotland (1997) A meta-analysis of the relations among training criteria. Personnel Psychology, 50(2), 341-358

Sitzmann, T, Brown, Casper, Ely and Zimmerman (2008) a review and meta-analysis of the nomological network of trainee reactions, Journal of Applied Psychology, 93, 280-295

Please share your thoughts on this series! I am preparing the infrastructure for a new voice teacher mentoring course and could use your reactions to these posts.