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.

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

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!

Sign up for our mailing list to receive regular publication updates & fun peeks

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or Follow us on Instagram if you are off of Facebook. You’ll need to download the Instagram app to your phone, create an account, and then just look for “Singing Through Change” and Follow.

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.

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!

Regina Spektor and a Classical Vocal Exercise

I owe this idea to a recent conversation on The New Forum for Professional Voice Teachers. Many on this forum sing, train and teach both classical and popular genres of music. We have a wide assortment of training methods, resources and approaches stored in our mental libraries and our own music-making.

Recently someone posted Regina Spektor’s “Us,” to illustrate her technical approach to one part of the song. One of the comments was that some passages were “straight out of Lutgen.”

So I went a-looking…..

Lutgen was a German composer who wrote many books of vocal training exercises in the mid 1800’s. The exercises were for those studying European classical singing of the time.

Intrigued WHY my colleague would relate Regina Spektor to Lutgen’s 18th century vocalises, I looked them up. And there it was. Lutgen exercise #1–

Listen to Spektor and then see how the above exercises could be used to help someone sing parts of this song. Or ask your young students to listen for these exercise patterns in the song. This might be a great project for them or you when you need to work less strenuously. You can also search for Lutgen exercises on Youtube. Some enterprising music educator has put up keyboard renditions of all the Lutgen exercises!

Help your students find patterns between 1) CCM singer/song-writers and 2) classical vocal patterns found in old exercises! A little sleuthing is lots of fun.

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.