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.

Vocal Pedagogy and Creativity, Part II

Part I in this series was well-received and lays out the groundwork for Part II–

Introduction

In this post, I’ve gone academic on you–just to have a framework to discuss broad topics.  I’ve highlighted three elements that are part of a larger concept that psychologist Benjamin Bloom identified for his learning model widely known as Bloom’s Taxology.

Anyone who wants to teach or to transform information into a useful body of personal wisdom would find his work very interesting. However, you certainly don’t need to consciously know this stuff to have the same outcome. I have operated in the following “mode” most of my life and didn’t know any of this.

Our culture does not allow for the following kinds of developmental learning, starting as early as age 5. Yet, we are all capable of it!

Bloom identified three “areas” of Learning as:

I.   Cognitive Learning (Mental skills and Knowledge)

II.  Affective (Growth in Feelings and Emotional Areas)

III. Psychomotor (Manual or Physical Skills)

According to Bloom, collecting information and remembering data are considered the beginning, or bottom rung, of Cognitive Learning.

And Creating is the top rung.

And here’s what the Cognitive Domain looks like in Bloom’s pyramid:

bloom-taxonomy

Some teachers teach from the place of collecting and remembering information, and then maybe have stepped up onto the level of Understanding what it means to them. This is a good start.

But as an exceptional teacher, you need to  eventually get to the top 1-3 parts of the pyramid.

There is obviously some overlap of all three domains because we each are unique individuals who find our own ways.

For the purposes of this article, I would like to highlight THREE aspects of learning, one from each domain, for you to consider.

Cognitive Domain

1. “Divergent Thinking” means generating multiple ways of taking information and finding new ways to address a topic or find solutions to a problem. This kind of thinking has become a hot topic for the study of brain function in creativity.

Divergent thinking occurs in a spontaneous, free-flowing, ‘non-linear’ manner. It does not move from ‘a’ to ‘b’ to ‘c.’

It prefers to zig when everyone else is zagging. It thrives in solitude, uncertainty and the imagination. It makes useful connections among unrelated pieces of information. The manner in which divergent thinking takes place is unique to everyone and everyone has to discover their own ways to develop and allow it.

“Convergent thinking”, on the other hand, is the ability to apply rules to arrive at a single ‘correct’ solution to a problem, such as an answer to an IQ test question. This process is systematic and linear.  Both styles of thinking are important and are meant to work together.

Psychomotor Domain

1. Somatic Re-Education of the Body and establishing the realization that your body carries its own wisdom!

This connection has been severed in our culture, but has revived among singers, dancers, actors, athletes, healers and physical therapists because our art is the stuff of which this connection is made.  The reason I place such fundamental importance on learning through somatic re-education is that western culture is still imbued with the notion that all worthy learning takes place in the brain and “higher realms.”

Oh my goodness, no. no no no! The physical body learns and holds information too, and is an equal with the brain and heart center. Sometimes the heart needs to heal before the body can heal. Sometimes the body needs to heal before the brain can work well. Somatic Education helps us reestablish how our bodies and minds are meant to function together, and is especially important as we age.

Alexander Technique, Feldenkreis, Yoga, Rolfing, Nutrition etc., and other modalities are all methods of somatic re-education.  But the effect it has on you is directly related to the kind of teaching you receive.

Affective Learning

1. Development of Emotional Intelligence

Emotional Intelligence can be a natural gift which seems to be more hard-wired in women that in men.  But it can be developed in anyone. It is the capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathetically. E.I. is now being taught in business schools like Wharton and Case Western Reserve as a necessary tool in what is called “Resonant Leadership.”

Other ways of developing this part of Affective Learning are through counseling and modeling behavior of other emotionally intelligent people.  Time Magazine published a recent article which, at the end of an article on drugs and depression, lists drug-free ways that have all been scientifically proven to have transformative effects on emotions and in handling interpersonal relationships well: Exercise, Cognitive Behavioral Therapy, Behavioral-Activation Therapy, Mindfulness Training and Transcranial Magnetic Stimulation.

(I totally understand the need for the right drugs in the right doses, monitored by a health care professional.)

Conclusion to a long blog post…

These aspects  of turning information into something useful are true for anyone in any field.  Many life-long learners and some of your favorite teachers are using these steps to teach, even though they may not be consciously aware that Learning Theory has names for the processes.

Are there any Vocal Pedagogy graduate programs out there including Bloom’s theories in the coursework? The steps can be cultivated and are incredibly rewarding. Those EUREKA moments and connections are the stuff of ecstasy!

Life is about experiencing ALL the aspects of learning, not just running around devouring and acquiring new information and others’ ideas. And don’t panic. You have Time to realize learning is life long and no one is ever finished.  I started teaching music when I was 13 years old, had my first paid singing gig at 18, and am now 61. It sure did not happen all at once and is on-going.

Please like, comment or share this post if you found it useful. Thank you for being here!

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Also check out this video by Sir Ken Robinson

 

Vocal Pedagogy and Creativity, Part I

I once had 4 voice lessons with an expensive and well-known singer who had sung opera many years in Europe. After returning to the States, she developed a method of voice teaching based on 15 years of her personal research into voice science.

I sought her help after seeing an ENT (supposedly he worked with singers) who completely missed the fact that I was developing bi-lateral vocal fold paralysis. (!) Neither the teacher or the ENT helped me at all and both sets of information were actually harmful both physically and psychologically. GRRRRRR

So here were two learned professionals, WHO COULD NOT SEE or HEAR THE PERSON IN FRONT OF THEM. Did they need more information so they could have helped me? NO. What they both needed was to get outside of the information they had collected and turn it into something useful.

One of the main differences between intelligence and creativity is that the creative person has the ability to draw connections among bits of information and imagine various paths and outcomes. And this is the missing ingredient with many voice teachers who run around collecting information, certifications and degrees by the boat-load.

Read How to Make Connections Like a Creative Genius.

These are all valid ways to learn and perhaps start to assimilate experience, but one vital thing we are not taught in our school systems, academia and general culture is how to turn information and book learning into something useful. Has it occurred to you that the information presented in the learning environment is just an INTRODUCTION to understanding? Just the tip of the iceberg?

Information, by itself, is not the stuff that enables you to be effective.

Chances are good that you are getting information from someone who is also consuming information without turning it into their own Experience. When you teach, you are teaching who you are as well as whatever it is you teach. So inability to turn information into something useful is passed on in your manner of working. Rather a vicious circle.

The transformative and alchemical process to turn information into a creative experience requires time, self-acceptance, effort, and in many cases, more money. And this inner process is different for everyone.  It has its own time-table to follow and does not give a hoot about you being productive, “an expert,” and a reliable cog in society.

A personal note from my own voice studio: I work with voice teachers who are certified in 2 or 3  methods of vocal pedagogy. They are good teachers and wonderful human beings who at some level, feel that a few lessons going over the exercises that they learned in the certifications will turn them into the singers they want to be or help them with their students. So when they have not reached where they want to go after 4-6 lessons, or even 6 months, they stop. I understand. It is expensive and time-consuming. And who has the time to practice, experiment, observe, and at the same time learn how to ALLOW the process of the slow change of muscle fibers and neurological connections? And do this year after year after year? After year?

Yet, that is exactly the kind of creative process necessary, whether you do it yourself or reach out for guidance, to transform learning into useful experience.

Information continually changes, BUT SO DO OUR BODIES and EMOTIONS. Especially for women because of our life cycles and hormonal effects on the voice. But it is true for men, too, and for anyone who has survived physical or mental health crisis. If you are coping with a chronic issue that doctors can not solve, it is doubly true. It is a constant creative act to experience, assimilate and present information to others.  What you learned as a 21-year-old will no longer serve you at 25, 30, 40, 50, 60, 70+

Guess what. Life is continually about transformation into something new until it is time to transform again.

THIS IS THE SECRET THAT NO ONE TALKS ABOUT. We are taught that having a magic degree or certification or studying with that Broadway star can lead to wisdom and effectiveness.  While learning is a wonderful experience, having a personal value system that allows you to assimilate the new process is something that I have observed many teachers do not have.

Finding your own creative path is never easy in a culture that says it values creativity but does not value the time, solitude and continuous experimentation to develop a creative thing or thought and turn it into experience. As far as singing and teaching singing goes, you are more apt to do this if your personal values match up with these commitments.

I just finished watching the tv series “Genius” about the life and work of Albert Einstein, produced by Ron Howard. I recommend this series as a way to illustrate my point.

And here’s the KICKER–our personal values are shaped by our culture, religious traditions and the hive mind. What is required to live creatively and turn information into a body of deep personal experience?

I am not talking about work experience. I am talking about a deeper knowing that often comes from our deepest, most vulnerable places.

In Part II, I’ll outline some of the counter-culture elements that are needed to walk this particular path.  A good book to read, in the meantime, is The Courage to Teach, by Parker Palmer.

Please comment, like, share or subscribe if this post interests you!

“Transformation” abstract study by Cate Frazier-Neely

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Part V, Final Post, Journal of a Richard Miller Week

Thanks for joining me for the final installment of Journal of a Richard Miller Week. In this series I am sharing my journal notes from a 1994 week’s workshop with the great vocal pedagogue, Richard Miller.

It is interesting to compare these notes to what is available in pedagogy graduate programs now days. This information seems basic now, but 20 years ago it was new information.

Friday, May 27

The first part of the morning is spent studying female registration.
Chest voice “pivotal point” around E-flat above middle C.
From E-flat to F# 5, “voce media”–sometimes called head voice
F# first passaggio.

(I hope we have time to talk about this more. My first passaggio is around E-flat)

High C–F6–Flageolet

The size of the larynx determines the “pivotal point.” In mezzos and dramatic sopranos these points are obviously different. (my question answered.)
Lighter voices have an ease about registration matters.

Whistle voice is not the same as flageolet according to voice science. Whistle voice is a dampening and slapping apart of the folds.

Flageolet is a great assister, but not necessary for all voices. Some voices can’t do this.

Miller feels it is best to start vocalizing in upper middle voice.

Insert 1

Miller emphasizes charging what you are worth. “Is this an avocation or a profession?”

We work with the following–

1—–5—–1——54321
EH———————-

In upper middle range–
5′ 5′ 5—-1
Eh EH EH—–

1——8—7—8—–1
EH

Equality of timbre dependent on more appogiuro.

Heavier baritones may need to go toward (a) on top. Use ah-oh-oo combinations.

Do not base tenor (or anything) on the “HEY!” or “call” technique. Introduces too much vocalis pressure which can create imbalance. (Note: this was before voice science knew much about registration balance in popular music or musical theater.)

Insert 1

Mezzo di voce important every day.

Zwichen-fachs must be the patient in development.

We listen to recordings of Boerling, Corelli, Comingo, Pavarotti, all singing the same “pen-sier” to a high B-flat. All very different, all thrilling. Vowel choices interesting.

It is a common male teacher mistake to have women sing up high with too much breath pressure. Female teachers tend to underenergize their male students.

We have been saving our questions all week for today. There are many technical questions and clarifications. I ask him about his wife. What role has she played in his professional success?

Miller seems surprised by this question and says he has never had anyone ask it before. His eyes actually tear up a bit, when he says he would not be where he is without her. She has enabled him in every way to be where he is today, from taking care of his home and children to typing and editing manuscripts to listening to him practice talks.

There is a good-natured disagreement between Miller and the female teachers/singers in the class (myself included) over his assertion that the abdominal muscles have no play in support. He says there is no use of abdominal muscles other than all the muscles of the thorax have their origins in the pubic area and are therefore “used” without thinking about it in appogiuro. All the women have spoken up in disagreement, and we have a show and tell that is very interesting. He concedes that women have more space in the abdomen because of the womb, and perhaps we feel things differently.

We end the week with singing “daily regimen warm-ups.” He emphasizes warming-up before teaching.

On performing dates, sing through the voice by 12 noon. Before performing, sing agility exercises.

Learn not to sing fully during contracted orchestra rehearsals and save bloom for performance.

We leave the room slowly, speaking with each other, trading business cards, thanking Miller and talking in small groups. I am anxious to see the children but don’t fly back to DC until tomorrow morning.