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 reached out to find out what this meant and see what she could do to help her student.

It would seem that any vocal fold injury or pathology creates “vocal cord dysfunction.” Right??

But in the medical and vocal health community “Vocal Fold Dysfunction” is another name for “PDFM”–Paradoxical Vocal Fold Motion. It can cause “Muscle Tension Dysphonia,”or not.

Plot Twist!

But ‘Vocal Cord Dysfunction’ is not categorized the same as ‘Vocal Fold Injury.’ Both do affect movements of the vocal folds and the larynx.

Vocal Fold Dysfunction (or PVFM) doesn’t refer to one specific vocal fold injury diagnosis. It is anything that causes “an episodic unintentional adduction of the vocal folds on inspiration.”  Which means the vocal folds are working backwards—in a functioning system, they “abduct” (come apart) when you inhale, and “adduct” (come together) when you speak or sing.

It pays to have cool colleagues who know the words and things

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 lots of other names, 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 added:

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 confusing….

Other stuff to know

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

What is VERY interesting is that 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 and can be caused by other things such as constantly being exposed to second hand smoke or irritants in perfumes.

It’s really important 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 Specialist and my qualifications:

I. Individual Singing Voice Rehabilitation

For individual singers after a diagnosis is made from your fellowship trained otolaryngologist. (An ENT with the extra training to work with singers and vocal function.)

II. Cate’s Collegial Consults

Together, an experienced voice teacher and their student book one session with me to make sure they have the information they need and for the teacher to observe ways to work with the student. Questions answered and total respect for the teacher’s work is given and acknowledged.

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!

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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.”