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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Join us on our Facebook Group Page for insights, information and some great conversations.

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.

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.”

Vocal Warm Ups to Enchant Your Singing

I was inspired to write this blog post by Nikki Loney, a Canadian vocal music educator who runs a popular vocal music education podcast called The Full Voice. She has a three-part series called “Warm Ups from Around the World.”

The warm-ups Nikki includes are suitable for many ages and stages of singers. Part of her mission is to help singers & teachers understand the reasons for the vocal exercises they use, and sing them in a spirit of fun and exploration. While the exercises may be familiar to more experienced teachers, I was thrilled to hear the guest artist/teachers’ explanations for WHY you are using them and HOW to do them.

This matters much more than the actual exercises themselves! So consider heading over to her series and listen.

In the meantime, here’s three vocal warm-ups from CateFNStudios that I use.

I.  Pick a short musical phrase from the music that your student or group is singing. Choose one that can be moved up and down the chromatic scale easily. Limit them one or two measures at the most.

Here’s an example for developing voices of any age or stage: a passage from the end of Linda Ronstadt’s recording of Ray Orbison’s “Blue Bayou.”

Use “Blue—Bay—-Ou—-“

Works for women and men. Roy Orbison recorded it first, but he ends on the upper tonic, not the displaced third. If you aren’t sure what that means, listen to them both. You’ll hear the difference without needing to know the theory.

This helps coordinate chest to head registration smoothly in all styles of music, perhaps after registration work has taken root. It easily syncs with most functional vocal pedagogy models out there that use other names for those registrations/qualities.

It can also help with teaching relationships between intervals and with coordinating sustained singing. You can also use it as a “Messa di Voce” exercise.

Plus you get to introduce young people to Ronstadt and Orbison if they look at you with a blank stare….

For choristers, any pattern that has slow, sustained passages has the benefit of the kind of choral tuning that American choral conductor Robert Shaw used. Church choir directors can’t usually take the time needed for this way of working, but it can be incorporated into 2 minutes with one short passage as part of your choir’s warm-up. Over time this will develop stamina, mental focus, and group bonding.

II. For vocal flexibility and ear training for world music, Indie artists or jazz singers–have them warm up on arpeggiated patterns that are not the traditional major scale 1-3-5-8-5-3-1 pattern.

Eventually move to other arpeggiated blues or harmonic patterns using syllables they choose. Try to guide them to “ahs and ays” on the lower notes and “ees, oos or ohs” on the higher pitches. Scat singers will use their patterns or you can suggest something like “doo-bway-doo,” etc.

PS. I make classical singers do this, too, to wake up their ears.

I recognize that not all singers and teachers can play this warm up in different keys on a keyboard. You can adapt this idea for you and your students in any way that serves them.

III. This general idea is for singers who know their music well and are far enough along that it makes sense to them:

I coached privately many years ago with the late Randolph Maulden, of The Washington Opera. Obviously I warmed up before coachings, but then he often had me sing phrases from whatever I was working on, starting 4 1/2 steps down from its key, and going up two more 1/2 steps beyond the highest note and back down. I experienced this as a real work out. This gave me a chance to move through all the registration minutia, and solidified where high notes in the right key actually existed in my throat, body and psyche (as a whole singer.) This idea also can be adapted, so open to your creativity!

Once you know the HOW and the WHY for a warm-up or exercise, you can always adapt it to be the most useful!

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Creative Renewal: Five Responses to What Have You “Done” Lately?

I usually introduce students and clients to each other between lesson by way of cool tidbits. The other day I said, “Steven, meet Carolyn–she loves the American songbook and is a wonderful singer. Carolyn, meet Steven, he is also a voice teacher and is also a two-time Grammy award-winner!”

Carolyn was duly impressed, and as the brief conversation unfolded to include when those Grammies were won and for what, (2008 and 2012) Carolyn said “well, that WAS a while ago. What have you done recently?”

‘Scuze me, but WTFridge?

Lordy, I know we are perceived as only as “good” as our last major accomplishment–that college appointment, performance or tour, workshop taught, media article or pounds lost, but this comment really got under my skin. The monster that is the World Wide Web reenforces this mind-set every second of every day.

It is a mindset of judging others based on what they are churning out, as if that is the golden measure of skill, worthiness, integrity and tenacity. We live, not only in a violent, rape culture, but one that pays surface appreciation for the results of creativity and collaboration without valuing the time required for both.

That judgement from others is a massive reflection of the resounding and crippling judgement we have for ourselves. AND JUDGEMENT KILLS CREATIVITY and CREATES HEART WOUNDS.

As a life-long Creative, I live with this knowledge every day.

“She hasn’t done anything since she released that album 2 years ago.”

“He must be getting old because I haven’t seen anything about him in years.”

“He won a couple of Grammies but hasn’t done much since then.”

This attitude means “she/he isn’t relevant anymore/has lost steam/insert other moronic conclusion here.” As if the artist/teacher is a pampered cow, for others to milk and live off of.

This attitude reflects the hungry monster of consuming, consuming, consuming, and also the endless self-promotion and social media feed as part of the “cult of personality” we love. We have a presidential candidate that has risen in prominence solely because of his skills in all those areas.

We are good at that here in the United States. We are a nation of Pac-Men and Pac-Women, eating and consuming and demanding endless loops of SPLASH! to fill our empty, nervous spaces.

So here are five examples of responses for when someone asks you “What Have You Done Since Then?” or perhaps, more if the person is more enlightened, “What Are You Working On Now?”

  1. I am researching ways to cope more efficiently and joyfully with a chronic health issue. It is taking a lot of time and money, but what I have found out is—and this relates to my field because—
  2. I have sustained a free lance performing and teaching career, where I actually supported myself financially for (x) many years,–have you ever done that?–and am looking for ways to streamline my operation so I can have more time for (x).
  3.  I am writing a series of articles on (x) to help people who are (x)
  4.  I’ve been teaching, performing and caring for a family for (x) years, and have been constantly treading this super-human balancing act. As in agriculture, sometimes fields have to be left fallow to renew, and I am letting some of my fields lie fallow to renew by x, y, z.
  5.  I am working with a consultant to combine my skills in music, teaching and yoga–which are now hot topics but I have the experience of combining them for 30 years–into a more modern brand that can compete with other, less experienced but technologically-savy generations, as long as I want to work.

How else can you verbalize your current status to reflect some of what is required to live life-long creativity and relevance in the marketplace while learning to truly love yourself?

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Psoas Release and Strengthening in a Tenor: Vocal Master Class #2

Nick is a musical 28-year old tenor with a Theater Degree and college voice lessons. He was on the roster of the Annapolis Shakespeare Company and sings in operetta, opera and golden age musical theater. He arrived full of enthusiasm…and with a voice transitioning from baritone to tenor.

About 15 years ago, through personal circumstance, I realized that the ‘Psoas Muscles’  are an important part of both the body’s Core Muscles and Respiratory System. Somatic Educators are talking about them now, but they remain rarely discussed in the voice teaching community. They are  primary muscles in stabilizing the trunk of the body and in movement and have their insertions in the Lumbar Spine.

The Psoas is deeply connected to the diaphragm through the fascia, and with the main ligaments of the diaphragm  which run alongside the psoas and wrap around the top of the psoas.

Nicks’ postural habits were to stand with his pelvis thrust forward and his thoracic and cervical vertebrae collapsed. He stood and walked with his knees turned out and feet splayed. Vocal pedagogue, Marybeth Dayme, (Dynamics of the Singing Voice and other vocal pedagogy books), advocates that singers stand with their feet pointing straight out, knees unlocked, to help biodynamic energy flow. I use this idea with most students and for most, it stabilizes the hips and pelvic structure so breath management and general grounding work more efficiently. But Nick could not stand this way comfortably, and it made his alignment even worse, so I knew he needed to tea to first release, then strengthen, his psoas muscles if we were going to free up his alignment in order to have his functional voice training really take root.

Releasing and strengthening the psoas  also means working with the “holding” patterns of other muscles around them. For the first two months of weekly lessons, we worked on psoas lengthening, releasing, and strengthening. This took about five to ten minutes of every lesson, and he did the exercises at home. His body alignment used to make him look like a “curmudgeon,” and now reads “leading man!”

There was a gradual change in his perception of standing and moving.

Here are some good sources for learning about the Psoas Muscles and how to release and strengthen them for free and flexible alignment.

Liz Koch’s “The Psoas Book.”  Or Visit her Website.

How to Stretch and Strengthen the Psoas

articles from Align Integration and Movement

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