Dear Dr. Jahn: When I was six, I had my adenoids removed in the hope of stopping my chronic throat sicknesses. It didn’t stop them, and in September of 2006 at the age of 24 I had my tonsils removed. I’ve noticed, after they healed, there was an increased dryness in my throat. Also, there are three white spots on my uvula which haven’t gone away.
I went to the ENT who performed my surgery. He briefly looked into my throat and diagnosed me as having a less common form of acid reflux, one which gets caught around the larynx and causes irritation and, subsequently, caused my voice to stop or have a little “machine gun” kind of sound or gap in it when I sang a sustained note. I’ve found after treating it with a Tums at each meal and elevating my headboard, I’m doing much better, but I still experience dryness and sometimes a difficulty swallowing.
I’m curious what those weird spots on my uvula could be. Do you have any thoughts about what these things are, and what I might be able to do about them?
—Deep Throat
Dear Deep Throat: Based on what you have described, I would first say that an adenoidectomy would cure throat infections only if you were breathing through your mouth before and the surgery would allow you to breathe through your nose, preventing the throat from drying out. Tonsillectomy can relieve chronic sore throats, particularly if they are chronically infected.
I am not aware that either of these surgeries would leave you with a dry throat. White spots on the uvula, if they don’t go away after several weeks, are unlikely to be an infection. The only possible infection would be a yeast infection (thrush), which you might get from taking antibiotics or using a cortisone throat spray for asthma. If none of the above is true and they persist unchanged, you might need to have them biopsied.
Finally, if you do have acid reflux into the pharynx, a four-week trial of antacids and proton pump inhibitors should relieve your symptoms. I’m sorry I cannot be more specific, but these are some suggested directions for you to go.
Good luck!
—Dr. Jahn
Dear Dr. Jahn: I have just begun a meditation practice that involves chanting 20 minutes on “ah” in the morning, and 20 minutes on “om” in the evening. (Paraphrasing Berlin, “I got the ‘ah’ in the morning and the ‘om’ at night.”) Each 20-minute period is to be divided into one-third medium loud, one-third medium soft, and one-third silent.
I wonder if chanting one pitch only for a sustained period, and first thing in the morning upon rising, will be hard on my voice?
—Meditative Musing
Dear Meditative: I love your Berlin paraphrase. From the medical point of view, I really don’t think chanting should hurt your voice, providing it is at a comfortable pitch and not an excessive volume. The pitch should probably be in chest voice, at least a third below the passaggio, and well supported (i.e., floating on the breath and not pushed). In terms of dynamics, chanting turns your mind inward, and you will quickly become focused on the breath and the sensation of vibration in the chest. So I suspect you will not push or hurt yourself.
You might be interested to read about the five tones in Chinese medicine, each corresponding to a specific organ. The Chinese say you can strengthen solid (zhang) organs in the body by chanting different tones.
The truth is, you can find out only by doing it. You will certainly not physically hurt yourself by trying. If you find there is any adverse effect on your voice, you could consider other forms of meditation, such as qigong.
Happy chanting!
—Dr. Jahn
Dear Dr. Jahn: I recently had knee surgery and have taken up swimming as a means of exercise since I’m out of the running loop for a little while. I’ve been swimming for a couple of weeks now and have noticed that by the time I’m done with my swim, my voice is really tired. Obviously I’m not yelling or even talking while I’m swimming, so I’m wondering if this has something to do with the chlorine.
I swam quite a bit last summer and remember having the same problem, but I wasn’t singing as much as I am now, so I wasn’t too concerned about it. Now, though, I feel as if I can’t sing for quite a while (four or five hours) after I swim since my voice is so tired and worn. Is this something I should be overly concerned about? Is there something I can do to prevent it or make the effects less severe?
—Fish out of Water
Dear Fish: I am not sure what the association is, but I have a couple of thoughts. Chlorine could certainly be a problem and, since chlorine is broken down and evaporates more outdoors, the chlorine level is typically highest in indoor public pools. But you don’t normally get chlorinated water down to your larynx or lungs, although some irritating spray or vapor may get in as you breathe through your mouth. On the other hand, you may get chlorine into your nose, and this may have a reflex effect on the vocal tract. We do know that breathing through an open nose increases the compliance of the lungs—i.e., makes them more flexible and effective. Conversely, breathing through your mouth, especially in the presence of an irritant such as chlorine, may have the opposite effect.
Another possible association could be if you strain your neck or shoulders during stroking. This might create a reflex tension in the pharynx and elevate the larynx. I would be interested to check your neck before and after swimming, to compare the position of the larynx. If the larynx is elevated, this can affect your voice, and you may need to work a bit to lower it again before singing well.
One way to determine which of the two possibilities is the culprit would be to swim in a (non-chlorinated) lake during the summer and see how you feel.
Good luck!
—Dr. Jahn
Dear Dr. Jahn: I read your article about young voices [CS July 2009] and was fascinated by the amount of changes that happen in a young voice. I am 17 years old and am interested in a career in classical vocal performance. Recently I have been having trouble reaching my upper range without my voice cracking. These notes used to be extremely easy for me to reach. I haven’t been vocalizing more than usual or changed anything about my lifestyle. The only changes are that I recently began taking an asthma controller medication called Alvesco and have begun to learn to play the flute. Could either of these variables have created this change in my voice, or is the change just a common stage that my young voice is going through? I would really appreciate any insight that you could give me.
—Breathless in Boston
Dear Breathless: A number of issues come to mind. I am assuming at age 17 that you are fully grown, so your larynx would be at its adult dimensions. During puberty the larynx is unstable in terms of muscle control, which accounts for the pubertal wobble (called mutational falsetto) often heard in young teenage boys. It may be that your larynx, although anatomically adult in size, is still undergoing some muscular adjustments. A second issue has to do with what you are singing. If your voice has dropped during puberty (again, more of an issue in boys), you may not be as able to access those high notes without specific training. Most important is the asthma spray—some of these (especially Advair) can cause hoarseness. All of them can potentially predispose you to a low-grade yeast infection of the throat as well.
I would first of all stop your asthma spray (change to another effective medication) and have your larynx examined. If everything looks normal, return to your teacher to work on those high notes.
Good luck!
—Dr. Jahn
Dear Dr. Jahn: After reading your article “The Youngest Singers: A Cautionary Tale” in the July issue of Classical Singer, I had some questions to ask you. At the end of June I went to [a voice clinic] to get my voice checked out because I was experiencing airiness and a voice teacher had suggested it. I found out that I had a vocal callus, and so I wanted to get your advice on how I should treat it.
I am 19 years old and am going to be a junior in college. The otolaryngologist I went to was not sure what had caused the callus. He was not sure if it was my singing, speaking, or bassoon playing that had caused it. He suggested that I do voice therapy and work with a speech pathologist. I was wondering if it would be better to work with a voice teacher or someone that specializes with the singing voice?
—Young and Calloused
Dear Young: I am not clear on the term “vocal callus.” I assume your doctor is referring to a nodule? Nodules normally occur in pairs, one on each vocal fold, so if you only had one “callus,” it might be something else, such as a bit of thickening which is the residuum of a vocal polyp. So the first thing is to figure out what he really saw, since the treatment for the two conditions is quite different.
Airiness in the voice, especially on top, normally means that the vocal folds are not approximating. This can be the result of a mass on the vocal fold, such a polyp, nodule, or “callus.” It can also be the result of how you posture your vocal folds—using excess muscle tension prevents the vocal folds from properly approximating.
Regarding the bassoon, in my opinion, this is good for a singer. It teaches you to exhale against resistance, to manage your breath, and to open the upper airway. There is of course some tension in the mouth itself as you hold the double reed, but I think most would agree that any wind instrument, especially a double reed, is not harmful for singers.
Good luck!
—Dr. Jahn
Dear Dr. Jahn: I was diagnosed with acid reflux. I was originally on famotidine for a week, but it did not work. Now, I am on Prilosec 20 mg. I have been on this medicine for a week. How long will it be before I rebuild the vocal stamina that I have lost? My voice feels different now. I just want my normal voice back. How hard should I be working the voice daily to achieve this?
—Impatient in Iowa
Dear Impatient: The first question is do you actually have acid reflux? This is a diagnosis which is made so often that for a lot of physicians it becomes the diagnosis when they are not sure whether there is anything else going on. If you do indeed have reflux, the next question is are you on the right drug and on a high enough dose to deal with the problem? My preference for reflux is to start with Nexium 40 mg taken one hour before dinner or, if necessary, twice a day, before breakfast and before dinner. The response typically takes a couple of weeks, even if the diagnosis, drug, and dosage are all correct.
Even if all of the above issues have been addressed, you will need to work the voice to get it back. Typically the larynx elevates when there is reflux disease, and you need to actively work on lowering the larynx and opening the pharynx to regain your voice.
Good luck!
—Dr. Jahn
