Understanding the Singing Voice: Anatomy or Imagery?

Are you left brained or right brained? Most of us are familiar with the distinction: right brained is intuitive, imaginative, and abstract while left brained is concrete and analytic. The English psychiatrist Iain McGilchrist argues that society is becoming increasingly left brained. In fact, in his book The Master and His Emissary, he shows that human artistic endeavor over the course of history has become increasingly left brained, whether in literature, architecture, visual arts, or music. 

It would seem that the imagery and abstract thinking of the past is becoming increasingly pushed aside by science. The poetry of metaphor is becoming displaced by the hard prose of facts: numbers, data, and pixels on a screen. As science is increasingly incorporated into vocal pedagogy, anatomy is displacing imagery. 

One reason for this is the dominant nature of vision over the other senses. We trust our eyes and believe what we can see and document. The image, the written word, numbers, and data have come to validate the reality of any phenomenon. By contrast, things that cannot be photographed, measured, or tabulated become implicitly less significant. In short, we are becoming more left brained. And this growing addiction to the visual is not unique to science, but is increasingly the direction society is taking.

I believe that in this visually dominated world, all of us—laryngologists, voice teachers and singers—have become overly focused on the appearance of the larynx. The doctor’s visit of older days, the transient glimpse through a laryngeal mirror, has been replaced by a magnified stroboscopic image in vivid color that displays every tiny blood vessel or drop of mucus. Because we can now readily see the larynx and visually document its function in real time, that structure has come to symbolize the singing voice, somewhat to the neglect of other parts of the vocal tract. We have chosen science as our truth and our eyes as our guide.

But the larynx is not the voice. In the words of the Zen Buddhist, “Do not confuse the finger pointing to the moon with the moon.” Stroboscopy can be misleading. It shows (in momentary flickers) how the larynx looks but has less to say about how the larynx works. When you look at the stroboscopic image of gently oscillating vocal folds, you are not seeing vocal fold vibrations in real time. 

The stroboscope displays only selected images (at specific points of oscillation) and not every movement that the larynx makes. Movements that are not regular and recurring (called aperiodic) are simply not shown. The color of the images can also be deceptive—it depends on the amount of illumination, the angle of the light striking the vocal folds, and the electronic enhancement of the image. The stroboscopic image is certainly enlightening and informative, but its apparent immediacy and reality is also deceptive.

The image is an imperfect representation of the voice. Singing is about physiology, not anatomy. The structures of the vocal tract are the substrate—but what you, as a singer, do with them, how you employ them to produce the voice, is a different matter. And, while the two are related, they are not equivalent. 

The seductive nature of the visual image is not only misleading, it can be potentially harmful. Once we accept how the larynx looks as the equivalent of how the voice functions, we might be misled, treating visible “abnormalities” that may not be responsible for alterations in vocal function. We have seen many singers over the years who have had surgical procedures performed based on apparent “pathology” detected on video images of the larynx. While the visual evidence seems compelling, it doesn’t always explain the vocal difficulties the singer experiences, and treating that abnormality may not always restore the voice. 

A particularly worrisome example is the tendency to inject vocal folds with steroids or fillers because they “don’t look right.” Sometimes the diagnosis is a persistent gap between the folds or slightly decreased movement or apparent stiffness in one, or both, vocal folds. Quite often, these apparent abnormalities do not meaningfully account for the vocal difficulties the singer is experiencing, difficulties that can be less intrusively remedied with voice therapy. Remember, the larynx doesn’t have to look perfect, it only has to function well. And this is where many of us—not only doctors but also singers and voice teachers—are mislead by that seductive video image.

There is so much to singing—auditory, sensory, and proprioceptive—that cannot be seen, or readily reduced to pictures or numbers. No laryngoscope or video image can document sound, voice placement, or color. These phenomena are invisible but nonetheless real, perceptible, and a significant component of learning how to sing. 

This is where science, as a guide, falls short and imagery needs to take over. By directing the singer to hear and feel the sound, even using images that may not be anatomically accurate, the teacher can enhance the nonvisual perception and control of the voice. At the same time, understanding the components of the vocal tract and how they work is also an important element of learning how to sing. Seeing anatomy attaches a visual correlate to what you might hear and feel.

So, anatomy or imagery? Is one “better” than the other? Certainly, for a scientist, the reality of science trumps imagery. But in the context of learning singing, that reality has limited relevance. Since for the singer, both science and imagery are only guides to learning, their validity in this context rests not on “reality” but on functionality. 

Therefore I recommend that, as you look in awe at the gently rolling vocal folds on the screen, you keep in mind that the function of the vocal tract, in all its nuanced complexity, cannot be reduced to words or images—and any description is only an inadequate representation of a phenomenon that eludes an all-encompassing definition. Left and right brains must collaborate. We need both science and imagery to guide us to the goal: learning how to sing.

Anthony Jahn, M.D.

Anthony Jahn M.D. is an otolaryngologist with a subspecialty interest in ear diseases, disorders of hearing and balance, and disorders of the voice. He is a professor of clinical otolaryngology at Mount Sinai School of Medicine and is the noted author of Care of the Professional Voice. For more resources, go to his website www.earandvoicedoctor.com.