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Hi Dr. Thomas, thanks so much for such an informative website and the great videos on you tube. I am a voice teacher in Chicago. I have also sung professionally for 20 years. Although I am trained as a classical opera singer (music degrees from Illinois Wesleyan University and Northwestern), my passion has always been rock and pop. I carry a heavy load of voice students (another passion of mine). Quite often I get students who want to sing in bands, or learn to sing quite high in their chest voice for particular musical roles. Usually, teachers refuse to teach students in their chest voice. The classical vocal world does not really allow the use of chest voice. I have always sung in my chest voice, as I have been in musicals and bands and recording studios since I was a kid and I have to believe there is a way to sing high in the chest voice healthily. I have learned to implement my classical training on my chest voice so that it is as forward and clear sounding as possible, a technique that I also teach my students. I know that the classical vocal world says that singing in chest voice will produce nodes, but I was wondering if you have any medical knowledge in the area of chest voice versus head voice and if one can truly cause nodes more frequently than the other, or if the issue is caused by poor technique regardless. I am in the midst of writing a book on the subject as well as trying to get an internship with an ent to learn more of the medical side of the vocal cords. I have extensive knowledge in the are of vocal pedagogy, but would love some medical knwoledge to back it up!! Thanks so much for any help you can give in the area of chest voice. With so many wonderful pop and rock singers of the present and past who have never had vocal problems, it is hard to believe that all use of chest voice could be that dangerous! Thanks again for any help you can give!
CK
Changing pitch in chest voice is largely performed by tensioning the thyroarytenoid muscle. This is the muscle within the vocal cord itself. Changing pitch in falsetto is largely from the cricothyroid muscle. This muscle rests outside the larynx and rocks the 2 main cartilages of the larynx producing a change in length of the vocal cord. Consequently, we have 2 sets of muscles to change pitch. They tend to overlap in the middle of our vocal range and we can produce the same note in more than one way. That is, we can sing the note C4 (middle C) primarily by contracting our thyroarytenoid muscle, which would thicken and tighten the vocal cord while it remains the same length. This produces the rather full sound that you describe as chest voice.
Alternatively, we could tighten our cricothyroid muscle until we reached the note C4 and we would stretch the vocal cord longer and thinner until we reached this note. Even though we have 2 discrete ways to produce the same note, and you could do this on a guitar with 2 different size strings, the quality will be different when a thicker string vibrates at a given pitch then when a longer and thinner string vibrates at the same pitch. We could also produce the same pitch with some intermediate tension on each of these 2 muscles. Consequently there are many ways of creating the notes in the mid-range of our voice. A classical singer would typically spend years trying to smooth out this transition between using one muscle and the other. This would create a blend rather than a break as we shift the tension from one muscle to the other gradually.
In my experience, vocal elevations/swellings (nodules, polyps etc.) come from vocal overuse. Very few people sing sufficiently to create vocal swellings solely from singing. However, a great many people are extremely talkative and filled their life with vocal activity, both singing and speaking. The greatest factor for creating a vocal swelling is vocal overuse, talking too much. A person who is very talkative and hoarse has about an 80% chance of having a vocal swelling based solely on this information. The second factor contributing to vocal swelling is vocal volume. The third factor is likely vocal technique.
I think the use of chest voice or head voice (falsetto) plays almost no role in the formation of vocal swellings. Quantity mostly and volume second are the overriding factors creating lesions along the vibrating margin of the vocal cord.
I had a test done of rapid sequence filming of the cervical esophagus was performed during swallowing. Frontal and lateral projections were obtained. These demonstrate no anatomic abnormalities of the cervical esophagus, although trace penetration was observed. My question is what is this trace penetration mean? The nurse practioner stated that sometimes some liquid goes down wrong pipe. Hopefully you can give me more insite on this. Jimmy D Jones 7700 Odell Ave, Bridgeview, Il 60455
Thank you
Dear Mr. Jones,
Your question is a good one and certainly one that the physician who reads your test should be able to interpret for you. Since x-ray contrast material going into the larynx is generally the wrong place for liquids, physicians and speech therapists often described this as penetration. However, the amount and the degree are important. In fact, when I look at swallowing, I show patients my video exam and answer questions such as yours.
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Hi Dr, I think your site is first class. I have a question about botox injections for voice problems. I heard it can cause swallowing, eating, swelling, breathing problems and others.
Could this be true and how dangerous is it?
I just read today about a Dr Mort Cooper who claims to have a natural cure for Spasmodic Dysphagia, which from the sounds of people speaking on his videos sounds like my condition. He calls it Direct Voice Rehabilatation. (DVR) Have you heard of it and would that be a feasible treatment?
In general, botulinum toxin injections are not given for “voice problems”. Injections of botulinum toxin are used specifically for laryngeal spasms. Laryngeal spasms can be present in various muscles of the larynx. They also can be active during differing tasks. For instance, they can be present during phonation or they can be present during breathing. On the Therapy:Dystonia page I speak about this in more detail.
In my experience, speech therapy works very well with nonorganic types of voice disorders. I have not seen it work with laryngeal spasms, which are a neurologic disorder.
So the most important consideration is to have an accurate diagnosis before undergoing a treatment. Consequently it is difficult to discuss treatment without having an accurate diagnosis. The only way I know to obtain this is with an appropriate listening and laryngeal examination.
Hi Dr. Thomas.
I'm a 53 year old male to female, I've had all my surgerys to be a female, but people call me sir whem I'm on the phone. I have no problem when I'm face to face in public.
Do you think I'm to old for feminization largoplasty? I've had my addams apple shaved 5 years ago.
Jamie..
Dear Jamie,
I don't have a set age limit for the procedure of feminization laryngoplasty. I have a sense that younger patients do tend to get a more complete change in their voice. Also, two patients whose voice did not change at all were over 50 and had a fairly muscular and large body build. Some of the sense of success or failure has to do with resonance. That is, if you have a large throat, mouth and nasal cavities, the deep tones will still he amplified more. Still, that's not really enough numbers to statistically predict who will get a great voice, who will get an average voice and who will not benefit very much. It also depends on how much vocal cord length is altered. So the short answer is I don't think you are too old for the feminization laryngoplasty procedure, though the risk that you won't have a better-than-average result might be higher.
Hey Doc,
I am a singer and have been struggling with mega phlegm in my low register. (E above middle C down to F below middle C) The phlegm at times feels so thick that my vocal chords for a second seem paralyzed. They best way to describe this sensation is that I feel like I'm singing through molasses. Pitch problems occur and sometimes the pitch will even change on it's own! I know I am compensating by tensing throat muscles to create pitches (which is probably not good). What is even worse is that this has been going on for years. I don't have this problem at all in my high register. It's very frustrating and I'm starting to wonder if something is wrong. What should I do?
Lindsay
Dear Lindsay,
There are quite a few reasons to have the sense of phlegm building up or as some people describe it “postnasal drip”. I seldom see large quantities of phlegm in anyone.
On some occasions, I see people with rather thick secretions. There may be reasons such as dehydration, for example, especially when patients are on diuretic blood pressure pills.
More often, normal amounts of secretions tend to accumulate because of some irregularity in vibration. For example, swellings on the vocal cords dampen the vibration of one segment of the cord, so secretions accumulate on the swelling. In people with bowing of the vocal cords, secretions tend to accumulate at each end of the by vibrating segment of the vocal cord.
The only real way to know is to have an appropriate examination. I do list some physicians who are especially interested in voice disorders on the "Home:physicians" page.
Best wishes.
Dear Doctor I have a 20 year old daughter that was in a near fatal ATV accident on March 20th of this year. She was in a coma for 6 days and had a server TBI and stopped breathing. She was Intubated at the trauma center and upon awakening she had NO voice. They took her for exploratory surgery and the DR came out and said if she were an opera singger her career would be over! She no vocal cords in the pictures he gave me. The vocal cords have come back but they were first paralyzed 1/2 open and 1/2 closed making coughing up phlem and even breathing has been a problem. She is now pregnant (not planned) and her ENT says that the VC are now closing all the way but they will not open all the way and she does not know why. I am worried as the pregnancy goes on she will get worse and worse. We are very blessed she is as together as she is with the injuries she sustained but I sure would feel better if someone could tell us what we can do. Do you think it could be built up scar tissue and if so can a surgeon remove it or will that leave her with more problems. She was in nursing school before all this happened. Can you please tell me what we should do!! Thank you so very much for your time!! Kristin Sholaya
The most important distinction a laryngologist can make after an intubation injury is whether nerves have been paralyzed or whether scar tissue has been created. Both fixation and paralysis can visually appear the same as both types of injury can prevent movement of the vocal cords, but are treated differently. Typically the laryngologist will need to topically anesthetize the vocal cords and pass their endoscope between them to see whether there is scar tissue present at the back side and underneath the vocal cords. I do list a number of physicians interested in vocal cord problems on this website. You may see them by clicking on "Home: physicians”.
Hello Dr. Thomas!
My name is Makena and I'm an eighteen year old female singer. Lately I have been experiencing symptoms of MTD after/while singing, that I've never had before and I've been singing my whole life. I had an appt. with an ear nose and throat specialist recently but she said I wasn't describing symptoms of nodules because I haven't noticed a change in my voice, just the pain is present. She recommended a formal vocal coach and said that training would solve the problem, which I have also scheduled soon. She saw no pictures of my larynx or anything, so I wanted to ask your advice. Do you think surgery or injections would be necesarry? What can I do to ease the discomfort in the meantime? Is this permanently damaging to my voice?
Thank you for your time,
Makena
it would be impossible for me to make a diagnosis without seeing both the vocal cords themselves as well as the actual movement of the vocal cords. In addition, there are a wide range of qualities of endoscopes with the fiber-optic endoscopes giving the dirtiest image and high definition chip endoscopes or high-definition rigid endoscopes giving a very clear view.
While pain is a symptom of muscle tension, it can certainly be a symptom of other problems which an ENT should be able to sort out. When the pain is from muscle tension, the laryngologist will see that the vocal cords are opening in the back when making sound, yet they are capable of coming completely together at other times. In other words, there is not a paralysis or joint fixation which is limiting closure of the vocal cords, rather competing muscles are tensioning and holding the vocal cords apart.
It would be impossible to jump to conclusions about treatment until an accurate diagnosis is made. If the patient is ever in doubt, a second opinion with a laryngologist can often be quite helpful. I do list a number of laryngologists on this website at “Home: physicians”.
What are some "at home" ways that a singer can check if his or her voice is getting too fatigued or if there is vocal nodules or damage?
A singer may learn to perform the "vocal swelling tests" described http://old.voicedoctor.net/Optimal-exam/vocal-capabilities .
Hi Doctor, after a recent exam with a fiberscope, my ENT wrote, "He has got a little bit of vocal cord edema and he has what I deem a proto nodule on the left cord."
I am a professional singer and have had a busy schedule, sometimes two shows a day. Since that exam, I have cut back my performances, focused on rest, water, and a "back-to-basics" approach to vocalizing. I am doing much better, and continue to see improvements each week. My biggest hurdle at this point is trying to get my head voice back.
My question is: What does "proto nodule" mean? Thank you very much!
Sincerely,
Ken Wanovich
Dear Ken,
Your question is a good one and one that your doctor should be able to answer.
Myself, I see nodules come in all different sizes. Since a nodule is basically a callus, really just like the ones you get on your hands from overuse - that is, a nodule is a thickening of the skin from rubbing and overuse - the size of nodules depends on how much the vocal cords have been overused.
In order to test the size of the swelling, basically the higher and softer one can sing, the smaller the swellings are on the vocal cords. Conversely, the larger the swellings are on the vocal cords, the more that the high and soft singing voice will be impaired. See vocal capabilities testing at http://old.voicedoctor.net/Optimal-exam/vocal-capabilities.
im a 28 year old female and have been on omeprazole for the past 4 weeks and have had a lumpy feeling in my throat all along which comes and goes every few minutes or so... i told my doctor about it and they said it was acid then again it was to do with anxiety... this lumpy sensation has happened before and the symptoms disappeared in a short time but this time they havent.. i try to cough it out so as to get some sort of relief and instead i find myself almost vomiting..i gag so much, iv developed anxiety,and have become so uneasy and constantly worried..GP said symptoms are self limiting but its made my life unbearable...iv decided to stop omeprazole and see if the side effects go away becoz im getting the common and the the rare side effects...is there something seriously wrong with my throat or is it the constant worry and anxiety and insomnia that im getting from the medication..
The question you ask at the end "...is there something seriously wrong with my throat or is it the constant worry and anxiety and insomnia that im getting from the medication.. " is really the question you should direct to the ear nose and throat surgeon who has seen the inside of your throat. After looking, he or she should be able to answer this question for you and alleviate your anxiety.
Dr. Thomas,
I'm 33 yr/male from Honolulu who have been having recurrent throat problems. My history, at about 12 years old, I was punched in the throat at the adam's apple. Until then, my developing adam's apple could be easily seen but no longer since that event. Through out my life, I've had issues with speech, higher than normal pitched voice, and difficulty singing. Throats hurts when I try. Always having that lump feeling in there. Also, whenever I have a cold, it always end up in also a sore throat that requires antibiotic treatment. Noticeable symptom always include swollen tonsils. Strep Throat culture and Flu test, due to high fever, always negative. My PCP have been unable to explain what's causing the swollen tonsils and makes it difficult for me to swallow, drink, or eat.
Is it possible that the injury I had when I was 12, a contributing factor or direct cause of my illness, voice pitch issues, and sore/hoarse voice when attempting to sing? I desire to find out the root cause of my illness and to have a normal or lower pitched/tone voice.
Thank you for your time.
For your voice problems, you might seek out a laryngologist, someone who specializes in voice. I list quite a few of them here on this website. A pitch issue is directly related to the vocal cords, so seeing the vocal cords vibrate and testing your pitch range, a laryngologist should be able to answer your questions..
I was diagnosed with adductor spasmodic dysphonia in 2004. I received my first Botox injection in 2006 from the NIH in Bethesda, Md. as part of their clinical studies. I received injections until 2009 when I was told I had developed antibodies to the Botox and it was no longer working. A few months later in 2009, my doctor in Orlando, Florida started using Myobloc and it worked beautifully. I have started having less and less results the last 4 months and after my injection yesterday, it is not working at all. What is available besides these 2 medicines to relieve the spasms? Are there any other medicines available to give me a good voice??
Debra Anderson
I have read scientific literature that suggests it is possible to develop antibodies to botulinum toxin. However, I have also met patients who were told they had antibodies and yet I was still able to treat them with botulinum toxin. In my experience, I have found that technique of injection more often affects outcome then development of antibodies. See comments on "The art of the injection". Consequently, while I don't know of other medications, there are times when seeing a different physician who utilizes a different approach or technique or injects a different muscle can lead to a different outcome.
Hi Dr Thomas,
I was recently referred to you and had an appointment scheduled to rule out/in VCD. At the time I scheduled, it occurred to me that I had been on daily inhalers and only after a couple of months did I find that my vocal cords/airway were very inflamed. I decided to start gargling instead of just washing any residue away. Within 4 days, the inflammation I was experiencing was gone along with voice issues that sometimes came and went (sometimes I could scarcely speak). My experiment was running some cross country races. The first one before the gargling was horrendous, even with albuterol beforehand and my usual daily symbicort. It took extreme focus to keep the vocal cords from clamping shut. The same occurred in a half marathon I ran the next weekend.
After the gargling, I have not had any issues, ony one slight "almost" for a few seconds during a race. I have been feeling great lately, so much so that I signed up for another marathon. Looking back I realized how miserable I have felt this entire year.
Fast forward a couple of weeks, my physician decided we would do a methacholine challenge to rule out asthma. It was negative. I have been off the inhalers (but still gargle 2x per day) for about three days and I am experiencing discomfort in my airway though not to the extreme as before along with voice changes. This does not make sense: inhalers and gargle, feeling good. No inhalers and gargle, not feeling so great when all of the pulmonary testing I have had was negative.
My questions (I have done a lot of research but am unable to locate my specific symptoms):
Can VCD be a 24/7 issue? It is not only during exercise that I experience this. I will often feel lightheaded and feel a bit of "congestion" throughout the entire day, even when I am not training. The information I find describes episodes during extreme exercise and granted, this year I was training for another Ironman (lots of extremes) and I couldn't breath when it came to running off the bike in training or on race day. I had symptoms every waking moment. My first doctor called it reactive airway, but from my understanding, the methacholine challenge would have picked up on it?
I was told for the appointment we would try to induce the vocal cords into closing. I did not want to do that (and have a bill) if I had no way to induce the problem once I started the gargling. I have already ended up in the emergency room, gotten second opinions and still have questions. I am not sure if the testing the other day irritated things enough that it may take a few days to clear. I will certainly know more this weekend after another cross country race.
The next step was a voice therapist though I think I need more information. My concern is that it may not be only one issue based upon my research of symptoms, though it might be that it isn't published that it can be a 24/7 problem. Sleeping actually is not an issue and I feel okay when I get up. Usually after an hour or so we begin the cycle.
Any thoughts would greatly be appreciated,
Christine
Dear Christine,
I tend to think that good examinations are typically the answer to the type of question you are asking.
Dear Dr. Thomas,
Long story short, I tried to learn to sing and went to a vocal coach for the 1st time and caught laryngitis for a week where I couldn't talk. Everything healed, but lately my throat has been irritated. It seems whenever i talk or attempt to sing, my vocal cords will feel irritated like they are dried out and rubbing together. When I don't talk or sing, everything is fine. The frustrating part it happens at random times. I have visited 3 ENT's who all say my vocal cords look fine and two of them think it's laryngopharyngeal reflux and told me to take Prilosec OTC. I've never had reflux in my life and I just turned 30. They also said I have a deviated septum and post nasal drip may be irritating my throat, but that has never happened in my other 29 years. Everytime I tell them it feels like my vocal cords are dried out and rubbing together at random times when i talk or sing they just dismiss this as if it cannot happen. But when it happens, I drink some water and pineapple juice and may breathe in some steam while resting my voice for a little while and everything is fine. I know you cannot give me a proper diagnosis without seeing me yourself but can you at least tell me:
-Is it possible for your vocal cords to dry out or feel like they're rubbing together with no thin mucus layer when you talk or speak at random times?
-Are these really symptoms for LPR or is it something else?
-How can you properly treat this?
I appreciate you taking the time to read this.
The answer to your question lies in getting a good examination. You might consider visiting a laryngologist, someone who specializes in vocal cord issues.
I hope you can help me. I am 30 year old man who has an abnormal
voice, it is high pitched and 'gay sounding'. I have read and done many
exercises without success, however reading more and more about this and I am
aware that surgery may help me.
I read that removing a segment of cartilage from the voice box would loosen
the vocal folds.
Any help or advice would be great, if it is not possible from yourself than
maybe a recommendation.
I live in the UK.
Before deciding on a surgical treatment, it is important to know what the diagnosis is. Someone needs to answer why your voice is at a high pitch. Without a cause, it is difficult, if not impossible to comment on the treatment. I list the physicians that I know on this website at http://old.voicedoctor.net/Physicians-0/index-000
Dr. Thomas, I have been diagnosed with Emphasyma. I painted cars for 42 years and smoked for the first 20. I always assumed the lump in the throat sensation that I expierence was related to dust and toxins. However I have been out of that enviroment for almost 2 years now. I have sang since Iwas a kid and remember for the most part constantly clearing my throat. I am presently seeing an oratologist whom seems sure my condition is related to reflux. After doubling the dose of nexium and then switching to a double dose of prilosec, I have saw minimum improvement.
I love music and currently do volunteer in Nursing homes. I have lost my voice to hoarsness a couple times on stage. This is to say the least embarrassing and taking away an outlet I really need. I think perhaps the stress of wondering if my voice will hold is making the problem worse. I think your explanation of lump sensation makes sense but somehow I don't think this doctor will aprreciate my self diagnoses. Although I constatly am clearing my throat during waking hours, I do not wake myself or my partner up at sleep clearing my throat. What can I do? Do you know any doctors in the Columbus Ohio area who would be willing to look further than acid Reflux?I would be most grateful! Jimmy
Dear Jimmy,
I list the doctors that I know on this website - http://old.voicedoctor.net/Physicians-0/index-000
if you aren't getting better on treatment, that can be because the diagnosis is incorrect. The only way to know what is the cause of losing your voice is to have a good examination. I also talk about how to evaluate the quality of your examination on this website - http://old.voicedoctor.net/Physicians-0/Choosing-your-doctor
Best wishes,
James P Thomas
Hi Dr, My name is Sarah, 20 years old female and a very passionate singer. I don't have any vocal cord "problems" as i have a very clean and loud voice, but i am desperate to lower my tone and pitch (singing and speaking lower notes with more depth) and i was wondering if the CaHA injection would be the solution to my problem?
Could you please give me your oppinion?
Kind Regards,
Sarah.
Dear Sarah,
Pitch is a result of how thick the vocal cords are, although it is the edge of the vocal cord that vibrates more then the body or deep portion of the vocal cord. In a person with abnormally thin cords, some sort of implant can lower the pitch. Typically with a normal sized vocal cord, it is difficult to lower the pitch very much by increasing the mass of the vocal cord further. Unfortunately, vocal overuse (especially when combined with tobacco consumption) tends to increase the fluid beneath the surface of the vocal cord (in smokers this is called Rienke's edema) and presently I don't know of an injection that can mimic this quality. Otherwise training is the most effective way to lower the pitch as well as to improve the resonance of the lower tones by learning how to expand the size of the pharynx.
Hello Doctor Thomas,
I am a rock and metal singer from Germany. Four weeks ago I continued singing tracks for my solo album despite having a cold, because I told the label I'd be done by the end of this year. To make matters worse, I decided to yell some parts of the chorus in a way a doc barks (only longer), forcing my voice to sound rough and hoarse while producing the tone. The outcome was great, but I haven't been able to produce a clean, soft sound since then, even my speaking voice sounds hoarse most of the time, and this is four weeks after the recording. My live performance is also far worse than it used to be. So I finally visited a doctor, but he didn't really have time for me, I was in and out within 3 minutes. He said I had vocal nodules and I that needed speech therapy, I could look it up. When I asked the doctor if that would get rid of my nodules, he said I should think of them as chicken eyes on my vocal cords, which didn't answer my question.
Nevertheless, I've cancelled all live appearances and informed my management I couldn't sing for the next couple of weeks. I've already made an appointment with another ENT (hopefully one with more time to explain stuff), but as I was browsing the web for vocal nodules I came across your website and thought: This site is brilliant, maybe Dr. Thomas can answer my questions. Which are those: Firstly, will speech therapy make my vocal nodules go away? And if not: Will it only help my speaking voice or will it improve my singing voice as well? Secondly: Is surgery an option for a singer? I read about Bonnie Tyler and Julie Andrews, and I wouldn't want my voice to be different after the nodules are removed. And finally: I've done the soft singing test from your website (and obviously failed), but I also noticed that there is a section in the middle, that I have failed to produce for over ten years, which leads me to believe I already had nodules before, but never noticed them. Are there non-surgical ways to get rid of old nodules or have they already turned into scar tissue?
Thank you so much for your time and thanks in advance for your answer. Keep up the brilliant work.
Dear rock 'n roller,
I believe that accurate diagnosis is the most important element of treatment. With a general ENT exam, it may be difficult to distinguish between vocal nodules, vocal polyps, hemorrhagic polyps and small ectasias. I do list the number of physicians around the world, including some in Germany who specialize in voice disorders. You may be more likely to get an accurate diagnosis from one of them - http://old.voicedoctor.net/Physicians-0/index-000. Anyway, I couldn't comment on the appropriateness of surgery without knowing exactly what the problem is.
Hello,
I have had already 3 separate surgeries on my voice box since my hockey injury in 1991 which paralyzed my right vocal cord.
2 of them helped push the right over to meet the left, and the last one was an implant.
I now can use it to talk on a cell phone with competing noises, with the window down for instance, but still talking to someone during a party I have to almost shout at them for them to hear me.
I also have developed what I call, the Chewbacca syndrome, where my voice flutters now like the character in Star Wars if I blow out steady air on certain vowel sounds.
Would the Injection laryngoplasty help in strenghtening the resonance of my voice?
Thank you for your time and advice on my situation.
Grant
Dear Grant,
It would be most helpful for someone to visualize what is making the fluttering sound that you describe. Once that is identified, a treatment can be proposed to stop the flutter. In general, if your vocal cords close completely, your voice will be loud and clear. So if you are still having an inadequate volume, this suggests that the vocal cords are not coming completely together. It sounds like it is time for a good vocal cord examination performed at the volumes and pitches that you are having trouble with. I list a number of laryngologists at http://old.voicedoctor.net/Physicians-0/index-000.
Thank you so much for your article about lumps in the throat - it was such a relief to read it. Knowing that there will be an end to it and that the symptoms are not imagined is a great help.
My comment is for other sufferers:I seem to be getting some very temporary relief by relaxing my jaw (and therefore the throat) so there is a gap of about 1/2cm between my teeth and my lips are just closed. As it is often a struggle to swallow saliva and panic about breathing difficulties can start, (I appear to be developing allergy induced asthma at the same time) any relief is most welcome.
I do hope this might help someone.
Nell
Thank you for the feedback on the web page.
Hello Doctor Thomas,
after my surgeon suggested to strip my right vocal cord to remove a nodule, I googled the procedure and found your video about it. Now I am a little intimidated. If I let the doctor proceed, will the stuff eventually grow back?
Thanks in advance,
Dave
Dear Dave,
When a surgeon says they're going to strip a vocal cord, that tells me that their technique is quite old and secondly that they do not understand that there is a lubricating layer within the vocal cord between the muscle and the mucosa on the surface that is necessary to produce a good-quality voice. So, for me, if the surgeon doesn't understand the anatomy, I would avoid their surgery. 2 more specifically answer your question, if the lubricating layer is removed, there is no way to replace it. It might be time for a 2nd opinion. I list a number of physicians who specialize in vocal cord surgery at http://old.voicedoctor.net/Physicians-0/index-000.
Hey, I have been having all kinds of trouble with my singing voice, I got a cold, in June and my voice got a little hoarse, after this cold my voice was fine again, and I use to sing everyday, all day without any problams, a few weeks later we where rehearsing for 2 diffrent concerts, and I got a little hoarse again, then, just after the 1 concert in August, we got a cat. I'm allergic to cats. I took some allergy pills but they did not work, my throat kept getting soarer and soarer. It started to hurt when I breathe and more when I swallowed, the pain just suddenly stopped after a few weeks. This was when I started to feel a lump in the back of my throat, sometimes completely shutting of my air when I take a fast deep breath. I can't sing the top octave of my natural range without forsing my voice and my valsetto is completely gone. My mouth tastes sour and the back of my throat, mostly in the morning. I constantly cough, I have post nasal drip and when I do cough up something, it is not much. Also my voice feels closed when I sing, it sounds as if I'm singing with a towel or something covering my mouth. Overall it just really affects my singing voice, I feel very uncomfortable when I sing.
Overall symptoms: lump in throat, sour taste, hoarseness, coughing, throat clearing, pain in my throat, trouble with singing, post-nasal drip.
Please tell me what this is and how I can stop it.
The only way to know what is wrong with the voice is to have a look. I list a number of physicians who can provide this type of examination at http://old.voicedoctor.net/Physicians-0/index-000.
I had a Anterior Cervical Fusion on C6-7 on 12/12/11. I am 2 weeks post op and I have only a faint nasal hoarse voice. I was a professional singer. They put me on steriods and today is the last day. Still, no voice. I can only talk in one pitch and I can't produce any high pitch at all. HELP ME!!
While it is quite likely that the surgery has injured one of the nerves that control your vocal cords, only an examination can tell you how significant the injury is. I list a number of specialists in voice at http://old.voicedoctor.net/Physicians-0/index-000, if you would like to get a more accurate opinion.
It is true that a great many injuries of the nerve improve over time. Only you can decide if you just want to wait and see what happens or would prefer to get a more accurate opinion. Additionally, some of the laryngologists are skilled in placing temporary injections in the vocal cord to temporarily improve the voice while you are waiting for any recovery. These injections may or may not affect the final outcome, but are certainly helpful while waiting.
Hi, for the past 6 months, I have had serious issues with my throat that are really affecting my breathing. My nose feels it too. Let me explain. At the nose level, my nose is extremely tight all day. What I mean is, even the very bottom of my nostrils are permanently in a tense state, effectively making my nose opening more narrow. However, my nose itself is apparently "clear" based on what doctors say. So, that leads me to believe it's my extremely tight throat that's causing my breathing symptoms. Essentially, my throat feels like it's being squeezed at all times. When I breathe in, it's as if my throat is sucking in on itself, and I feel like I didn't get a normal breath. I often end up taking a deep breath out of my mouth repeatedly. When I breathe in through my nose, in addition to the sucking in feeling, it's almost like this feeling of cool air somewhere in the back of my nose or upper throat. It feels like a thin column of cool air is getting through only. When it's at its worst, the cool air feeling goes away. I found a few tricks that seem to help slightly. One is a very deep yawn. It seems to almost stretch my muscles out or something and the next few breaths (for about 20 seconds or so) are a bit more satisfying. What I notice during those breaths is my nose seems less tense and the cool air feeling becomes more pronounced in my throat, as if the column of coolness has increased thickness slightly, meaning more air going down.
Some other weird symptoms I have noticed are when burping, my throat seems to block them off now, like they literally can't come out my mouth anymore. In fact, every time I burp, my nose often blocks off temporarily even more. I hear like air popping sounds and liquid type gurgling sounds in my throat afterwards. It almost feels like my esophagus has somehow shifted higher in my throat or something. Another thing is when I breathe in through my nose or mouth, my stomach constantly growls, a sign that air is getting into my stomach. But, it's literally happening repeatedly now. One of my theories is that something is so tight, enlarged, or out of place in my throat, that air is getting somehow displaced towards my esophagus instead of my wind pipe, which is causing all these symptoms. The thing about it is, no matter what, even if I do everything possible to make my nose feel clear, it isn't enough, because my throat still sucks in on itself when I breathe in, and air seems to get displaced from into my esophagus. It also seems to explain why burping seems to go into the back of my nose. It's almost like there's some kind of direct path from my nose to my esophagus that has formed. I often take breaths through my nose know as brief "sniffs" cause extended breaths in just seem to tighten my throat more and more.
I know it sounds crazy, but these are the symptoms I feel 24/7 now. My ENT basically "released" me after 2 visits, saying I'm crazy. He did do that straight scope thing. Basically, even my family thinks I'm crazy, but they have no idea that I know something isn't right here. It's almost like I'm the only one who really knows how bad these symptoms are, and these stupid doctors here just blame everything on psychological problems or "reflux". I'm not sure what to do. I live in Panama City, Florida. I'm going to the Mayo Clinic in Jacksonville soon, but my doc is sending me to a gastro doc. Truth be told, I'm not so sure that's the issue. Something very insidious is going on here, but the symptoms are terrible. It's really not like a cold feeling in my nose, it's more like some kind of physical restriction at my throat level is affecting both my throat and nose and breathing. I don't know what it could possibly be.
Anyway, is my theory about something shifting out of place like my esophagus or air rerouting into my esophagus instead of my trachea too crazy to be true? I know the thyroid can cause those issues, but mine by all accounts isn't enlarged at all. I really feel like something is structurally wrong here.
Certainly a correct diagnosis would go a long ways towards finding a treatment for your condition.
I was 36 and had a massive stroke May 19,2008. I didn't have any physcial problems just my language, memory,and side vision. On April 30th, 2010 I lost my voice I went to a doctor and he said my voice box was paralysis on the left side. He told me it might be a year before it comes back . It came back April 20,2011. On Oct.29,2011 I lost my voice again. I went back to the doctor and he has know answer for me. Do you have any answers for me? Thankyou Nicole
Dear Nicole,
The only way to provide an answer is to have a look. There are many types of and many degrees of paralysis. Many of them can be improved upon with appropriate treatments. If you would like a 2nd opinion, I list a number of specialists invoice problems at http://old.voicedoctor.net/Physicians-0/index-000.
I have been singing all my life, and told i have an amazing gift.
I had the vocal range of mariah carey and barbra strisand.in the last
ten years being dianosed with chronic bronchitis i often suffer with thick
mucus like scretions that seem to sit at the base of my throat like a pocket. doctors have given me inhailers and say i should try speach. i have a vocal coach and even she says there is something theyer not seeing.
when i try to sing i have no pitch in high range.even low vocalizing becomes difficult.
I feel i can be helped because there are days when just for a day my voice seems clear.
i love to sing and just want to enjoy my gift again, what can be done for me.I am 55 years old.
thank you
Rose
Dear Rose,
An accurate diagnosis would be extremely helpful in resolving your problem. I would suggest that a laryngologist take a close look at your vocal cords while trying to generate sound in the area of your range where you are experiencing problems. With appropriate video equipment, problems with roughness of the voice can be visualized. I do list some specialists at http://old.voicedoctor.net/Physicians-0/index-000 .
I'm 40 years old and 3 1/2 year ago I had a stroke. On April 30, 2010 I had a cold and lost my voice. It didn't come back until April 26,2011. On Oct.29,2011 I had a cold and
I lost my voice again and it is still gone. I have gone to a doctor and he has know answer for me. Do you have any ideas? I would like if you can call me so you can hear my voice. Thank you for your time. Nicole from Iowa
Dear Nicole from Iowa,
It sounds like you need a good examination of your vocal cords. See http://old.voicedoctor.net/Physicians-0/index-000 .
Good Day Doc,
I am a Singer from the Caribbean Island of Grenada. Lately I've noticed that i am not able to hit notes that i am accustom to. I am also hoarse alot of the time. What do you think might be the problem?
Nekoyan.
Dear Nekoyan,
I would love to hazard a guess, but it would be no more than a guess with so little information. About the best I can suggest is to see an ENT doctor, and I do not know how hard it would be to find one on your island. The other option is to read the various areas of this website and see if anything seems to match up with your symptoms. Ultimately, only a good look of the vocal cords will answer your question precisely.
Dear Dr. Thomas,
One of my young students (age 12) developed a polyp/hemmoragh in early November from screaming/crying when she fell back and hit her head on the sharp table corner. Her singing up to that point was wonderful, with a 3.5 octave range, clarity, etc. Her singing voice was compromised greatly because of the screaming/crying event. I heard it right away when they called me the day after it happened, - her range was cut in half and the sound was raspy. The doctor to whom she went to, only advised her to be on voice rest for one week. After one week, she came to me for her voice lesson, but it was obvious that she was nowhere near vocal recovery, (so, no voice lesson). She went back to the laryngologist and they/he said to have a second week of voice rest. She did this, and after the second week, her voice was still nowhere near vocal recovery. Yes, I have seen photos at different stages of the recovery. A few days ago, she came in for a voice lesson, this time after about three sessions with a voice therapist working on breathing and airflow with lip trills, sound/no sound airflow exercises, etc., and still, the photo showed a slight swelling on either side of the cords where the polyp had been. Firstly, I do not understand why the doctor would have her receiving voice therapy when her cords are still swollen. Secondly, I do not understand why the doctor would have given her only one week of voice rest, then followed by only a second week of voice rest. In other instances, I am familiar with singers being totally silent for a month or even two, just to give the polyp and bleeding the best possible opportunity to heal completely, before beginning any type of voice therapy. Does voice therapy aide or hinder the recovery of still swollen vocal cords?
Dear voice teacher,
When there is a sudden loss of voice, the problem is usually related to blood vessels and hemorrhage. If that was the case with your student, the amount of time for recovery is quite variable, although one week would almost certainly be too little for blood to absorb and a blood vessel which was broken to heal. Secondly, if a blood vessel was involved, it is not clear to me that any type of exercise can promote healing of such a blood vessel.
This is in contrast to chronic vocal overuse which tends to produce a thickening of the skin, otherwise known as a vocal nodule(s). Appropriate therapy can be initiated to alter vocal behavior and perhaps diminish vocal trauma, in the long run reducing the size of the vocal swellings.
One can still sing with a hemorrhagic polyp, the risk of re-breaking the polyp is just higher and the voice is likely impaired to some degree. Some people are willing to take that risk. Quite frequently hemorrhage will reabsorb into the body. In contrast, once a hemorrhagic polyp is formed, in my experience this usually requires surgery to remove it, along with a number of weeks of recovery afterwards. The good news is that, if a hemorrhagic polyp formed from a vocal accident, there is usually no underlying inappropriate use of the voice so that once healed, no specific therapy is needed to alter voice use. Regular voice lessons can just be resumed.
The best way to know what is going on is to have a good close examination, something I talk about in several videos. I have tried to list the physicians I know who are highly interested in the voice elsewhere on this website: http://old.voicedoctor.net/Physicians-0/index-000 .
my mother was okay all along. but for about eight years now her voice cant be heard when she is speaking. she was born 1948. so i want to find a solution for her. just last year around march the situation worsened and she was in oxygen machine as she could not even breath. she is in zambia and am in canada working. what help can she be given for her problem thanks
beauty
Unfortunately, only a correct and accurate diagnosis would be helpful in this situation. Generally a weak voice is from the vocal cords not coming together and allowing air to leak out so the volume is lower. She would need to find someone who could examine her vocal cords, sort out if this is the case and then a treatment could be discussed.
I have been diagnosed with laryngitis. Doctor suggest no talking. I have read and heard that whispering is the same to the vocal chords as yelling. Is this true and could you give any suggestions on how to recover the voice and when it's wise to start speaking or singing again.
Sincerely,
Ringo Maestro
The word laryngitis means inflammation of the larynx. If your larynx is inflamed, at some point it should become not-inflamed. You and your doctor would need to determine when that point is.
Whispering is much different than yelling. In a true whisper, the airway is narrowed and airflows turbulent leak through this narrow point. This generates white noise which we hear as a whisper. Consequently there is no movement of the edges of the vocal cord. This is in strong contrast to a yell where the vocal cords are hitting each other rather aggressively. There is an in-between sound called a stage whisper where the vocal cords are partially closed and partially allowed to vibrate. There is both a white noise quality and a pitch quality to a stage whisper.
Hi Doc. I sustained an injury to my throat on 12/31/2011 when I slipped and fell during a game of broom ball landing with my throat into someones knee. Immediately I was unable to speak. CT scan taken that night revealed "edema with possibly some hemorrhage of the soft tissues in the left laryngeal vestibule and left ventricaular and vocal folds with some narrowing of the airway. Truncation of the lower aspect of the left pyriform sinus." I was given antibiotics and steriods until 1/4/12. I saw an ENT on 1/3/12 he preformed an exam using a flexible fiberopic scope with findings of ecchymosis and edema involving the left true vocal cord, arytenoid,and false vocal fold. Another flexible fiberopic scope was done on 1/16/12 with "a red stripe down the middle on the left vocal cord." I have progressed from having a very breathy voice to a soft voice that is low. I am a physical therapist and I work only two days a week, however on those days even though I try hard to limit my speech it is difficult and some patients are hard of hearing. I have been told if I do too much talking I will develop scar tissue that will be irreversible. I definitely would like to heal and avoid surgery. Is scar tissue the same as a polyp? I was told by a speech therapist that I should go on complete vocal rest for six weeks. I have three teenage daughters and life is challenging trying to limit speech, let alone complete vocal rest. I would appreciate any advice. Thank you for your time.
An accurate assessment is the most important foundation for making clinical decisions. Your ENT or laryngologist should be able to explain to you why your voice is soft. Generally air leak is the cause of a soft voice, and your physician would need to look for air leak.
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