Heading Out to the Doctor

The week after the dreadful Met competition, I went to my scheduled voice lesson with my teacher.  We talked about what had happened at the competition, and I must have alluded to my conclusion that I just wasn’t as talented as everyone else.  Instead of agreeing with me, my teacher that day said something both great and wonderful that day, (although I didn’t think so at the time).  She said:  “I think it’s time we really get your voice looked at by a doctor specializing in professional voices.”  She went on to say that there is still so much tongue tension, breathiness, and “valve-ing” (which is her way of describing that “squeezing the tooth paste tube” feeling I was talking about earlier), when I sang.  She also said, and I will forever love her for saying this, “I don’t think it’s your fault that these problems are still there.  I think there’s something wrong at the laryngeal level.”  I nearly cried for joy at that.  I had had other teachers give me a similar talk, but it always went something more along the lines of, “Why are these problems (i.e. tongue tension and airiness) still there?  Are you just not practicing your technique?”  These talks always left me thinking to myself, “Why am I just not getting it?  Am I just too stupid or something?”  To have a teacher emphasize that it wasn’t my fault, that I was too intelligent and thoughtful about my singing to just not be “getting it,” was such a miracle!  It was probably the reason I wanted to get to that doctor right away.  This visit, this stroboscope could be the answer to all my problems.  It could be the absolution for my singing troubles!  (Although to be completely honest, I didn’t actually think they would find anything particularly wrong with my voice.  I was still holding on to my “ballet” theory of comparative singing talent.)

I made my appointment for the next week and walked in to the ENT’s office expecting for him to find something common and simple to treat, like acid reflux or something.  About mid-way through, the physician’s assistant, who was handling the camera, and the doctor, who was watching the video up on the big screen behind me, were talking about something in that shocked “is that really what we’re seeing” kind of voice doctors’ occasionally use that totally freaks their patients out.  (Seriously, aren’t they taught not to do that in med. school?)  So I was getting a little uncomfortable.  Nonetheless, they took the camera out of my throat and swung my chair around to tell me what they saw.  First, there were some red spots that were indicative of acid reflux.  (Ah!  I was right!  It’s probably nothing really all that wrong with me!  I’ll get a prescription, go home, and be better by my next audition.)  Well, no.  My vocal folds started out looking pretty good at the beginning of the scope.  They were that grayish-white color they’re supposed to be.  The surrounding tissue was a nice shade of pink.  There weren’t any signs of asymmetry on the folds themselves, no nodes, hemorrhages, or polyps.  They were open symmetrically during my breathing.  Then, the real problem showed up.  As I started to phonate, my vocal folds started actually going a bit diagonal.  My left fold was crossing the mid-line in order to meet up with my right fold…which seemed to be almost getting stuck at a certain point of closure.  It was almost as if someone had put a pin in the tissue to the side of my right fold that kept it from moving all the way in.  And, my right fold looked shorter and smaller than my left fold, which was pretty big in comparison to the other one.  I had had enough vocal pedagogy to know this was not what a 29 year old classical singer’s voice was supposed to look like.  I started to panic.  (Of course, at the same time the vocal science geek in me was excited to see this problem first hand…if I forced myself to forget temporarily it was my voice I was seeing.)

So basically, the diagnosis was: vocal fold paresis of the right recurrent nerve.  And this, apparently, was not what the doctor was used to seeing in singers.  He did ask if teachers have ever complained about tongue tension when I sing.  I said “yes, quite frequently.”  Then he said, “This is why,” and he pointed on the paused video to the left side of my tongue base that was just peaking into view of the camera during phonation.  It was being pulled down when the left folds had to pull so far over to the right.  He also pointed to how there was occasionally an opening near the arytenoids when the left fold didn’t get far enough over, which would explain any breathiness in my voice as well and the reason why that breathiness was not always there.  He asked how long had teachers been mentioning those issues, and it took me a while to think back that far.  I said the breathiness comment showed up about junior year of my undergraduate degree and that both of those problems were abundant during the entirety of my master’s program.  He said it was highly likely the paresis had happened during my undergraduate degree in that case, (which I graduated from in 2001…so yeah, it’d been around a long time).

The first thing I did after getting back to my car was cry for about ten minutes.  The second thing I did was to call my voice teacher.  I left her a voice mail with the diagnosis and drove home.  She called back later that day to give me words of reassurance that therapy will take care of it.  She said “now we know what’s wrong, and we’ll get it fixed.”  

Next up:  We'll take a little detour from my story and go more in depth about which nerves innervate the larynx as well as what paresis is and what the symptoms are.  So up next:  Voice Science Talk:  Paresis!