Ep 4 Live Q&A – March 13, 2019 – How do you know your voice is damaged?

Mike Elson: Awesome. Let’s move on to the next one. Question number four. Okay, so question number four is, “How do you know … ” So now you’ve gone too far. “How do you know you’ve damaged your vocal cords?” This question comes in, and maybe if you’re asking this question … Okay, so this one also looks like came in from Adam, didn’t have a last name. So Adam asked this question.

Mike Elson: Okay, so how do you know? I’m just going to say, if you’re asking this question, might already be pushing a little too far, or maybe you already did, and that’s okay. Look, again, I had a little … Everyone goes through different paths when they learn, right? Sometimes the best way to learn is to fail first, right? So if you did have some damage, and if you’re singing a lot, you’re going to have some of these things come up.

Mike Elson: So how do you know when you’ve actually occurred it? And then what are some steps you might take if you do think you have damage?

Matthew Edwards: Yeah. First of all, there is a huge stigma around vocal damage, right? People get so worked up about someone getting injured as a singer. We’re athletes, right? Athletes get hurt. You see people in games all the time, they make a run, and in a football game, and they just twist their ankle slightly wrong, and they’re down.

Mike Elson: Yeah, tear their ACL, they’re out, you know? Throw their back out.

Matthew Edwards: Right. And then there are other people that have a whole career playing out of control, super-aggressive, doing stuff they probably shouldn’t be doing to take care of their body, and they’re perfectly fine. And you’re looking at their career and going, “How did they pull that off?” It’s just genetics, man, right?

Mike Elson: Right.

Matthew Edwards: Some people are more prone to injury than others, okay? So we need to lay that out on the table first. What you need to realize is that a lot of people say that opera singers, you know, is the safe way to sing, you don’t get injured. That’s bogus. Okay? I sang at an opera company where I think it was almost a quarter or a third of the females had some sort of a voice problem. All right? They called them soprano pads at that point in time, but there is a lot of women who were messing with issues. It’s very possible the men had issues as well, but women are more prone to some of these injuries, and they tend to show up a little bit more because of the way that they sing. Men can push through it, women who are singing operatically, it’s harder to push through some of that stuff.

Matthew Edwards: We also have to realize that the opera-going portion of America is about 2.4%, 2.3%. Okay? USA Today does not run articles about people who are celebrated by 2.3% of the population.

Mike Elson: This is true.

Matthew Edwards: So when Jane Opera Singer pulls out of a production at Columbus Opera, that’s not national news. Right? But when Adele cancels a $1 million concert in Columbus, Ohio, for 50,000 people, those fans want to know about tickets on that day, and people leak, they leak information and stuff come out. So they usually say they needed to take a little bit of a voice break, right?

Matthew Edwards: In Broadway, when you need to take a voice break, the show goes on. You put on your understudy. At an opera, if you take a voice break, you have an understudy. They go on as well. When you’re Adele, there is no understudy. You’re out. Okay? So people think that rock singers are so prone to injury because you hear about it all the time, but you’re hearing about it because of the realities of the industry. Okay?

Matthew Edwards: The other thing, opera singers will often get days off in between performance. You may have a really awesome month of performing and do somewhere between seven and eleven performances over the course of a month. Okay? And that comes from some research I did on Thomas Hampson, a world-famous baritone. The busiest month I found in his schedule when I did this one research project was 11 performances in a month. And I think he was in five or six different cities.

Matthew Edwards: I compared him to The Gin Blossoms, who had like 22 performances in 30 days in two countries, and it was like 20 cities along the way.

Mike Elson: Wow.

Matthew Edwards: So your pop performers are going through unrealistic performance expectations. So again, the more that you do this thing, the more prone you are to injury. Opera singers often get to go onto stage, and they sing a little recitative, which is basically singing like you speak. Then they sing a solo, which we call an aria. Then they go back and go off-stage for a half hour. Then come back and sing a duet. Then they go off-stage for 10 minutes. Then they come back, and then they get a 15-minute intermission.

Matthew Edwards: Your rock singer sings 45 minutes straight, maybe takes a break. But nowadays, that’s not that common. And instead, they end up doing an hour and a half in a row. Right? And if you ask the opera singer to sing an hour and a half in a row, for 22 nights out of the month, in two different countries and 20 different cities, the answer is going to be no. Right?

Mike Elson: Yes, it is.

Matthew Edwards: So I think we just need to have that discussion because we got to get that stigma out of the way. Then we can start having honest conversations about how you know if they’re damaged. Okay?

Matthew Edwards: The best way that you’re going to know that there’s something going on is a sudden voice change or a gradual voice change that’s not reversing itself. Okay? You can do something as simple as clear your throat, and hemorrhage a vocal fold. All right? So again, back to let’s get rid of the stigma, there is a video that’s frequently shown at medical conferences where they’re doing one of those stroboscopes that we talked about at the beginning, and the doctor says, “Clear your throat,” because that’s a really common things that a doctor will say because it helps move [crosstalk 00:33:30] the phlegm, the mucous out of the way, right?

Matthew Edwards: So what happens, though, is this guy clears his throat, he goes on camera, and immediately a blood vessel bursts, and the vocal fold is hemorrhaged ring on camera. So it can be something as simple as that.

Matthew Edwards: So if all of a sudden you’re trying to sing in a concert and your voice is gone, you need to stop then. Because what happens, most of the time if you have an immediate voice loss, it is a sign that you just hemorrhaged something in there. If you keep singing on it, you are likely to end up with a blood-filled polyp. What happens is the blood starts pooling and it starts pushing up and out on that jello layer, and then you have this big little wad of blood sitting on there, that sometimes your body will reabsorb, but sometimes it won’t. Okay? So sudden voice change, stop, go see a doctor.

Matthew Edwards: If you’ve been singing aggressively, and you’re rehearsing until you go hoarse, that is a bad sign. Okay? You should never sing until you’re hoarse, or practice till you’re hoarse. You should sing until you’re going, “Wow, I feel fatigued. I feel like I’ve used my voice today.” Right? So if you’re looking for an equivalent, you were at a party and you were talking for four hours, you can still talk when you get home, but you’re like, “Hmm, my voice is tired.” Right?

Mike Elson: Right.

Matthew Edwards: You never want to go any further than that as a singer. That might even be a little too far, but in general, you could use that as a guideline.

Matthew Edwards: Let’s say that you have a high G, and you do sing a little bit until you’ve gotten hoarse, and what you notice is that high G is starting to be flat, and you’re worried about it because you wrote your hit song that has a high G, and you have to perform it 10 times over the next two weeks, so you try to do it anyway.

Matthew Edwards: Two weeks later, the G is gone completely, the F sharp is barely there, and the F is starting to feel weak. That’s not a good sign. You should take some rest, and if it doesn’t resolve itself, you should go see a doctor. Okay?

Mike Elson: Right.

Matthew Edwards: If you don’t resolve it, and you just keep singing through it, you may start to get to the point where you have some notes, and then you have nothing, and then you have some notes. So the voice would go … and then they try to come down through your voice and they go … and then it comes in. Now, that can be a coordination issue. So if you don’t have any of these other symptoms that I’m talking about, you might just not have coordinated your chest voice and your head voice. But let’s assume you already did [crosstalk 00:35:59]-

Mike Elson: But if [crosstalk 00:35:59]

Matthew Edwards: …. coordinated head and chest voice, right?

Mike Elson: You already have them coordinated.

Matthew Edwards: When that’s happening, and you hear that gap, that’s not a good sign. That means it’s time to go see an ear, nose, and throat doctor. Okay? It’s not time to freak out.

Mike Elson: Is that typically a nodule, then, that’s preventing that particular pitch from coming out?

Matthew Edwards: Yes. And it can be lots … You can’t ever tell just by listening to somebody what’s going on in their voice. But that could be a sign of a nodule, could be a sign of a cyst. And sometimes cysts just happen, right? I mean, you know, I’ve known plenty who all of a sudden they have a little thing bulging up on their skin and they say, “I don’t know what this is,” they go to the doctor, they find out it’s just some weird cyst, and they remove it. You could just end up with some weird cyst on your vocal fold that just kind of happened, okay? So that’s why you got to go to the doctor. You’ve got to go to a doctor, and you got to find out what’s in there, instead of playing guessing games with yourself.

Matthew Edwards: Because the other thing that could happen, I just went through this with a client recently, he had huge gaps in his voice. Sounded the most dysphonic I have heard a man sound in ages. And I insisted that he get scoped. All it was, was an allergic … not an allergic, but it was just a bad reaction to medicine this person was taking. And the medicine dried his jello out so bad, it was just dry, inflamed, and red, and completely ruined his singing voice and speaking voice. Got off the medicine, six weeks later, he sounds like a god again. Right?

Matthew Edwards: So it can be something as simple as that. That’s why I say, you don’t freak out about it, you just say, “Hmm, that’s not normal. I should go see a laryngologist.” Okay?

Matthew Edwards: If you’re wondering, and you want a test, you can do what I call the falsetto test or the head voice test.

Mike Elson: That’s right, you mentioned that.

Matthew Edwards: Yeah. As lightly as you can sing, glide down from an airy, light, breathy voice, all the way down. So it’d be … So you hear, I was able to go all the way down.

Mike Elson: Yeah. I’m sick right now, I can’t do it like that.

Matthew Edwards: Yeah. And if you’re sick, you’re dry, any of those things, you’ll find that this probably won’t happen. You can be and make the clear sound when that jello is in great form, and it can easily just vibrate on that thin upper edge. But if your jello is dry, and it’s dried out or it’s swollen, it’s not going to vibrate as simply. Then you might get … as it tried to work its way through.

Matthew Edwards: If you find that over the course of several days, you cannot master that light falsetto and it used to be there, then you might want to go talk to a laryngologist. Okay? Because if you take those main things that we just touched on and use those as goalposts for yourself of things that you want to watch out for, you’re more likely to get into a doctor earlier rather than later, and early intervention is key. Okay?

Matthew Edwards: Let’s say that you did just start developing nodules, we call them pre-nodules, all right? And like I said, if we want to be nice sometimes we’ll call them singer pads or soprano pads or tenor pads, right? Most of the time, some voice rest and voice therapy, done. They go away, you get back to normal real fast.

Matthew Edwards: When the problem occurs is when somebody is in denial and they’re going, “No, I can’t have nodules. I have a great singing teacher. I have a great singing technique. I can’t have nodules. I’ll wait. I just need to adjust my technique, and I need to push more air through it.” They keep fighting that for six to eight weeks, and they take those baby nodules, and they grow them to full-grown adult nodules. Then we got a problem, right?

Matthew Edwards: They can still resolve with therapy, but now we’re talking a little bit longer.

Mike Elson: Sure, yeah.

Matthew Edwards: So early intervention is key, right? And being able to kind of listen for those voice changes that might slightly concern you along the way. And you know, seek out that qualified help.

Matthew Edwards: Sometimes people are worried about insurance covering getting an examination. The best thing you can say is that “I’m noticing changes in my speaking voice that are affecting my ability to communicate and are causing me a lot of stress.” Right? Because insurance will pay for athletic injuries for athletes, but they don’t like to pay for vocal injuries for singers. Okay?

Matthew Edwards: So a lot of times, the doctors know, especially if you go to a laryngologist, they know how to code it to get your insurance to take care of it. But instead of saying, “Hey, I’m a singer and I no longer have a high G. I want to come in and see the doctor and see if I can get that fixed,” you want to call the laryngologist’s office and say, “I’m noticing a lot of changes with my voice that aren’t normal. I’m finding it hard to speak at times. It’s affecting my ability to communicate with others, to do my work,” because if you’re a singer, it’s your work, “and it’s affecting my quality of like, and it’s starting to cause me some emotional distress.”

Matthew Edwards: All those things are valid medical reasons to get insurance to pay for your scope.

Mike Elson: Yeah, that’s great, great [crosstalk 00:40:58].

Matthew Edwards: Yeah. And the other thing is, if you have acid reflux, the one thing we didn’t talk about that’s most common is acid reflux. If you’re starting to feel like you have heartburn, so acid reflux is the fancy name for heartburn, if you’re having heartburn and you feel like you’re burping up acid, that can actually affect your vocal folds. It can burn them. I had this happen to me when I was a freshman in college, and it looked like a fish had laid eggs all around the soft tissue at the back of my vocal folds because I was so burnt up from acid.

Mike Elson: Really? Wow.

Matthew Edwards: So having consistent heartburn and noticing a voice change is also a reason to go get scoped. Because a regular doctor may say, “Oh, you have heartburn,” and just prescribe medicine. But if they prescribe medicine and it’s not actually heartburn, you could be singing on top of those vocal folds and they could get worse. The medicine can also get rid of the stomach acid, and your stomach can start burping up alkaline gas, and alkaline gas is just as bad as acid.

Matthew Edwards: So again, reflux, another great reason to go see a laryngologist, get a scope, find out what’s going on in there. And they can then help you recover from all of that.

Mike Elson: Yeah, great. Do you have, sorry, time for one more question?

Matthew Edwards: Yeah. I was just going to mention two other things about prevention. What’s our other question?