Miss Wisconsin Laura Kaeppeler won the Miss America title for 2012 this past weekend.
This news co-mingled with all the other news of the day, except for one key fact that caught my attention…
Miss Kaeppelar majored in music and vocal performance and plans to obtain a Master’s degree in speech and language pathology (SLP).
A voice major with a Master’s in SLP is a rare combination that is in great demand in the world of laryngology where singers with vocal injury are common. A SLP who specializes in the injured voice is rare. A SLP who knows and understands opera intimately is exceedingly rare.
The vast majority of SLP are specialists in speech production… not voice.
Why is this distinction important?
Speech is basically sound that is produced by a person after modification by the lips, teeth, tongue, palate, and throat of a person. As such, speech issues are related to problems stemming from these anatomical parts.
Voice is basically the sound that is produced by the voicebox. Basically, it is the noisemaker upon which the sound produced is modified to ultimately produce speech. In another words, “voice” is created prior to “speech”. Voice problems are limited to anatomical or functional abnormalities of the voicebox resulting in a raspy/hoarse/breathy sounding voice. Such problems include vocal cord nodules, vocal cord polyps, spasmodic dysphonia, paralyzed vocal cords, etc.
Depending on whether a patient is suffering from a speech problem or a voice problem determines what type of SLP is appropriate.
Miss Kaeppelar would (hopefully) be classified into a special (and rare) category of SLP who specializes not just in voice therapy, but voice therapy for singers with an injured voice.
NY Yankees pitcher Mariano Rivera may have a fabulous right arm, but his voice was not exactly golden. He apparently had vocal cord polyps that resulted in a progressively raspy voice. Read the NY Post article.
On Dec 2, 2011, he underwent surgery to get them removed and if he now sticks to an appropriate voice therapy program, his voice should essentially revert completely back to normal! Watch the video to see what vocal cord surgery looks like.
There are MANY theories as to how vocal cord polyps as well as other similar vocal abnormalities like cysts and nodules form. However, one theory that seems to make the most sense to me deals with how the vocal cord heals after a phono-traumatic event like screaming or yelling… something I’m sure Mr. Rivera routinely performs during baseball games.
To differentiate among the various benign vocal cord masses, consider a cyst which is formed when the mucosal vocal cord lining breaks down and during the healing process a cyst develops due to entrapped cells meant for creating lining. A polyp, however, is in essence a blistering of the vocal cord lining. Vocal cord nodule for comparison’s sake is just callous thickening of the vocal cord lining that occurs over time.
To use human skin as an analogy…
A vocal cord cyst is like a sebaceous cyst that commonly occurs under the skin of the face or neck (a pimple, but no opening to the surface).
A vocal cord polyp is like a blister that forms on the hand if you shovel dirt too much.
A vocal cord nodule is like a callous that forms after prolonged repetitive skin trauma (like callous on the hands after shoveling dirt for years).
There are MANY theories as to how vocal cord cysts, polyps, and nodules form. However, one theory that seems to make the most sense to me deals with how the vocal cord heals after a traumatic event (ie, screaming, yelling, coughing, etc).
With a cyst, the mucosal vocal cord lining breaks down and during the healing process a cyst develops due to entrapped cells meant for creating lining. A polyp, however, is in essence a blistering of the vocal cord lining. Vocal cord nodule for comparison’s sake is just callous thickening of the vocal cord lining that occurs over time.
To use human skin as an analogy…
A vocal cord cyst is like a sebaceous cyst that commonly occurs under the skin of the face or neck (a pimple, but no opening to the surface).
A vocal cord polyp is like a blister that forms on the hand if you shovel dirt too much.
A vocal cord nodule is like a callous that forms after prolonged repetitive skin trauma (like callous on the hands after shoveling dirt for years).
Respiratory spasmodic dysphonia is one of the most rare subtypes of a class of laryngeal dystonia collectively known as spasmodic dysphonia. It is also known more accurately as laryngeal adductor breathing dystonia or respiratory spasmodic dystonia or respiratory laryngeal dystonia.
Introduction
Spasmodic dysphonia is a type of dystonia in which there are involuntary muscle spasms or contractions of the muscles involved in voice production. This disorder is similar to the involuntary eyelid twitches of blepharospasm. Spasmodic dysphonia should not be, but is often confused with muscle tension dysphonia or tremor. There are 2 main types of spasmodic dysphonia: ABductor and ADductor. Other much more rare types include mixed and respiratory.
ADductor dysphonia is when the vocal cords comes together suddenly while talking resulting in voice stops and effortful speech. Often, the voice chokes off. Counting from 80 to 89 is harder than counting from 60 to 69. Stressful situations often exacerbate the condition. ABductor dysphonia is when the vocal cords suddenly moves apart while talking resulting in loss of voice (breathy). These patients find counting from 60 to 69 harder than counting from 80 to 89. ABductor dysphonia is not as common as ADductor dysphonia.Respiratory Spasmodic Dysphonia
Respiratory spasmodic dysphonia is when the vocal cords come together suddenly when inhaling. So the voice actually sounds quite normal… until the patient takes a breath in. During such inhalation, one can hear an audible choking sound.
A brief word about nomenclature. “Dysphonia” means hoarseness. As such, the term respiratory spasmodic dysphonia is not accurate. Rather, “dystonia” should be used instead which is defined as an abnormal muscle contraction.
Watch the video clip shown in this blog (same as this article, but video was not able to be uploaded here). In the first half of the video, listen to the audio of a patient suffering from respiratory spasmodic dystonia talking. The latter half is a video of the patient’s voicebox while vocalizing. Note that the vocal cords intermittently do not move apart when she is taking a breath in. Normally with breathing, the vocal cords should move apart to allow air to pass between the vocal cords.
Treatment
Treatment is the same as for ADductor spasmodic dysphonia. Botox is injected into the vocal cords which reduces the spasms when she takes a breath in.
On Sept 16, 2011, the Stone Temple Pilots had to cancel their tour because their lead singer Scott Weiland was placed on voice rest due to damaged vocal cords at risk for permanent damage. Specifically, the doctors at University of Cincinnati Voice Health Center determined that he had scarring on his left vocal cord and a tremendously inflamed right vocal cord.
The left vocal cord scarring is likely from past vocal trauma that did not heal properly and is now permanently damaged whereas the right vocal cord is at risk of also becoming permanently damaged if not aggressively managed. The picture shown here is an example with inflammation involving both vocal cords. Compare this with the picture below which shows one normal vocal cord and one inflamed vocal cord.
Without further information, beyond voice rest to allow the vocal cord inflammation to resolve without further injury, treatment may also include steroids as well as reflux medication.
It seems to be a continuing trend for singers of all genres to be pushed to the point where their vocal cords get injured resulting in show cancellations and at worst, become a one-hit wonder.
If you are a singer and you don’t have a voice coach and supportive management, you need to remedy this immediately or you risk having a career that’s a one-hit wonder.
Jay Leno admired by many for his comic personality had his beginnings as a speech therapist. He graduated in 1973 from Emerson College with a bachelor’s degree in speech therapy. In order to help pay for his education, he worked in comedy clubs as well as an emcee in talent shows.
When it comes to robotics, the sounds they make is either due to the machinery that runs them or an electronic recording that comes out of a speaker.
Well, there’s a scientist, Hideyuki Sawada, who is working on a robotic “mouth” that produces sound the same way humans do.
- Lungs to power the voice using airflow
- Vocal cords to create the noise to create a voice
- Pharynx (Throat) to create the space and harmonic overtones that affect the “quality” of the voice
- Articulators (lips, teeth, tongue) to produce speech
In this picture of the robot, the lips are pretty obvious (the oval fish-mouth appearing aperture). The lungs are the glass jar on the right. The vocal cords are located where the glass jar connects to the pharynx which is represented by the skin-toned plastic pipe with the pistons attached at the bottom.
We have written up a new webpage discussing the unfortunate situation of bilateral vocal cord paralysis whereby both breathing and vocal quality is adversely affected.
Treatment for bilateral vocal cord paralysis is difficult and there is no perfect solution. Treatment to improve breathing usually makes the voice worse. Treatment to improve the voice usually makes the breathing worse. The best (but not perfect) treatment tries to pick a happy medium to address the breathing while trying not to hurt the voice too much, though some degradation in vocal quality is to be expected. Such treatment includes posterior cordotomy +/- medial arytenoidectomy.
In another situation, the patient may have bilateral vocal cord fixation resulting in the appearance of vocal cord paralysis, but is potentially “curable” with normal breathing and normal voice being the goal.
Dr. Christopher Chang will be a guest lecturer at Shenandoah University for a course on Anatomy and Function of the Singing Voice (MUPP 533) on February 9, 2011. The lecture will be held during normally scheduled hours at 5:00 – 6:40PM in Ruebush R209. This particular lecture will focus on Video Laryngoscopy.
The second lecture he will give for the same course will be held on March 23 at 5PM and will focus on Vocal Abuse and Misuse.
