A Voice Teacher with a Voice Problem: Part 2

I wanted to share a bit more about my experience at Philadelphia ENT and clarify the difference between a ENT (or Otolaryngologist) and Laryngologist.

​An Otolaryngologist is a head and neck surgeon, and specialist in medicine for the ears, nose, and throat (which is why they are commonly called ENTs). There are many fantastic ENTs! A Laryngologist has further, specialized training and clinical hours beyond that of an ENT, to focus on the voice and swallowing. They deal with the larynx and surrounding areas. If you are a professional voice user, like a singer or actor, and you are experiencing a voice problem, you should seek out a Laryngologist, not just an otolaryngologist or ENT. Not only did this make a big difference for me, but I have habilitation clients that were misdiagnosed many times before getting in with a laryngologist and receiving the correct diagnosis, and therefore treatment. (more on the difference here)

I feel incredibly lucky that I was able to seek treatment with Dr. Robert Sataloff. His voice team is one of the best in the country and I feel like I am in safe hands. My voice is my livelihood and my art (in singing and teaching). The extra care taken by laryngologists and their teams can make all the difference in your career.

After my initial strobe, I went for my neck CT and the stenosis was easily seen in the imaging. The team in Philly made it a point to get me back up to see Dr. Sataloff quickly, so he could assess the situation and make a plan. I had observed in the clinic for a week, just a month prior to my own initial visit as a patient, so I had a bit of an idea of what to expect. New patients spent almost the whole day there! Initial assessment and strobe by a fellow and/or resident, speech assessment by an SLP (speech language pathologist), main assessment with Dr. Sataloff or one of the other fantastic doctors in the clinic, first round of speech therapy with SLP, first round of singing habilitation with clinical SVS (singing voice specialist). This was sometimes followed by a laryngeal EMG, which I will discuss a little later. Most patients take home information on how to combat acid reflux, and some homework for their speech and singing voice tasks, along with the appointment for their next check-in, surgery, or treatment.

My appointment was bright and early in the morning, so I woke up before dawn to drive from Northern Virginia and get to Philly in time. As a new patient, you have the usual paperwork, but on top of that, there is a questionnaire about vocal behaviors and self-assessment of vocal issues, as well as a few questions about anxiety and lifestyle behaviors. The consultation is thorough and a little intense. He checks your nose, ears, mouth, balance, sensation on the skin of your face, has you vocalize a bit to see how you prepare to sing, asks many questions, then there's the hard scope (which goes through the mouth to the back of the throat) and flexible scope (which goes through the nose and down the vocal tract). If you have a sensitive gag reflex, you get a spray that (doesn't completely) taste like bananas, to numb the back of the throat. There's also a spray up the nose, which tastes even worse than the not-so-banana spray, to numb the sinuses a bit for the flexible scope. The video imagery is incredible! You are asked to do various sirens, high and low vocal tasks, sniffs, etc to see how your vocal folds behave. In my case, they wanted a closer look at what was happening just below the folds, so I focused on staying open and breathing (while a friend who works on the voice team there held my hand), and they moved the scope close to the glottis to get a good look at the narrowing in the trachea. This is not normally done because a quick cough or clearing of the throat could mean bad news bears for the folds! But we made it through and they were able to capture some great images for Dr. Sataloff to take a look.

It was determined that I need a bronchoscopy (out-patient endoscopic surgery) to dilate the narrowing, biopsy to see if a cause can be determined, and give a quick shot of steroid to heal up. The surgery is coming up next month. But while looking at my strobe, Dr. Sataloff also was worried about a bit of LPR (silent reflux) and a bit of asymmetrical movement or partial paresis on my folds. This may have been there for a long time (and can go unnoticed by regular ENT equipment and eyes), or it may be something that has developed over time. I was given the choice of having a laryngeal EMG (electromyography) done to see how my muscles are communicating with the laryngeal nerves. In an L-EMG, very thin needles (similar to acupuncture) are inserted into the muscles of the larynx (TA, CT, and PCA) to record the electrical activity of each muscle (more info here). It turns out my results were not quite normal, so I am now taking a medicine that helps my nerves and muscles communicate a bit better. The great news is, I have noticed significant improvement in my vocal stamina! I had been assuming that any vocal fatigue or instability was due to the chronic cough, but it turns out it may be an autoimmune disease or similar (not that chronic disease is great news, but knowing/understanding and treating the problem is great).

As the numbness wore off on my drive home from Philly that day, I was exhausted and emotional, but I had answers and a plan!

In preparation for surgery, I have done bloodwork (ten vials!!), an hour on the table for MRI and MRA imaging, ultrasounds of my thyroid and vascular system surrounding the area effected. I don't think I've ever felt so poked and prodded, even in two pregnancies, but to me it's worth it to have hope that by the end of the summer or the year, I will be able to sing again without working around "something." I can lecture in class or present in a seminar without sniffing to get oxygen in faster. I won't have to explain to concerned folks that I don't have a cold or COVID. I can ride my bike and run after my children without getting short of breath. I realize it won't be an instant fix, but I will once again have the ability to work up to "optimal from functional," instead of having to accept that my new normal is never going to be what I had hoped for myself. 

So...I say, very optimistically (and anxiously)...to be continued...

(This is only Part II of my little "Teacher with a Problem" series, so I will update about my surgery and long-term results of the nerve medication later this summer.)