Matthew Edwards

Artistic Director of the CCM Vocal Pedagogy Institute

What to look for in an ENT

Garcia-LaryngoskopProfessional singers are vocal athletes, and like all other athletes they are at risk of vocal injury. Injuries can happen because of abusive singing or coughing too hard or from acid reflux. If you suspect something is wrong, you should see an ear, nose, and throat doctor (ENT). Unfortunately not all ENTs have the same qualifications and you can easily run into problems. My wife recently suggested that one of her students see an ENT. Instead of consulting my wife for the name of a reputable doctor, the parent took their daughter to a friend of a friend. The doctor refused to look at the young girls vocal folds, didn’t listen to her sing, and based off of symptoms alone, he diagnosed the student as having acid reflux. That kind of doctoring is dangerous and arguably unethical. However, this kind of care is quite common. Many ENTs earn the majority of their income treating people for hearing loss, ear infections, swallowing disorders, and other head and neck disorders. If they have not spent considerable time studying the special needs of singers, they will likely lack the thorough understanding of the vocal mechanism required to treat vocal athletes. Doctors who specialize in working with professional voice users will often identify themselves as laryngologists. You should expect the following when visiting a laryngologist who regularly works with singers (these suggestions come from one of the world’s leading voice doctors, Dr. Robert Sataloff, M.D., D.M.A).

  • First, they should take a patient history, ask about past vocal issues, and discuss the patient’s concerns.
  • Next, the doctor should listen to the patient speak and sing.
  • The doctor should observe the patients laryngeal position, tongue position, posture, and breathing technique.
  • They should look at the ears, perform a hearing test (hearing loss can lead to vocal strain) and examine the nasal cavity for any abnormalities.
  • The vocal folds should be observed through indirect laryngoscopy. This may be done through a flexible trans-nasal stroboscopy (through the nose), a rigid stroboscopy (through the mouth), or a mirror exam (least effective unless used in combination with a stroboscopy).
  • The singer should be asked to vocalize while being scoped so that the doctor can visualize the vibration of the vocal folds while vocalizing.
  • The stroboscopy is a standardized means of assessing “fundamental frequency, symmetry of bilateral movements, periodicity, glottal closure, amplitude, mucosal wave, presence of non-vibrating portions, and other unusual findings” (Sataloff, 1998, p. 99).
  • Other tools that may be used include: “ultra-high-speed photography, electroglottography, and videokymography” (Sataloff, 1998, p. 99).
  • The doctor will often measure maximum phonation time (how long you can sustain /a/ on a comfortable pitch, the physiologic frequency range (lowest to highest note regardless of vocal quality), musical frequency range (lowest and highest note of musically acceptable quality.
  • They may also decide to take aerodynamic measurements to check your respiratory function.
  • If vocal paresis or paralysis is suspected (this is rare), the doctor may use laryngeal electromyography to test the function of the intrinsic (inside) muscles of the larynx.

(Sataloff, 1998)

If the doctor does not at least visualize the vocal folds, they have no possible way of knowing what is going on. There are singers who have no vocal damage yet sound very rough while there are beautiful operatic voices that have very visible nodules. Making a diagnosis without visualizing the vocal folds is irresponsible. If you cannot find a doctor in your area who is able or willing to do a thorough exam, here are a few nationally recognized clinics that I highly recommend.

Duke Voice Care Center

Philadelphia Ear, Nose, and Throat Associates (Dr. Sataloff)

Cleveland Clinic Voice Center

Massachusetts Eye and Ear

Massachusetts General Hospital Voice Center

Charlotte Eye, Nose, Ear, and Throat Associates

Texas Voice Center

Chicago Institute for Voice Care

NYU Voice Center

Dr. Peak Woo (NYC)

Osborne Head & Neck Institute

If you plan on singing for a living, taking care of your voice must be your top priority. If you owned a brand new Ferrari, would you take it to Pep Boys to be serviced? Probably not. You would most likely take it to a European Import Specialist. Your voice is your Ferrari, don’t take it to a “Pep Boys” ENT, take it to a specialist who cares about your concerns and understands the type of specialized care you deserve and need.

~Matt

Advertisements

One comment on “What to look for in an ENT

  1. Marie
    March 18, 2015

    Fauquier ENT (Dr. Christopher Chang) meets and exceeds all of the requirements above. He is a voice specialist, with certification. I know one professional voice teacher who earned her doctorate while interning with him; she is the one who recommended him – and he is fantastic. Here is his website to check him out: http://www.fauquierent.net/

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Information

This entry was posted on November 15, 2014 by in Vocal Health.

Ranked the #1 New Release in "Vocal and Singing" on Amazon.com (October 2014), "So You Want To Sing Rock 'N' Roll?" covers voice science, vocal health, technique, style, and how to find your artistic voice in a way that is beneficial to both singers and teachers. Order your copy today!

Enter your email address to follow this blog and receive notifications of new posts by email.

Join 301 other followers

%d bloggers like this: