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What an ENT Doctor Visit is like for an Opera Singer

So I was lucky enough to recently have had vocal troubles. I know, I know- sounds not so lucky. But, behold! It was. Because my vocal troubles were really minimal, actually. It started rather slowly and then got worse; I was often a bit hoarse after singing (either after an hour-long coaching of Opera Arias, or after 2 hours of private practice at home) and I knew that that wasn't normal. So off to the ENT Doctor (Ear, Nose and Throat, or in Germany they are called HNO which stands for Hals, Nasen, Ohren- the same as in English, just "auf Deutsch") I went. And luckily for me, here in Munich there is a ENT that works in the Klinikum Rechts der Isar, which is run by the Technische Universitaet Muenchen (for those non-German speakers- the Hospital on the right side of the Isar [River], which is run by the Technical University of Munich) who works in a department of the hospital which was specifically designed to treat Musicians' injuries. Cool, right? They often deal with things like repetitive stress injuries for instrumentalists or, in my case, something having to do with vocal distress from singing, which is then treated by their on-staff ENT.

Anyway, I thought it was pretty darn amazing that there was a whole department of one of the hospitals here that was dedicated to musicians' medical issues, so I was definitely more excited than usual to get checked out. (Normally, I'm not all that pumped to go to the ENT. I mean, sure, it's nice to know that my vocal folds are A-okay and things are looking healthy, but the actual being scoped is not a favorite free time activity of mine. If you're not sure what a Laryngoscopy is then take a look at this comprehensive explanation of it on WebMD. What we singers usually experience when we go into the ENT's office to get checked up is either a 'Flexible Laryngoscopy' or an 'Indirect Laryngoscopy', the latter of which is what I had at this appointment because the doctor said it helps her see the Vocal Folds most clearly while I'm singing- because normally you're asked to sing a note on an "ee" vowel or "ah" vowel while they look at your vocal folds via the scope.) Firstly, and perhaps retrospectively funniest but also most depressing in the moment, was that upon my arrival at the hospital I asked the woman at the front desk where I could find the Department for Musicians' Injuries (called "Musiker Ambulanz" auf Deutsch) and she was like, "Um....what? We have one of those?". To which my brain was like, "Of course! Why didn't I expect that? Even in a hospital it seems that music gets lowest billing. Sheesh. Is there anywhere we musicians can go in society without feeling like we're forgotten about or not wanted?" Of course, you see, my brain was way too psyched to have a wonderful experience and then its hopes were dashed. So, on one hand, at least we got that out of the way first and it wasn't the doctor who was disappointing, but on the other hand.....jeez- truly- why does it seem like musicians can't get any "R.E.S.P.E.C.T."? I mean, even the doctors who dedicated themselves to treating our injuries and illnesses seem to have now unilaterally been "put in the corner" for wanting to hang out with us. Ugh. Okay, moving on.

At least after I went on a wild goose chase to find the "Musiker Ambulanz" and aggravated at least 5 more different departments within the hospital to whom I was directed to by other equally-clueless departments who thought they were the right place (Ha! The irony continues!!) I finally, by sheer determination and going out a hospital door that was clearly marked "please use other exit when raining" (and it was raining! Sorry God!!) I found my destination. Where, I noted much to my chagrin, that the buzzer on the door of the building where they were located didn't even have their department name on it. GAH!! I really tried to forget how silly it was that no one knew they existed but now THIS!? Ay carumba. Seems like they need an organizational guru around here. And preferably one who's a music lover. ;)

Anyway, here's where the story takes a distinct upturn in its trajectory.

I entered the non-correctly-labeled building, proceeded up to the first floor and found, at the end of a long hallway, a door labeled "Musiker Ambulanz".  Woo Hoo! Success!! And, an actually correct label. Interesting! Trying not to let my now renewed hopes get the best of me, I knocked firmly but not authoritatively. Just enough to let whomever was on the other side of that door know (which was locked, by the way, I tried the knob) that I was there and politely looking forward to my appointment and rather less politely looking forward to filling out any paperwork that would be required. (I hate paperwork. Did I mention that?)

Within seconds, the door was opened by a tall woman with brown hair who was wearing a white doctor's coat and looking smart and authoritative. I liked how this was developing. She then told me that I'd have to fill out these papers (which she handed to me on a clipboard with a pen attached) and then once I was done I should knock again and she'd tell the doctor I was there. Well, so far so good, I thought. Then I looked at the papers that were on the clipboard for me to fill out. Holy mackerel! There must have been at least 10 double-sided pages to complete. Yeesh. I better get started.

The questions on the first few pages were something that you'd expect- name, address, insurance info, any prior illnesses, allergies to medications, surgeries, et cetera. All stuff that I've seen on every medical questionnaire. Then it got much, much stranger.  I knew that they dealt solely with musicians, and thus by default mainly professional singers, when I got to the questions like "Does singing nowadays make you feel depressed?", "Are you worried about not being able to make a living with your singing because of your current vocal problems?", "Are you frustrated with how your voice sounds?"....etc. All those things were, they definitely know what singers have to go through psychologically and physically when our voice isn't working correctly! I finally felt validated that I was in a place where people really understood me for once. Even if it was in a non-correctly-labeled building that few people in the hospital even knew existed. Who cares!! At least it exists, and that's a start!

Of course, as I was only halfway through the considerable paperwork, another door opened in the middle of the hallway and it was yet another woman in a white lab coat with brown hair, this time albeit a much shorter woman, and she called my name. As I slung my book bag over my shoulder (which I was carrying because a physical therapist told me it's better than a purse since the weight is evenly distributed on both shoulders- but that's a story for another blog post) she held out her hand for the paperwork clipboard, which I gave to her while feeling totally guilty since it wasn't yet done (!!), and followed her into the examination room. She motioned for me to sit and as I took a seat she looked through the paperwork and when she reached the middle and the pages that were still empty she said "Ah, okay, no problem". Phew!! I felt better. Perhaps she knew she was jumping the gun by calling me before I'd finished the paperwork. Anyway, she said it was okay and I could fill the rest out later, but that now she'd like to hear what my symptoms were.

I explained to her that I'd been experiencing for the past few months a bit of vocal tiredness after speaking German for a long time (on the phone for example) and also feeling the same thing while speaking English after a long time too. Plus, I felt that somehow it was connected to my singing because as my voice got tired from talking my singing voice also was less available and that was making me basically avoid all conversation so that I could at least practice singing. However, when I did sing, I also noticed that my voice felt tired, so that was worrisome. To my great surprise, she actually took my description of my symptoms seriously and said it could definitely have something to do with how I was speaking, or perhaps how I was speaking either German or English, and more possibly German because it was my second language. She said it was good that I came to check out what was really going on, and that a colleague of hers would do an evaluation of my singing and speaking voice and then she'd scope me to see my vocal folds in action afterward.

Thus she sent me back out into the hallway to wait for the next evaluation by her colleague, who promptly emerged from yet another door further down the hallway, and beckoned me to follow her into the examination room. Whereupon I was introduced to another woman who was also dressed in a lab coat and who was apparently a student training to be a speech therapist or mind's foggy on what exactly she was studying now, come to think of it. Anyway, she had me sit down, then asked me to explain my problem and what I thought might be the issue. Then she asked a series of questions about my singing practice- what my warm ups are like, how often I talk during the day, which languages do I use and for how long per day, and when do I notice the most difficulty? Is it consistently a problem or only after certain difficult rehearsals or long phone calls? Anyway, her barrage of questions ended and she asked me to do a few things so that they could measure my voice's response to gauge if it was normal or not and also to evaluate the effectiveness of my breathing. I had to sing a sustained tone, as soft and loud as possible, shout (as if I were trying to get someone's attention far away), a chromatic scale ascending and descending to the extremities of my range, blow into a breath-measuring device and a bunch of other things. She then explained to me that I was speaking English at a relatively high pitch (normally healthy women speak naturally at a pitch around middle C, regardless of whether they're high Sopranos or not, she said--important to note, fellow women singers!!) and that I was speaking somewhere around an E, a few notes right above middle C.

To me that didn't seem so very drastically different, and I explained to her the philosophy that a few voice teachers once told me (on separate occasions, so watch out, people! Don't fall into this trap!) that if you're a "High" soprano voice, you should really place your speaking voice where your voice likes to comfortably sing (i.e. the pitch range). So I had artificially moved the pitch of my speaking voice (which speaking English, not German, because I found that affected my German accent negatively) upwards because I was told it was better.  However, now, retrospectively, it does seem that perhaps what those teachers were trying to prevent me from doing was speaking in the vocal fry. But- I only spoke sometimes in the vocal fry, so I'm not sure why I'd need to move the entire pitch of my voice upwards just in general. Anyway---that's the first lesson to be learned here---do NOT artificially alter the pitch of your speaking voice for any reason. The woman who did my voice analysis explained to me that when I was speaking artificially higher, it basically was like I was singing because I had to create in my vocal tract and mouth the conditions for me to speak higher (which only required the edges of my vocal folds to vibrate, much like what happens when I sing in my higher range) and thus my singing voice was tired when I hadn't sung- because it was like I was singing, just not supporting, and so that was the reason my voice was often hoarse or tired. Secondly, she explained that when you speak around the pitch level of middle C (which is typical for most women!), then your vocal folds naturally vibrate fully and entirely (not just the outer part of the folds, but the entire fold itself), almost like when you sing in 'chest voice', which is able to be more naturally supported by your body and thus is more suited to long time periods of use without producing vocal wear-and-tear. So that was my first issue that they helped me iron out, and I was glad for it.  Then, she examined how I was speaking German and said that although I have a very good accent (aka, you cannot immediately tell that I'm an American) it may be that because I taught myself my German pronunciation (and didn't go to a speech therapist to get the accent minimized in a professionally trained way), it could very possibly be that I created considerable undo tension in the musculature surrounding my voice production (aka in the larynx, jaw, tongue, etc.) and that this happens frequently actually with people who are trying to eliminate accents. So, her idea was that I should see a Speech Therapist who could help me with the issue of 1.) eliminating my undo tension in the vocal tract and surrounding areas, and 2.) help me to speak German with a minimal accent in a correctly trained way, and not just approximating it by ear, as I had done myself. She assured me that she was pretty confident that those were my only vocal problems, and then she sent me back out to the hallway to wait for the other doctor who'd do my laryngoscopy.

So within moments, I was called into the ENT's office and she gave me an "Indirect Laryngoscopy". She began by spraying a numbing spray into the back of my throat which strangely reminded me of the taste of cough syrup from childhood (yuck!) and then she held my tongue down with some gauze and stuck a laryngoscope into my mouth and looked at my the movement of my vocal folds while she asked me to sing a note on an "ee" vowel, on an "ah" vowel, then a scale on both vowels. Then it was over. She recorded what she saw and played it back to me on a monitor directly afterward. It was cool to see my own phonation in action. She also said that I am definitely a Soprano because my vocal folds don't fully come together in certain parts of my range (as is commonly observed in Sopranos) and that they were totally healthy and normal. Phew! My mind was eased for sure, though I did hate how my throat was feeling. Boy, that numbing agent was serious! I could barely feel myself swallow and when I did, it was totally strange. And she told me it could feel that way for up to an hour afterward and that I shouldn't drink or eat anything. Sigh.

But, at least I found out so many important things during my visit to the "Musiker Ambulanz". Which I hope is a lesson to you, dear Reader, that you should not ever manipulate the tone at which you speak, and that you should always consult a professional when seeking to eliminate any accent that you may have, whether it be in your native language or a second or third or fourth language. You can cause yourself many unnecessary problems through both of these mistakes, and can freak yourself out too when your voice starts trying to tell you that it isn't right. ;)

As always, Happy (and Healthy!!) Singing (and Speaking)!!!


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