Words mean more than what is set down on paper. It takes the human voice to infuse them with shades of meaning.
“There is a large polyp located on your left vocal fold…“began the voice specialist confidently “…indicating that you have experienced a vocal hemorrhage.” My heart skipped a beat as I waited for more information. It had been well over a year since a virus attacked my body and 5 months since I had left my high school music position after my voice completely stopped functioning while touring with my high school band and choir students. After many challenging months of determining who I should see, I finally arrived on the doorstep of a vocal surgeon at Toronto’s St. Michael’s Hospital Vocal Disorder’s Clinic. She remarked, “Will you speak properly again? Yes! Will you sing again? Most probably, but only if you have vocal surgery and strictly follow the post-operative rules.” Tears welled up as I heard the relatively positive news. It had been over a year since I had begun this vocal journey and I was beginning to think that there was no hope for me.
The beginning of the journey
After a major bout with flu and a vocal virus, I was convinced that I could return to work even though my voice felt weakened by the sudden infection.
As the semester proceeded, I noted the gradual decline in my ability to project and a sense of increasing vocal and physical fatigue. Music was my passion and my job - a huge part of my life. Without full use of my voice, which was the vehicle for expressing this passion, I would no longer be an effective educator. And so I returned to my family doctor (GP). Her advice was to take the summer to rest as viruses often took months to dissipate. “Of course,” I thought, fully trusting my GP’s suggestion, “all I need is the summer to rest.”
Although I had felt healthy and stronger vocally upon my return to school in the fall, as the year unfolded, I experienced continued deterioration. While I contemplated returning to my GP for a fourth visit to request a referral to an ear, nose and throat specialist (ENT), I was somewhat worried that she would simply dismiss my concerns and send me on my way. On the other hand, I was also worried about what might be wrong and used my full life and the importance of my busy performance schedule as an excuse to avoid an assessment. Besides, time was running out to prepare my choirs for the upcoming national festival.
As the weeks for the school year moved on, I noted several disconcerting things about my vocal condition:
- my once clear, thin speaking voice now had a raspy, thick quality to it;
- the range of my speaking voice was down at least 5 tones lower than its original comfort zone. This was so obvious that several colleagues and friends teased me about its sexy quality and asked about my overall health. Students mentioned that it was more difficult to hear me in class;
- my singing range was also unusually low, extending almost 4 tones lower than my previous lowest comfortable pitch and I was no longer able to vocalize on higher notes past A 440 HZ without creating a scary cluster of tones simultaneously;
- my voice no longer could handle my daily vocal routine of early morning rehearsals followed by a full teaching day and several after school practices or meetings;
- by Friday, of most weeks, I could no longer sing and could barely talk with proper projection for any length of time.
My own personal research and knowledge indicated to me that I was experiencing symptoms of vocal nodes, but without a specialist note I understood that I had no options for long term vocal rest from my job. I took the next available appointment at the recommended music clinic and continued to teach, often taking a three day weekend to rest my voice. Other musical involvement was halted and I attempted to remain quiet - resorting to emails instead of phone calls whenever possible. I also purchased a small portable white board and erasable marker for at-home “conversations” with my husband and 6-year-old son. While I knew that my voice was worsening, all I felt I could do was wait and count the days.
After a stellar performance with my Concert Choir at Musicfest Canada, I gathered my students together to announce our gold level award. As I opened my mouth to complete my speech, my now husky voice completely cut out. I can only describe it as the most frightening moment in my life, engraved in my memory forever. While I had been able to phonate in some way despite the raspy quality, I was now unable to create even the most primitive audible sound. Quickly one of my music chaperones rose to translate the closing part of my speech as I mouthed my remaining thoughts.
Despite the electricity in the air and celebrative spirit in the room, my stomach was wrought with pain and my thoughts a whirl as my principal quietly said,
“I think that you are done your teaching for this year.” All I could think of was, “Please God, don’t let this be the end of my career.”
After visits to two ENT specialists, the news was clear and consistent: a vocal node was present on my right vocal fold and a large polyp located on the left side. While the node could dissipate with the help of voice therapy, the polyp, caused by an actual hemorrhage, would probably need to be surgically removed. However, it would be several months before I could get an appointment with the recommended surgeon.
Emails and faxed medical notes to my principal, union and disability insurance representatives completed the short checklist of all that I could actively do for myself at this point. Now would come weeks of unbearable silence, yet with it, an opportunity to learn to be still and wait.
After six weeks of persistence, I secured a cancellation appointment with Dr. Jennifer Anderson at Toronto’s St. Michael’s Voice Disorder’s Clinic. Finally I could meet with the person who could give me long term answers about my voice! And so I arrived, complete with a clipboard for note taking and pen in hand. I also brought a brief but succinct typewritten timeline of my vocal history. My husband also attended, as a support for me but also as a second pair of ears to help digest the information we were about to hear.
After experiencing yet another vocal scope and witnessing a video of my damaged folds in action, I accepted her recommendation and agreed to go through with the vocal surgery. At this point in my journey, what did I have to loose?
On January 6, 2007, I had a polypectomy, a day-surgery which involved the laser removal of a polyp from my left vocal fold. I was coming out of the anesthetic and was not to utter any words for the first 5 days. The surgery was considered a complete success. But that was only half of the procedure. The rest would depend on me and my ability to follow the post-operative rules. The five days of complete silence was a huge endeavor, yet with the support of my awesome parents (I went to their home to convalesce) I did it. While I was quite tired for the first two days, probably due to the anesthetic, I only required painkillers for the first twenty-four hours. I also had no bruises or facial cuts, something which I was warned to expect.
I returned to my home in a few days and began the first week of “five minutes of confidential talk” per 60 minutes. This meant that I could only speak at a quiet one-to-one volume but not a whisper for five minutes every waking hour. My son, who was seven years old at the time, was thrilled to be timekeeper. He would set an alarm clock; go off to play, then return whenever it would ring, happy to converse with me for the five minutes before the next quiet time 55 minutes later. Week three I moved to ten minutes of talk per hour and by week four I was up to 15 minutes per hour. As well, I was off to voice therapy twice a week
Although it took several weeks of research I was insistent on finding a speech therapist with training as a singer to offer me appropriate help post-operatively. I had found the perfect person at Hamilton’s Chedoke Voice Disorder’s Clinic who had both a vocal performance degree and a master’s of voice therapy. Finally my world felt brighter and more optimistic than it had for months. My first voice therapy session was a memorable one. By the end of the one hour session, I was actually singing my first notes! You cannot imagine the emotion tied to this event. My stomach was a combination of fear and knots as I took the first breath. As well I felt the excitement and relief when I heard the initial pitches and an actual clear tone. I felt like a grade nine vocal student too scared to sing in front of her peers for the first time for fear of the sounds that might come out.
My therapist indicated that I was progressing by leaps and bounds showing that I was obviously doing my scar tissue prevention exercises regularly and properly. He could not believe my progress. After many months of living in fear and uncertainty, his words were so encouraging.
I soon had an updated vocal scope and prognosis. On the down side, the cyst originally on the right side of my vocal fold did not show any change in its shape or form. The fact that I was presently singing a three octave vocal range with only slight difficulty around four mid-range notes meant that I was functioning well despite its presence, meaning the cyst may have always been present on my folds.
As for the surgically repaired left vocal fold, it was in perfect shape with absolutely no scarring or indication of trauma. After the scope, the ENT indicated the quality of my speaking and singing voice meant two things: that my surgery was 100% successful, the voice therapist’s work with me and my discipline in following the post-operative rules were exemplary. He also stated that I was a “walking miracle” as any surgery on a vocal fold had no complete guarantees.
A visit with Dr. Anderson the following week provided the final approval needed to give me the green light to return to work, but only with the understanding that I would employ a vocal amplification system in the classroom for the rest of my career. This system which was portable would be worn about my waist like a tiny money belt with a small headset attached to it. With the help of a volume control dial, this machine would alleviate any vocal stress on my voice never forcing me to speak beyond a gentle tone, yet projecting efficiently in any classroom, large group or outdoor situation. According to my voice therapist and surgeon, no teacher should ever work without this fabulous aid.
In retrospect, it is hard to believe that this series of events ever happened to me. I celebrate the fact that I am a survivor of vocal dysphonia. As a result of my vocal misfortune, I have the privilege and responsibility of ensuring that no one else faces the long term vocal loss and uncertainty that I did. I have met with or emailed and counseled approximately 30 teachers and other professionals such as ministers, seminar presenters and singers who are struggling with vocal issues. Each one has experienced some sort of trauma or fatigue requiring proper assessment followed by vocal rest and, in most cases, vocal amplification and voice therapy.
I have come to love my amplification system and would never consider addressing any large group, class or music group without it now. In fact, I have encouraged many colleagues to purchase these systems. They too, are thrilled with the way it has changed their lives and, in some cases, saved their careers.
Henry Wordsworth Longfellow once said, “The human voice is the organ of the soul.” There is not a day that goes by that I do not give thanks for the way that I can once again share myself and my “soul” with my family, my students, my church, my friends, my world!
Research & recommendations
A number of American studies have shown that teachers who are employed in elementary and secondary schools have a higher rate of self-purported voice disorders than those who work in other occupations. (Mattiske et al., 1998, Smith et al., 1997, Smith, Kirchner et al., 1998 Smith, Lemke et al., 1998) A recent study done at the University of Utah represents the largest epidemiologic study conducted regarding the prevalence of voice disorders and comparing teachers with other voice users. Results indicate that teachers represent a high-risk group for voice disorders, but also that the magnitude of current voice problems in the general population is substantial. (Roy et al., Prevalence of Voice Disorders in Teachers and the General Population, Journal of Speech, Language and Hearing Research, Vol. 47, pp. 281-293, April 2004)
If you are a teacher experiencing vocal fatigue or are in an occupation requiring heavy vocal use consider the following steps to avoid total vocal loss:
- Purchase a vocal amplification system immediately to assist you in the workplace regardless of your vocal health.
- Inform your boss or school principal as well as your union rep that you are experiencing concerns re- your vocal health.
- See your GP immediately and request a referral to a local ENT- (Ear, Nose and Throat Specialist) for a vocal scope.
- If nodes, cysts or acid reflux is diagnosed, get an ENT note with recommendation for one or a combination of the following:
- continued teaching/job performance with use of an amplification system
- voice therapy
- recommendation for vocal rest days or a long term leave-of absence
- continued classroom teaching with altered lifestyle such as cessation of late night snacks before bed, smoking and/or heavy alcohol consumption, increased water hydration and improved moisture in your working environment
- referral to a vocal surgeon or additional specialist for a second opinion
If you are assessed with nodes and are a singer, book an appointment with an appropriate voice therapist. It is important to note that not all voice therapists are capable of fully instructing you in both conversational and sung word so research to find the proper expertise for this aspect of your rehabilitation is important.
If you are a teacher, regardless of grade level, subject matter or vocal health, consider purchasing a portable vocal amplification system. These systems sell for a very reasonable rate and will not only save your voice but also your career. For further information regarding these systems in Canada or for voice therapist recommendations, feel free to email Jane at [email protected]
The Author: Jane Schultz-Janzen is Department Head of Music and a vocal, band, guitar and drama teacher at the Kitchener-Waterloo Collegiate Institute in Kitchener, Ontario. This year she is celebrating her 21st year of teaching and her second year back in the classroom after her vocal journey. She is also pleased to be harmonizing once again with her husband Terry and 9-year old son Jonathan. Together they live with their cat Scamper and rabbit Snowball on a “farmette” near Wellesley, Ontario.