Professional Voice

 

Traditionally, singers and actors are the elite group of professional voice users. However, today, anybody whose voice is integral to earning a livelihood is considered a professional voice user. This opens up the arena to teachers, lawyers, physicians, radio jockeys, politicians, receptionists and salespeople. In today’s world, it is an undisputed fact that our voice is very important in our society and all patients should be treated keeping this in mind. Whilst we are treating or restoring a person’s voice, often we are effectively changing or restoring there complete persona. Two of my patients who immediately come to mind are a successful doctor with a vocal fold paralysis and another wanting a feminizing voice surgery. Following surgery the dramatic change in personality as each “came into there own” hammered in me the powerful and almost frightening role our voice plays in our personality. Respect this at all times at it will stand you in good stead.

As a voice professional is a vocal athlete, even slight disabilities in voice production may result in disturbing changes in the voice quality. Understanding and managing voice professionals thus becomes a challenging job where the voice specialist has to have a clear understanding of normal anatomy and physiology of voice and the pathophysiology of abnormal voice production. Not only is it important to use this information to be able to treat the voice professional so that current commitments can be met, it is paramount to preserve the voice in the long run. Over enthusiastic treatment in order to let the singer meet pressing singing commitments may damage the longevity of the voice and it is the duty of the treating physician to explain this gently but firmly to the professional voice user.

Successfully managing voice problems in professional voice users necessitates spending adequate time discussing there complaints, evaluating the speaking and singing voice and previous available recordings and their expected goals for recovery .This usually means spending double the time spent with a non professional voice user. This is not because of any change in importance in the latter group but because understanding the subtle voice changes in singers usually necessitates more time for the treating consultant. It is therefore important to schedule appointments with appropriate time slots to efficiently meet the demands of professional voice users.

Not all pathologies seen in a singer need treatment! A singer may have a characteristic voice loved by the audience with the presence of long standing vocal nodules and may come in with a sudden voice change due to a bleeding vessel. The acute problem needs to be addressed and often the nodules are in no way causing any vocal limitation for the singer. Often this tricky situation involves deciding which of the findings are contributing to the voice complaint. When I see multiple lesions in a professional voice user, I treat conservatively any lesions that could potentially be acute in onset first. Voice therapy is always an important component of the management of voice disorders. All non surgical treatment options should be exhausted before considering surgery in a professional voice user. This however is NOT the mantra to be followed if dysplasia or malignancy is suspected. Even the professional voice user group is a subset of the general population and may be inflicted with dystonia, tuberculosis or tumours. In fact, they would present at a very early stage being sensitive to subtle changes in voice. This should be kept in mind at all times and in our enthusiasm for treating them conservatively, bigger problems should not be overlooked.   

upcoming (part 2) on history taking in professional voice users