Part 1 of 4: Vocal Health with Dr. Paul Kwak
A Singer’s Guide
to Vocal Health
Welcome to FFB's 4-Part January Series on Vocal Health with Dr. Paul Kwak! Throughout 2017, FFB will regularly host medical professionals, health gurus, fitness pros, & wellness experts on the blog to share their expert advice on the topics we love most!
Ya'll know I'm all about holistic vocal health but I have to admit, stressing the importance of getting scoped regularly (even when nothing is going wrong) hasn't been on my radar. I'm a changed songbird and definitely advocating for a whole new approach to vocal health, which we all get to journey through together, starting today! The field trip to the Voice Center was definitely a highlight for FFB and I couldn't be more honored to have our first medical expert, Dr. Paul Kwak leading the way for a healthy & happy 2017. - J.
Hi everyone! My name is Paul Kwak; I’m an ENT at the NYU Voice Center. More specifically, I’m a laryngologist and laryngeal surgeon; I’m a doctor who specializes in care of the professional voice and voice disorders. I love Fit for Broadway because of its commitment to holistic care and wellness of vocal performers, and I’m honored and excited to be with you through the blog for the month of January. We’ve put together a series of 4 weekly posts that comprise “A Singer’s Guide to Vocal Health.” Of course, topics related to vocal health could fill several massive textbooks, so the idea here is simply to give you some basic principles and essential information to help guide your thinking, understand the way doctors think about the voice, and to know when you should seek out medical attention.
I welcome any questions, and invite you to reach out to me by e-mail at paul.kwak@nyumc.org.
Week 1: Basic Principles
Let’s get started!My goal is to give you some basic advice over the next four weeks about how to stay vocally healthy in the midst of a grueling work, training, and performance schedule. That’s the rub, after all; it’s easy to imagine keeping your vocal cords in pristine condition and your voice well-trained if you had unlimited time for vocal rest and care. But that’s not real life, particularly for theater performers.
In fact, let me start with a simple observation: Broadway schedules are arguably the most grueling of all performing schedules. Whether you’re on Broadway, you’re in rehearsals for a show, you’re auditioning to be in a show, or you’re just starting to train so that one day you will be on Broadway – the vocal demands are enormous. 8 shows a week is essentially un-physiologic and unnatural for the voice within the context of the human experience. Think simply about the sheer number of times your vocal folds come into contact with one another during a performance. [As a point of reference – my mentors, Dr. Steven Zeitels and Dr. Robert Hillman, did an amazing study in which they concluded that in the course of one show, Aerosmith lead singer Steven Tyler’s vocal folds collide one million times!] Add to that the extra rehearsals you have between shows, the auditions; then the phone conversations you have with your friends and family, the loud dinners and evening outings. This can all add up to the vocal equivalent of playing a football game 8 times a week, in terms of the impact on the tissue of the vocal folds.
Vocal performers are vocal athletes and the proper care of a vocal performer is a multidisciplinary endeavor. The best care of a vocal athlete results from a collaboration between coaches, therapists, teachers, and physicians.
Just like how we have our go-to yoga instructor, meditation teacher, sound healer, acting coach, dermatologist, therapist, or headshot photographer! As you travel down the yellow brick road to Broadway, your team should expand (Dorothy didn't make it alone after all!) It might seem overwhelming at first- it was to me!- but as you'll discover, mindfully crafting your inner circle keeps you going for the marathon that is musical theatre. (it's not a sprint, loves) - J.
Tip 1: Have a squad
As a performer, you should have a squad – a team that knows you, your anatomy, your mechanics, your technique, and your pitfalls. I HIGHLY encourage you to assemble that squad before you run into a problem. A great squad consists of:
Voice teacher
Laryngologist
Voice therapist
Coaches (diction, breath, movement, Alexander technique)
My guess is that you already have 2 or 3 of your squad assembled, but in my experience, each of these professionals plays an integral, and unique part in your care, and each has valuable perspectives and insights into the cultivation of a healthy voice. If you are doing well and not encountering any problems, I'd advise seeing a laryngologist around once a year. Most performers like to see their coaches with greater regularity, but that schedule is up for you and your squad to decide. The key point is having the squad in place before problems arise.
Here’s why.
Your voice is your signature, an identity – and it is as widely individual from performer to performer as their fingerprints. It takes time for us who take care of vocal performers to get to know you, how your voice and mind work, how you are growing and developing both anatomically and artistically, and how you respond to interventions.For example, from my vantage point as a physician – it is extremely worthwhile and valuable for me to learn, over time, how you respond to medications (meds like antibiotics, nasal sprays, steroids, reflux medications), how to make a scope exam most comfortable and efficient for you, how your vocal folds change in response to increased vocal demand, and on and on. Because everyone is different! When your team knows you, then when you’re having a problem, they're much more efficient at solving it.
In contrast – if you come to my office 4 hours before a show, panicked because things aren’t going well, the voice is shot, and I’ve never seen you or examined your larynx – I have to try, in that 1 hour (sometimes more) clinic visit to get to know you, understand your voice, visualize your anatomy, and consider whether medicine will help quickly, or whether we need to think about having you call out of the show. No one wants to be in this situation – most of all, you.
I fully realize that it takes time, diligence, money, and effort to cultivate a squad, and it might seem easier to call a physician when something goes wrong and you need an immediate fix. But as in all aspects of health and wellness – it is far better for you to cultivate health proactively and with an eye toward longevity rather than waiting until crises arise.
A question to ask yourself when you’re considering how important a squad is: “how long do I want my career to be?” If your answer is not just through the end of your current show, audition cycle, or education – then you're a musical theatre unicorn who deserves the support of experts who can keep your voice healthy and happy! - J.
Tip 2: Have a baseline exam
The one thing that helps a laryngologist be an essential member of your squad – and the one thing that many performers don’t necessarily think about ahead of time – is having a baseline exam of the larynx. You may wonder – why should you bother having an exam if you don’t feel like anything is wrong?
The definition of a healthy voice is very simple: it is a voice that enables you to meet all of your vocal demands, without restriction, over a long period of time. Just as people of all shapes and sizes are healthy over the course of a lifetime, so vocal folds of all shapes, sizes, and configurations, can be healthy over the course of a lifetime.
Performers are vocal athletes! – so to think that your vocal folds look “perfect” at all times is unrealistic, and to think that you would never sustain an injury is naive. Think about hockey players’ faces, pitchers’ shoulders, football players’ knees – they show the wear and tear of daily, highly intensive athletic activity.
Similarly: you may have prominent veins on your vocal folds, you may have signs of reflux, your mucous membranes may be slightly redder than your friends’, you may have nodules or other lumps or bumps on your vocal folds. A performer– who is performing well!– may have any number of these; the irregularities and normal variations of your individual anatomy simply contribute to the way that you produce sound. A baseline exam establishes your vocal "home base" and eliminates the guesswork when a problem arises.
Basically, you guys, we're snowflakes! No two are the same which is why the voice is SO amazing and unique. It never occurred to me to establish my "normal" & "healthy". Imagine seeing your skin for the first time! – you'd probably mistake healthy, normal freckles & pigment variations for problems. But we see our skin every single day in the mirror so we can confidently say, "This blemish was definitely not on my nose yesterday!" (and then we run to the dermatologist in hopes that they give us a cream that makes it vanish– ha!) If you're in it for the long run, a yearly vocal scope is as important as your daily workout, your nutrition, and overall wellbeing as a performer. - J.
What is a scope exam?
We refer to the process of examining your larynx in many different ways – “getting a scope exam,” “getting scoped;” doctors call it “laryngoscopy” – all of these simply refer to visualizing your larynx with a laryngoscope (essentially, a camera). There are two ways we can pass a camera to the larynx – through your nose, or through your mouth. Either way gives us approximately the same information, and it mostly comes down to which is most comfortable for you.
I find that most singers are able to undergo the exam through the mouth (“transoral,” or “rigid laryngoscopy”). The thing that most commonly prevents a successful transoral exam is a strong gag reflex. If you have a strong gag reflex – no problem! Your doctor can use a flexible camera (“transnasal,” or “flexible laryngoscopy”) which is passed through the nose and over the back of the soft palate, which generally by-passes the gag reflex. The nose is a narrower passage, so you'll receive a decongestant and numbing topical spray in the nose before the scope so it’s less uncomfortable.
I think it is essential that this exam – either a transnasal or transoral – is performed with a strobe light. We refer to this as “stroboscopy” – because this is what enables us to see the mucosal wave of the vocal folds – the sound waveform that is generated when air from the lungs passes through the vocal folds. This is important in singers because it can detect more subtle anatomic features or irregularities, and give us information about smaller details that contribute significantly to vocal function.
Most laryngologists are able to record your exam and send you or give you a video file of the exam. I encourage you to keep your most recent exam with you (whether on your phone, or on a jump drive), particularly if you are traveling away from your home base and your squad; this gives the folks treating you while away extremely helpful information when working with you during a problem.
For those of you who've never had a vocal scope, I'm happy to report it was easy peasy and this was my first! I'd seen footage of vocal scopes in undergrad (during my opera singing days!) & have always been fascinated with the anatomy of the voice. Seeing my own vocal cords though was definitely next level cool. - J.
Tip 3: Get Educated
The most fundamental point in week 1 is that it is not only helpful – but, I believe, essential – for a vocal performer to have a longitudinal, long-term relationship with a team to help take care of your voice – your squad. Each voice is unique, and I believe that the best care arises from a team that knows your voice, your anatomy, and physiology, over the course of a long period of time.
Above all, the more you know about your own voice and how to take care of it, the better equipped you will be to take charge of your own vocal health, to own and embrace the beauty of and the changes to your voice over the course of a full life.
Stay tuned in the coming weeks for more helpful tips, and again, don’t hesitate to reach out to me at paul.kwak@nyumc.org, or to find more information at nyuvoicecenter.org.
Stay tuned for next week!
Next week, we’ll be covering hoarseness and sore throat – the most common causes in performers, and when to seek attention. I hope your 2017 is off to a happy and healthy start!
Thankful for the team at NYU Langone for welcoming FFB into their Voice Center! Stay tuned for an awesome event coming up about Vocal Health in NYC #LoveYourBodyLoveYourVoice - J.
(SAVE THE DATE: 2.11.17)
