Académique Documents
Professionnel Documents
Culture Documents
Bastian
sing any moment of the day pates in vibration of the vocal folds, it OTHER QUESTIONS
singing to themselves, using the is also the part most commonly in- ABOUT THE VOS
phone recreationally, or even engag- jured by that very vibration, if it is
ing strangers in conversation. When "overdone" in various ways How do you account for the fact that
both the intrinsic propensity and the amount, loudness (which incidental- not all vocal overdoers have a mu-
extrinsic opportunity or necessity to ly often tends to the high side in vo- cosal injury?
use the voice are high, the VOS is for- cal overdoers), pressed-ness, for
mally diagnosed. example. Hence, the vocal "overdo- Good question. A singer's bril-
ing" may lead to acute or chronic vi- liant personality may make him or
bratory mucosal injury. That is not her the life of every party. Yet, he or
THE VOS CORRELATES WITH always the case, however, as will be she continues to sing glorious high
RISK OF MUCOSAL INJURY notes, even at pianissimo. This is be-
subsequently demonstrated.
cause the genesis of nodules and oth-
As hinted above, when the VOS er vibration-induced injuries is of
is compared with many other threats USE OF VOS IN THE STUDIO course multifactorial. Physical consti-
to vocal fold health, it appears to cor- tution and manner and skill of voice
relate by far the best with acute and How can the voice teacher or production are just two additional
especially chronic injuries of the vo- singer make use of the VOS concept? pieces of the puzzle, not to mention
cal fold mucosa (e.g., nodules, polyps, The first way is to measure one's self the fact that there are degrees of the
cysts, vascular abnormalities). That against it. Where the VOS is present VOS. Nevertheless, vocal overdoers
is, singers with chronic mucosal in- in the teacher him- or herself, self-di- are worth identifying because, again,
juries such as those just mentioned agnosis can be personally protective they appear to be the group most at
are almost always vocal overdoers as and instructive by subliminally intro- risk for mucosal injury.
defined above; by contrast, they may ducing a bit of vocal prudence and in-
or may not have in common allergies, creased self-awareness, as though a Don't you suggest anything beyond
acid reflux, asthma, tobacco use, in- subconscious "word counter" were subconscious "prudence" for vocal
sufficient fluid intake, suboptimal installed. The second is to teach stu- overdoers?
voice production, or any other appar- dents and colleagues how to use the
ent cause of vocal problems. In fact, VOS concept. Given its high correla- Yes, vocal overdoers should
review of a large number of patients tion with mucosal injury, application work to avoid mucosal injury (or its
in the author's practice revealed that of the above questions / procedures furtherance) by optimizing the gen-
of all who met the criteria described to find every case of the VOS might eral measures of good vocal health so
here for the VOS (a selected popula- profitably be part of a first lesson, or often written about. For example,
tion, to be sure), eighty percent were as a small part of vocal pedagogy spacing rather than massing voice
found to have a mucosal injury. The classes. Singers who thus are led to use. Scheduling voice breaks into the
VOS is by far the strongest discern- recognize the VOS in themselves day. Liberal, regular consumption of
able commonality in this group. may also experience helpful behav- fluids. Attention to potential medical
Lacking any better explanation, the ioral self-adjustment. Or, when a contributors such as allergy and acid
VOS for now appears to be not only teacher detects ongoing upper voice reflux (which appear to be smaller
correlated with, but is also likely a limitations (delayed phonatory on- contributors to chronic mucosal in-
primary cause of mucosal injuries. sets, loss of upper range or pianissimi jury for most singers, as compared to
The explanation for how being in that region of the voice) in a stu- the VOS). Ongoing training of voice
a vocal overdoer causes mucosal in- dent who has an apparently normal production for both speech and
jury comes from understanding the speaking voice, or is approached be- singing so that phonation is efficient
mucosa and how it is injured. The cause of vocal frustrations, assess- and "inexpensive" to the mucosa.
mucosa is, of course, the wet, flexible ment for presence of the VOS would Attention to the manner and amount
surface tissue covering the vocal be an important place to begin prob- of personal and social voice use. And
folds. As the main tissue that partici- lem-solving. perhaps even personal amplification
412
Robert W. Bastian
when teaching in large, acoustically the specific secondary (resultant) di- Journal of Voice 4, no. 2 (1990):
unfriendly rehearsal spaces. In addi- agnosis? Are there nodules? An epi- 172-83.
tion, one should make a habit of dermoid cyst? A hemorrhagic polyp?
3. R. W. Bastian, "Vocal Fold Microsur-
monitoring mucosal health by per- Abnormally dilated capillaries? Is
gery in Singers," journal of Voice 10,
forming daily "swelling tests" which there even a tertiary (contributing) no. 4 (1996):389-404.
detect mucosal injury reliably, albeit diagnosis such as acid reflux? When
with a few false positives. 2 Those all of this is sorted out, the appropri-
used routinely at the Loyola Voice In- ate medical and/or behavioral and/or
stitute can be used at home, too: as- surgical options are applied. Medical Robert W Bastian. M.D., received his med-
cending by half-steps with the first optimization is usually the easy part. ical degree from Washington University,
phrase of "Happy Birthday" sung at Behavioral management is the pri- St. Louis, in 1978. Thereafter he completed
high frequency (above C5) and low mary initial approach in light of the his internship in General Surgery and a
intensity; or a five-note descending residency in OtolaryngologyHead and
primary diagnosis of VOS. And
staccato task. In the context of the Neck Surgery, also at Washington Univer-
when particular lesions do not re-
sity. After four yea rs as Assistant Profes-
VOS, a chronic tendency to huski- spond to an appropriate trial of voice sor at the same institution, he moved to
ness, delayed phonatoiy onsets, and therapy, vocal fold microsurgery, per- Loyola University Medical Center in the
air escape, all of which increase in formed expertly by an experienced Chicago area in 1987, where he currently
severity as one ascends the scale, surgeon, is extremely safe and voice- serves as Professor of Otolaryngoloqy-
should lead the singer to pursue a restoring. 3 In short, the question is Head and Neck Suryrry.
formal medical evaluation to confirm rarely whether the singer can re- Dr. Bastian 's work focuses exclusively on
or rule out mucosal injury. Getting store an excellent singing voice, it is voice and swallowing disorders. He was
louder, even to piano, will often instead exactly how will it be re- one of the first to promote a team approach
"make" the voice work, but this sort stored, and how long will it take? to these problems. Of particular interest to
of concealment is not the idea. Insist him are the medical, behavioral (voice
on "boy soprano pianissimo" to therapy), and surgical treatments that
"take the clothes off" the voice and to SUMMARY can he applied to the problems of singers.
increase the sensitivity of the As one part of a comprehensive treatment
swelling tests. Formalized definition and use strategy, Dr. Bastian has to date operated
of a concept termed the "vocal over- on hundreds of singers with otherwise irre-
doer syndrome" can help the voice versible lesions. Other areas of notable in-
And what if I or one of my "overdo-
teacher identify those individuals at terest and expertise include neurological
er" students or colleagues fails the
high risk for development of chronic voice disorders, including spasmodic dys-
"swelling tests" and is later found to phonia and larynx cancer. Dr. Bastian is
vocal fold mucosal injuries. It may be
have a chronic mucosal injury? What also a i accomplished si uqe,:
useful to teach this concept to stu-
would be done?
dents as well, for prevention, diagno-
sis, and treatment of these injuries.
Most of all, don't despair. The
ranks of those in this situation are
large indeed, and help is available.
NOTES
First, however, an exact and compre-
hensive diagnosis is needed, employ-
1. R. W. Bastian, C. Klitzke, and L.
ing the three tools of focused history, Thunnan, "Vocal Fold and Laryngeal
vocal capability assessment, and in- Surgery," Bodymind and Voice (Iowa
tense laryngeal examination, gener- City: The Voice Care Network, 1997),
ally including laryngeal videostro- 416-427.
boscopy. In the situation mentioned
2. R. W. Bastian, A. Keidar, and K. Ver-
in this question, the primary diagno- dolini-Marston, "Simple Vocal Tasks
sis is generally the VOS. But what is for Detecting Vocal Fold Swelling,"