My laryngoscopy (updated)

I recently completed a major rite of passage as a singer: I had my very first laryngoscopy (March 2009). In case that sounds like Greek to you (which, actually, it is) a laryngoscopy is an examination of the interior of the larynx. It allows a doctor - and the patient - to see the vocal cords in action. I went to the doctor because I was seeking answers to vocal problems that began when I was a high school senior:

  • vocal fatigue
  • difficulty projecting the voice
  • breathiness
  • sensations of tightness in the throat
  • loss of upper range
  • Increased warm-up time
  • increased vocal effort
  • occasional choking on liquids

This is the video monitor where I was able to view my vocal cords in action.

The process was less uncomfortable than I had expected and every bit as fascinating as I had hoped. The office I visited - Philadelphia Ear, Nose and Throat Associates - has a reputation for restoring damaged voices. The practice has two locations: one in an old brownstone (whose walls are lined with autographed photos of famous singers) and the other in a generic looking medical building.

My appointment was in the generic medical building. I remembered to bring my “homework” - a 10-page questionnaire about my medical and vocal history. A medical assistant met with me to go over the history and ask additional questions. He even wrote down my vocal range - in musical notation! The doctor met with me and asked more questions, then sent the assistant back to do the actual procedure.

The vocal exam

They sprayed some kind of numbing medicine up my nose. Then the assistant inserted a long, black tube with a strobe light on the end into my left nostril. It hurt a bit going in, but once it was there it wasn’t that bad. He had me sing a series of exercises, plus “Happy Birthday” and a few lines from an aria I’ve been working on.

Then he removed the tube and had me stick out my tongue. He held my tongue and put a telescope tube into my mouth. (This allows for a closer view of the vocal cords.) He had me say “eeeeeeee” - not an easy or comfortable task when someone is literally holding your tongue!

I couldn’t see the video screen during the exam - probably so the sight of my vocal cords wouldn’t distract me. When it was over, the doctor came in to review the video footage with me. It was amazing to watch my vocal cords in action. The pictures look incredibly clinical, and yet for me there’s so much emotion associated with my voice. I’ve invested so much time, energy, hope, and money in those tiny bands of tissue, but I’d never actually seen them before. I almost felt like a mother viewing a sonogram of her unborn child.

My vocal cords: the left cord is slow to meet up with the right, due to a slightly weakened superior laryngeal nerve.

Diagnosis

So what did we see? The right vocal cord looks fine (it’s active and moves quickly), but the left one is slow. It moves, and it even meets the right cord, but it’s sluggish. As my voice teacher suspected, I probably have paresis (partial paralysis) of my left vocal cord.

The next step is to have a laryngeal electromyography (LEMG), a medical procedure that will measure the nerve input to the muscles that control the vocal cords. The results will tell the doctor which nerves - there are two, the recurrent laryngeal nerve (RLN) and the superior laryngeal nerve (SLN) - may have been damaged and to what degree. At that point, my doctor will be able to give a more complete diagnosis.

The treatment will most likely involve more of what I’ve already been doing - voice therapy (my voice teacher specializes in vocal rehab) along with yoga and other relaxation techniques. (People with vocal weakness often develop a lot of unhelpful laryngeal tension to compensate for the muscles that aren’t working properly.)

For now, I feel relieved to have some answers and grateful to have found a doctor who takes my voice as seriously as I do.

UPDATE: I had my laryngeal electromyography (LEMG) in June 2009. The doctor told me that my recurrent laryngeal nerve is fine, but that the superior laryngeal nerve (SLN) has only 80% function. (I guess that explains why I lost an octave off the top of my vocal range.) The results were not surprising, and I am lucky to have made wonderful progress with voice therapy. 

There's no way to know what weakened my SLN, but viruses are a common culprit, and my vocal symptoms began after I got the flu several times during my senior year of high school. Additionally, I strongly suspect that I am genetically prone to these issues. My father, who is not a singer, does a fair amount of public speaking and has similar issues with his speaking voice.