muscle tension dysphonia

(from a previous semester)

Hey all! Adriana asked me to make this post sort of detailing what I went through with my vocal
injury and my experience with voice therapy so here it is!

In 2015 I had gotten really lucky and was presented with a lot of opportunities to perform locally.
It was really exciting for me that so many people wanted me to sing for their events and in their
bars because I never really thought of myself as being very good so this was a big confidence
boost, but also meant I was going from just singing at home for fun, to singing in a more
professional sort of way, all the time, and some of the events I was singing for had me singing for
as long as 10am-5pm and I was typically doing some sort of performance at least once a week so
I was really using my voice more than I ever had in my life. For the most part my voice held up
pretty well though the first 6 months of this (although sometimes on the 10am-5pm I would be in a
lot of pain by the end but I always thought that was just because it was such a long day of
singing.) However after a while I really started to notice that something was wrong. Singing
became so painful that I could barely make it through my sets and people who came to see me
regularly could tell that something was wrong. I started to lose control of my voice and was often
missing notes and couldn't access my usual range. I made an appointment with an ENT who
scoped me (sending a camera up my nose and down my throat, very uncomfortable) and saw
that my vocal cords and everything around them were swollen and irritated, I have a family
history of acid reflux so he thought that could be the cause, prescribed me medication for that
and sent me on my way, but nothing changed and soon it was painful even to talk for more than
10 minutes. I went back to the ENT and he scoped me again, my heart sank and I tried not to cry
when I saw blood. The muscles around my vocal cords were hemorrhaging, but I was reassured
that this was unlikely to cause long term damage. I was prescribed a steroid to bring down the
swelling and hopefully stop the hemorrhaging (which it did), but the ENT was totally stumped and
had no idea why this was happening so he referred me to a doctor at Georgetown University
Hospital who specialized in the voice. Georgetown had more equipment and resources and so
the new doctor was able to diagnose me right away after scoping me and having me speak with
the camera in my throat. He was able to cut the recording to see exactly how my vocal cords
were moving and what he found was that while I was speaking I wasn't using my air to move my
vocal cords, but instead using my muscles to smack them together. He diagnosed me with
muscle tension dysphonia and gave me a list of voice therapists in my area who could help me. I
started voice therapy right away and let me tell you it is very difficult to change the way you talk
when it's the way you've done things for your entire life. In voice therapy she would a lot of the
time just listen to me talk about different things, my job, my dog, my friends, and record me and
see how my voice changed when I used certain words or expressed certain emotions. She
worked with me on resonance placement and how to use my air, so she would have me do things
like put a straw in a water cup and hum, if there were bubbles I was doing it right. She would
have me read lists of words and say them over and over again until I was saying them correctly,
and she showed me how to massage my throat to release tension. She also gave me a list of a
do's and don'ts for caring for my voice and recommended a steam inhaler. Honestly this is still
something I really struggle with, if I don't think about it actively then I slip right back into my old
habits, and sometimes I do let the tension get the best of me and the pain might come back for
an hour or so, but thats more of an issues when I talk now than when I sing. I'd say 99% of the
time that I sing now I am pain free.

Here is a reply on this post from another student in the class....

As a massage therapist for over 20 years, I worked mostly with athletes which included people in
the performing arts. I recall how many of my clients with shoulder and neck issues had 'vocal
issues' as well. Raspy/husky voices: most often they thought that was just how their voice was.
We would address breathing habits, speaking, posture, etc to help alleviate so much of the
discomfort and pain. Of course it helped.
I want to point out a public figure who does not sing, who is a speaker, and is considered to be
very physically fit - Tony Robbins. I can tell when I hear his voice if he has just come off of a
coaching weekend. He is known to become very vocal during his seminars. Not to mention I bet
he has a fairly high level of stress to live the life he lives.

Here's my reply to her...

As for Tony Robbins - I walked on hot coals with him and he started me on my self empowerment
journey. So I love the results he can create. However, his VOICE is another conversation. It hurts
to hear him speak. I think he has accepted it as a masculine powerhouse sound - which it can
translate into. I am sure he has the exact balance sorted out so that he can recover and do it
again. I've been waiting for his vocal cords to protest and stop working. Maybe they have and he
has dealt with it in private. I hope to know his real story someday.

Important: these are not stories to induce fear - just knowledge and understanding of the
mechanics of the voice. Please share if you have any insight or experience with vocal issues like
this, so that we can learn from each other.