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Medicine in the Vocal Arts


by Dawn Brazell
Special to The Catalyst 
It’s not every day that Julie Blair gets a tube run down her nose, but often enough that she doesn't even flinch. She sings “The Star Spangled Banner,” her vocal chords displayed like a yawning mouth as they are magnified on a video screen next to her. As Blair runs through the song, the chords spring into motion seeming to chatter away.

Their internal play is caught by a strobe on the end of the flexible scope controlled by Lucinda Halstead, M.D., associate professor in the Department of Otolaryngology and head of  MUSC's Voice Center. The song is one of Halstead’s favorites because it requires a singer to move from chest to head voice. Not as thrilled at the selection is Blair, a speech pathologist who assists Halstead, often serving as a guinea pig to demonstrate stroboscopy to other doctors and medical students.

As the tube slips from her nose, she wipes tears from her eyes, which form as part of a reflex, and smiles. It's a job hazard, but a welcome one given what modern electrical stroboscopy can teach them in solving the myriad of problems that can afflict the voice. No one knows that better than the elite vocal performers who are a part of Halstead's focus as head of MUSC’s Voice Center.

The otolaryngologist on call for this year's Spoleto Festival, Halstead deals with amateur and professional performers on a regular basis. Unlike other specialties where healing is the primary goal, Halstead has two hoops to get through—healing her patient and getting them on stage on time.

She smiles, remembering  some white-knuckle days she's had in dealing with amateur theater performers. “It’s not like they have an understudy who can relieve them,” she said. “That's very satisfying to give them treatment and see them be able to perform. That’s their livelihood.”

Working against curtain time got Halstead hooked more than a decade ago during her residency in Boston. Graduating from George Washington University School of Medicine, she then trained in the combined Tufts and Boston universities' otolaryngology residency program. There she worked with an attending physician who served as the otlolaryngologist for the Boston Opera. This took Halstead behind the scenes and exposed her to the complexities of treating elite vocal artists. 

“I love music,” Halstead said. “I love to hear the human voice sing. I think it’s one of the most wonderful gifts that we have. Dancing also is wonderful, but singing is so moving and beautiful. No one knows exactly why someone is a good singer. You can't just look at someone’s voice box and say, ‘Oh, they're going to be a great soprano. It has to do with the resonating cavities at the end of the throat, and musicality and all of these other factors.”

It's that mystery that combines the science and art of the field that brought Halstead to Charleston to start a voice center in 1987. The staff  boasts three members, including Halstead, Blair and Deanna McBroom, an exceptionally talented local singer and associate professor of music at the College of Charleston. The center's reputation has grown, with its services expanding. They plan to add a Ph.D.-level speech pathologist, and later this year turn their attentions to establishing a performing arts medical center, where all performers from dancers to singers can receive treatment from an interdisciplinary team of specialists that would include orthopedics, psychiatry and alternative health.

Her goal is to give elite performers a higher level of care. What she likes about the creation of a performing arts medical center is that they can streamline treatment for performers, who often have hectic schedules, to be seen in a timely fashion by as many specialists as they may need. For example, McBroom evaluates patients' voices and checks for technique difficulties, helping bring them back into voice after they've had treatment. A psychiatrist could help with performance anxiety and an alternative medicine doctor could prescribe massage or acupuncture.

“The time is coming for there to be centers that deal with performing artists as a group,” she said, recognizing that often performers’ jobs require multiple talents. A singer may play a musical instrument and have physical complaints relating to each discipline. An actor may have a role that requires dancing and singing. The center would be for local performers as well as the wide array of national and international performers who visit Charleston every year.

Hosting the 14th Medicine in the Vocal Arts Symposium during Spoleto, Halstead's department is excited about watching this field move from its infancy. The symposiums have raised the prominence of the university, attracting internationally known specialists who present cutting-edge research.

But it's not just elite performers that the voice center tries to help.

Voice problems affect much more than just singers, said Halstead. Anyone whose job depends on speaking and that ranges from teachers and preachers to radio broadcasters and telephone marketers could benefit from specialized treatment that a voice center could offer.

“There's this vast number of people who rely on their voice for their job and come to us with problems. They depend on having an attractive voice that is engaging that makes your client warm up to you rather than thinking, ‘what's wrong with this person?’” 

Halstead, who's a member of an international network of doctors who specialize in treating elite performers, said she has no idea how many calls she'll get during this festival, but she's looking forward to enjoying the wealth of talent both of visiting performers and of specialists attending the symposium.

“There're lots of things we know now and can impart to singers to help them stay healthy and prevent injury. The voice is truly a specialty just like sinus and allergies or ear problems.”

It used to be singers didn't have answers to their problems so they had to perform despite discomfort, a practice that often causes worse damage. For example, antihistamines can dry out the throat and make it easy to injure the vocal chords. Likewise, taking aspirin or Motrin can be a bad idea for a singer because these drugs can thin the blood some, making it easier for a blood vessel rupture on the vocal chords, she said.

Vocal artists give so much to the community, it's nice to be able to help them extend their careers, she said. 

“In many ways your voice is a mirror of what's going on inside you. It's one of our most expressive organs. Your voice will betray just about everything that is going on inside you. If you have allergies or have been crying, it's going to affect your voice. It truly is a mirror of your soul.”
 

How to save your voice

The following are tips from the voice center. Some relate to singers, but most apply to people who extensively use their voice daily for their professions.
  • Avoid loud talking or talking for long in noisy environments. For teachers or others in noisy situations, this means developing nonverbal ways of getting attention and communicating. 
  • Have the proper breath support. Develop good breathing habits and posture. Learn to pause before important words and at the end of a phrase.
  • Be natural. Avoid pitching your voice too low or too high.
  • Avoid throat clearing. Swallow instead and take small sips of water to clear mucus.
  • Slow down your rate of speech and always face your listener.
  • Be aware that diet affects your voice. Avoid food and drinks with high acid content: colas, citrus juices, tomato products etc.
  • Avoid food and drinks high in caffeine.
  • Do not smoke and avoid second-hand smoke.
  • Avoid dust, mold, mildew and strong perfumed smells from commercial products.
  • Get plenty of rest and exercise.
  • Drink a total 8 to 10 glasses of water a day. Drink extra water when flying
  • Avoid medications that cause dryness (e.g. antihistamines, diuretics) if possible. But if not, increase water intake.
  • Limit talking when you have a cold. Do not attempt to sing through a cold.