Here I am, making a career out of teaching vocal health, the art of subtle risk in performance, and breathing techniques….and half of the time I am having trouble breathing.
I am a voice teacher with a voice problem. (*gasp*...trust me, I know)
BODY - I have respiratory issues.
MIND - I am anxious about it, which makes them worse.
VOICE - This affects my voice.
STUDIO - And the imposter syndrome kicks in…
My chronic cough journey started almost a decade ago. I was singing on a cruise ship, the last of seven contracts full of high belt and re-circulated air. I was Vocal Captain, and while reviewing show videos and taking notes, I noticed that you could hear a whistle almost every time I inhaled. I knew it was happening, but didn’t realize that it was that audible and being picked up by the mics. At the end of my contract, we moved back to Oklahoma City so I could finish my masters degree. I saw an ENT and had a scope of my vocal folds to find out what was causing this wheeze. I had been coughing a bit, but wasn’t sick. It was a productive cough, but prolonged coughing is not good for the vocal folds, so I wanted to also be sure there was no damage. Luckily, my vocal folds were in great shape. They noticed a bit of redness in my trachea, which was unusual. They put me on PPIs, ruled out acid reflux, and sent me on my way with an inhaler for exercise-induced asthma.
Fast forward - still coughing and the inhaler doesn’t seem to do anything. I went back to the ENT. Luckily, vocal folds still happy. He sent me to get tested for allergies (all of those little x’s on my arm) and asthma (which I don’t have). They ordered a CT, but my insurance said no (multiple times). Thanks USA.
Fast forward - still coughing, but now coughing in Japan. I went to an ENT in Tokyo, who ruled out reflux again by putting me on PPIs, then stronger PPIs. He sent me to a pulmonologist who tested for all kinds of things…all negative. I had an MRI of my sinuses, which came back negative for chronic rhinitis. The pulmonologist gave me an inhaler, which didn’t do anything.
This was my story for almost a decade…starting over and over again, being tested for reflux, asthma, allergies…because those are the three top causes for chronic cough 95% of the time!
I am in the 5%.
This year, in my DMA studies, I am doing an internship with various Singing Voice Specialists. I spent a week observing in Dr. Robert Sataloff’s clinic in Philadelphia. While there, I mentioned my chronic cough (because I didn’t want them thinking I had COVID every time I coughed) and asked if I might have a strobe done while visiting. One afternoon, Dr. Lyons, one of the other wonderful doctors there, did a quick strobe and discovered that it looked like there was some narrowing in my trachea. I had just met with a local pulmonologist in Virginia and he asked me to schedule a chest CT and pulmonary function tests (all normal). Dr. Lyons advised that I ask for a neck CT as well. And this is where the pattern changed…
If I had just gotten the chest CT, the pulmonologist would have sent me back to an ENT or told me it’s probably reflux/asthma/allergies, etc. Because the chest CT was normal.
The neck CT shows a 50% narrowing of the trachea just below the vocal folds, a sub-glottic stenosis. This is why I have difficulty inhaling while singing. This is likely why I have a productive chronic cough as my body tries to deal with this irregularity.
THIS IS WHY SINGERS NEED TO SEE LARYNGOLOGISTS and not just any ENT doctor.
Stay tuned for Part II...
Super cool image taken from my scans and adapted by Dr. David Meyer to show the negative space of my vocal tract and trachea, . The part that looks like someone is pinching my trachea is where the stenosis is. This makes it feel like a suction every time I breathe, and makes it hard to get enough air to sustain longer phrases in singing.