Vocal Cord Tear Silences R&B Singer Frank Ocean

Image by Fred von Lohmann from Wikipedia

On July 25, 2013, R&B singer Frank Ocean was forced to cancel his entire Australian concert tour due to a small vocal cord tear.

After singing his opening night with a sore throat during which he reportedly sounded "noticeably off-key," he seeked medical attention and was informed of the unfortunate condition of his vocal cord. Listening to his voice on this YouTube video recorded during this fateful concert, his voice actually does not sound as bad as I would expect with a vocal cord tear. However, at time point 1:20, there was an obvious pitch break.

If a vocal cord tear was truly present, it must have been extremely small and not along the free edge because even with a small vocal cord tear located along the vibrating margin, the vocal quality would have been noticeably degraded throughout the vocal range. Why?


In order for the vocal cords to produce a clear voice, the vocal cords must come together and vibrate evenly. This vibration occurs on the vocal cord mucosa. ANYTHING that disrupts this mucosal vibration would result in a raspy voice including small bumps like a nodule or polyp, but also a vocal cord tear. Watch video of normal vocal cords in motion.

Small bumps typically cause problems in the voice only in the high range at quiet volumes because often the bump can vibrate along with the mucosa (just like a buoy on the ocean). As long as the vibration is unaffected, the voice comes out. As a bump gets bigger, a greater portion of the vocal range becomes affected.

A tear, however, depending on where it is located could affect the entire vocal range due to vibratory disruption as it moves to and around the tear (the tear acts like an anchored pillar in the ocean).

The only way to correct a tear is MANDATORY strict voice rest for several weeks. Further using the voice when injured like this may only "rip" the tear larger potentially causing a greater risk of scar formation and a permanent hoarse voice.

Strict voice rest means absolutely no talking and whispering. Such activities cause the vocal cords to come together and "bang" against the vocal cord tear preventing proper healing. I would even instruct patients to avoid even mouthing words as it causes the brain to "think" you are talking even if you are not. Essentially, the lips should always remain closed except when eating/drinking. The analogy would be if you have surgery done on the heel of your foot, you should not walk or put any weight on the heel, otherwise risk improper healing.

Here's an example picture of a vocal cord tear on both vocal cords in a patient suffering from viral laryngitis who did not quit using her voice for a prolonged period of time.

WHY would a vocal cord tear appear in the first place? Usually from excessively traumatic vocal abuse (ie, strong cough, scream, yell, etc).

Source:
Frank Ocean Suffers Tear to Vocal Cord, Scraps Australian Mini-Tour. Billboard Biz 7/26/13

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Beyonce Cancels Concert Due to Dehydration (and Exhaustion)

Image by Jingjing Cheng from Wikipedia

Media has reported the superstar pop singer Beyonce cancelled her May 14, 2013 concert in Belgium on the advice of her doctors "due to dehydration and exhaustion".

Though the rumor mill is churning with the possibility of a pregnancy, I was more interested that a concert was cancelled due to dehydration concerns.

Why is hydration so important for voice production, especially in as athletic activity as singing?

With hydration, the glands that line the throat and voicebox produce nice thin secretions. With dehydration, the secretions become thicker and stickier and can adversely affect the voice.

Keep in mind that hydration with its associated thin secretions is like the oil that makes an engine run smooth. When a person talks or sings, the vocal cords vibrate very quickly. Hydration with its thin secretions allows the vibration to occur smoothly and consistently. If dryness is present, the vibrations will not occur as easily.

Watch the video below. You can see the secretions "dancing" on the vocal cords as it should with smooth, even vibrations producing clarity in voice production.

Regardless of what may have prompted Beyonce to cancel her concert, fans hope her recovery will be speedy!

Source:
Is Beyonce Pregnant? Singer Cancels Show; Rumor Mill Reignites. Huffington Post 5/14/13

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Dr. Chang Quoted in Voice Council Magazine

Dr. Christopher Chang was quoted in a Nov 4, 2012 article published in Voice Council Magazine.

The Voice Council Magazine is based out of United Kingdom and focuses on "practical insight for the emerging vocalist."

The article by Megan Gloss was focused on why Celine Dion cancelled her concert 2/22/12 in Las Vegas (a viral laryngitis), a subject I already blogged about here.

Read the published Voice Council article here.

Source:
Celine Dion's Viral Voice. Voice Council Magazine 2/22/12.

Viral Infections and Singing — More From Dr. Chang. Voice Council Magazine 2/22/12.

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Singer Nicki Minaj with Strained Vocal Cords

Media has reported that pop star Nicki Minaj had to cancel upcoming concerts in England due to injured vocal cords.

She apparently saw a doctor who diagnosed "strained vocal cords" after an x-ray and recommended voice rest for a few days.

The singer apparently ignored this advice and sang in New York City on Aug 18 causing her voice to substantially worsen resulting in her decision to cancel her concerts this weekend.

Details of her vocal cord condition are sparse. However, based on the limited information provided, there's a few things I can guess at.

First off, an x-ray can NOT diagnose any type of vocal cord condition. The singer must have undergone a trans-nasal endoscopic procedure which is the ONLY way to visualize the vocal cord and diagnose any vocal problems.

Given the singer was instructed to rest her voice for "a few days," she most likely suffered from a mild acute laryngitis causing inflamed vocal cords. By ignoring advice to rest her voice, she potentially turned a mild laryngitis into a more severe laryngitis. She probably did not suffer from any physical problems on her vocal cords like nodules or polyps which would take weeks if not months to recover (not days) as happened to singers Adele and John Mayer.

Really, at this point, strict voice rest, hydration, acid reflux control, and steroids (ie, prednisone) would enable her to recover her normal voice ASAP.

Here's a picture of a severe laryngitis (left) compared a normal appearing vocal cords (right). Note that the vocal cords are swollen and red compared to normal pearly white and thin appearance.

 

Source:
Nicki Minaj cancels U.K. concerts due to strained vocal cords. NBC News 8/18/12

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People DO Suffer Hearing Loss After a Loud Concert

Almost everybody at some point in their lives have attended a loud concert or loud nightclub.

Almost everybody will also recall a temporary reduction in their hearing with or without ringing afterwards for a short period of time.

This phenomenon is called temporary threshold shift (TTS) whereby the affected person has a temporary hearing loss that may last hours to days due to temporary damage of the outer hair cells of the cochlea.

If loud nose exposure happens enough times, permanent hearing loss can occur.

For some, permanent hearing loss may occur after attending numerous loud concerts whereas in other more "susceptible" individuals, it can happen after a single loud concert.

It doesn't even have to be a loud music concert. ANY loud noise exposure can do including shooting guns, listening to a portable music player like the iPod, fireworks, playing in an orchestra/band, etc.

However, loud concerts are of particular interest given how many individuals are exposed all at once and provided a unique research opportunity which was presented on May 21, 2012 at the American Otologic Society Meeting in Los Angeles.

The researchers (led by Dr. Jennifer Derebery of the House Ear Institute) essentially took hearing test before and after the concert of 29 teenagers.

72% suffered objective hearing loss after the concert though only 53% reported subjective hearing loss. 25% reported new onset tinnitus after the concert.

Of note, hearing ear plugs were offered to the study subjects, but only 3 accepted them.

Adult researchers who sat with the teenagers under investigation measured sound levels throughout the concert. During the 26 songs played during the three hour concert, sound levels ranged from 82 to 110 decibels with an average of 98.5 decibels. The mean level was greater than 100 decibels for 10 of the 26 songs.

As a reference, ear pain occurs at 125dB. Jet engine noise is at 140dB. Sustained loud noise exposure of 90-95dB can result in permanent hearing loss.

OSHA (Office of Safety and Health Administration) mandates workers to never be exposed to sound levels of 100dB for more than 2 hours per day (no more than 4 hours per day at 95dB).

Clearly something more needs to be done to protect teenagers' hearing, especially given how few accepted hearing ear plugs. A fundamental cultural shift would most likely have to occur with encouragement from not only the musicians but also parents and teachers...

OR, the music volume at concerts should be turned down... No boos please.


Reference:
Teenagers Hear Worse After Attending Concert. LiveScience 5/21/12

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