Arena Stage 'My Fair Lady' Laid Low by the Flu with Performance Cancellations

It has been an early and bad start to the flu season in the DC metro area. It is just the beginning of the traditional 3 month flu season and flu numbers have already exceeded last year's.

Although professional singers may feel they should have a special exemption from this debilitating illness which also adversely affects the voice, it is not to be...

The flu has literally crippled performances of "My Fair Lady" at the Arena Stage this season with two show cancellations and another possible show cancellation this past Saturday Jan 5, 2013 when both the lead singer AND understudy were unable to perform due to laryngitis. It was not just the lead singer out with the flu, but also 3 other parts which fortunately did have understudy coverage. [more]

However, rather than canceling the show, the show did go on with the lead role being performed by a member of the regular ensemble with script in hand and only a few hours of rehearsal.

Sounds like an episode of the TV show "Smash," but apparently the ensemble singer Hannah Willman did spectacularly well.

I'm also sure Arena Stage breathed a sigh of relief not just for the standing ovation, but also because it was the show's last weekend.

Source:
‘My Fair Lady’ replacement shines at Arena Stage in an unforgettable evening. Washington Post 1/6/13

Flu spreading earlier, faster than usual this season. Washington Post 1/6/13

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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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TV Show SMASH Portrays Ivy With Vocal Issues

In last night's episode (Episode 106: Chemistry) of the new hit TV drama SMASH, the main character Ivy who plays Marilyn Monroe in the show developed laryngitis that affected her ability to sing clearly, especially in the high registers. However, her speaking voice did sound normal.

To treat this condition, she was given prednisone which did help her voice, but suffered unfortunate side effects of mood lability, hallucinations, insomnia, etc.

Did the show accurately portray what actually happens in real life?

Yes...

Laryngitis

Ivy probably did suffer laryngitis, but more in the sense of pre-nodule formation (otherwise known as vocal cord swelling) from vocal overuse given how much singing she has been doing. With such "pre-nodule" formation, the singer is able to sound perfectly normal when talking, but suffers from pitch breaks and onset delays in the high range, especially when singing quietly. Watch a video and audio demonstrating this phenomenon.

I should also point out that this problem is also under-recognized by medical professionals including ENTs... When such singer/patients with vocal cord swelling present complaining of hoarseness, they sound normal... talk normal... and for all intensive purposes seem to be making up their perceived raspy voice.

A simple test to demonstrate vocal cord swelling is to have the singer sing a song at a high pitch (octave above middle C), but to sing the song very quietly. I typically have patients sing Happy Birthday. Listen for any vocal quality problems.

Even though the vocal issue is only in the high range, for professional (and amateur) singers, such "minor" vocal raspiness is a HUGE problem. Consider this... if this patient is singing a solo for a performance where there's several hundred people in the audience... it's hard enough to sing a solo just from nervousness. Now add the concern that you have no idea what your voice is going to do in that one part of the song where it goes high. Confidence is key to a good performance and with an undependable voice, confidence is lost and the performance overall suffers.

Prednisone

Is prednisone really as good as the show suggests? Yes... including the side effects, though they did stretch the side effects some.

Typically steroids provide almost immediate (within 4-12 hours) resolution of vocal cord swelling and inflammation. Problem is, it only works for a short period of time.

I typically prescribe decadron rather than prednisone as I feel it works faster, better, and more reliably than prednisone. I also prescribe it judiciously.

Judiciously means I prescribe it if there's a single major concert or single audition that is very important to the singer. I typically prescribe a single large dose to be taken the night before.

If it is a singer who is undergoing a series of auditions over a short period of time, I may prescribe a week long course of steroids to maintain its good effects.

The USUAL common side effects are reflux, insomnia, mood lability, and jitteriness. However, for those who are sensitive to medications can suffer many of the side effects experienced by Ivy.

NOW... for the problem with steroids beyond the side effects... Its effects are temporary and the better way of treating vocal cord swelling is behavioral changes as one can't just keep prescribing steroids indefinitely. It is much like giving morphine to a football player to mask the pain of a sprained ankle so he can still keep playing football. MORE vocal injury can occur while taking the steroids!

With steroids, I usually also recommend restricted voice use (strict voice use is even better). What this means is talk ONLY when you MUST talk and with low energy if you do. NO social talking, no whispering, no yelling, no raising voice, etc. Strict voice rest is when you are not even talking at all.

Also, work with a singing voice therapist.

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Celine Dion Cancels Shows Due to Laryngitis

In late Feb 2012, Celine Dion who was to have performed in Las Vegas Feb 22, 2012, cancelled her show at the last minute at the Caesar's Palace due to laryngitis on the advice of her doctors. According to media reports, her doctors instructed her to rest for 7 days to ensure full recovery due to vocal cord inflammation caused by a virus.

What does that mean exactly?

When a virus infects the mucosa of the upper airway, it causes inflammation of the mucosa lining including the vocal cords. With inflammation, the vocal cords swell.

That's why with laryngitis, the pitch of the voice decreases and it becomes more effortful to talk. To use an analogy, think of a violin string where the thicker string has a deeper pitch than a thin string. It also takes more power to play the thicker string. Watch the video below of normal vocal cord functioning:


In order for voice production to occur, the lining of the vocal cords vibrates very quickly when they come together. If the vocal cords are swollen, they don't vibrate as easily.

Here's what inflamed vocal cords might have looked like for Celine Dion. Note the slight bend to the vocal cords and overall dull appearance.

Below is what her vocal cords might look like when they are at peak health!

Voice rest is absolutely important for vocal recovery as quickly as possible. With talking/singing during active laryngitis, further trauma may occur to the vocal cord lining promoting even more inflammation and swelling. It may also lead to another vocal disorder known as muscle tension dysphonia.


Source:
Celine Dion cancels act: laryngitis. UPI 2/26/12

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Misleading FoxNews Report: Laryngitis for 30 Years

On Dec 23, 2011, Fox News reported on a woman who supposedly had laryngitis for 30 years.

The story reported that the woman had a viral URI in 1982 which resulted in laryngitis and a paralyzed vocal cord.

What people should be aware of is that a paralyzed vocal cord is NOT laryngitis. Laryngitis is an infection of the larynx or voicebox. Stating that a paralyzed vocal cord is akin to laryngitis is like claiming a person who has a paralyzed arm/leg from a stroke has an arm/leg infection.

Now it is true that a viral laryngitis can cause a paralyzed vocal cord, but they should not be considered synonymous.

Patients with a paralyzed vocal cord have a very breathy sounding weak voice and a weak cough. They may also suffer from aspiration where liquids/foods go down the wrong way more easily than normal.

Typically, the first way to treat a paralyzed vocal cord is voice therapy. If voice therapy does not make much improvement, surgical intervention can be considered.

Typically, a vocal cord injection is performed if the paralysis onset was within one year. After one year, an implant can be placed as the Fox News report mentioned.

Read more about paralyzed vocal cords as well as watch a video here.

Source:
Woman Gets Voice Back After Suffering From Laryngitis for 30 Years. FoxNews 12/23/11

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