Saturday, September 15, 2018

Maryland Lyric Opera - La Fanciulla del West (post 1)

Dear Readers,

Stasera a La Polka, il saloon di Minnie, v'annunzierò Jake Wallace, il cantastorie del campo!!! VENGA VENGA! Alle 19:30!! Sarà l'ultima opportunità di vederla e sentirla!

Thursday, September 13, 2018

On the topic of tongue-tie, Ankyloglossia, and Surgery 3 (Facebook user)

Dear readers,


This is the third of three posts in response to three singers who have reached out to me in the last few months inquiring about my experience with frenotomy (aka. frenulotomy, frenulectomy, and frenectomy - I, of course, know that there are differences in these terms specific to the procedure, please accept my attempt to be as inclusive as possible). As I mentioned in the previous post: I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts. 
Please see my previous blog entries for a detailed and pictorial documentation of my experience 

1)My 1st blog post on the topic: "Ankyloglossia Day 5" DECEMBER 4, 20162)My 2nd blog post on the topic: "Ankyloglossia Day 11" DECEMBER 9, 20163)My 3rd blog post on the topic: "Ankyloglossia 5 Weeks" JANUARY 7, 2017

To re-cap: I was tongue-tied since birth. I had no speech or mastication issues - for all intents and purposes I was an unimpeded average person. The choice to have the procedure done was a difficult one. I was scared. The lack of available information and effects made me skeptical and fearful. It was not an easy decision. I wrote "After discussing the procedure with other singers, teachers, and months of research I came to the conclusion that I should have it done. The surgery might, as an ancillary benefit, proved great freedom at the base of my tongue and in vocal production. The primary benefit is in the mobility of my tongue to articulate consonants and vowels clearly and easily. Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation. Assuming that I do my rehabilitative stretched [sic] to prevent the frenulum from re-growing then I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible - though I do still have my malocclusion a.k.a under-bite)." I had the feeling that it was at least a "cosmetic" procedure that would affect nothing, and at best be a great liberating and problem solving benefit.

My sincere and heart felt concern, and sympathy to those who reached out to me. I can imagine - if your scenario is anything like mine - that this is scary, you feel nervous about accepting this as a panacea. Again, 
I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts.  Below are the questions and my responses to a facebook user who had reached out. I hope this post, as well as my previous posts will be of some help.

To re-cap: I was tongue-tied since birth. I had no speech or mastication issues - for all intents and purposes I was an unimpeded average person. The choice to have the procedure done was a difficult one. I was scared. The lack of available information and effects made me skeptical and fearful. It was not an easy decision. I wrote "After discussing the procedure with other singers, teachers, and months of research I came to the conclusion that I should have it done. The surgery might, as an ancillary benefit, proved great freedom at the base of my tongue and in vocal production. The primary benefit is in the mobility of my tongue to articulate consonants and vowels clearly and easily. Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation. Assuming that I do my rehabilitative stretched [sic] to prevent the frenulum from re-growing then I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible - though I do still have my malocclusion a.k.a under-bite)." I had the feeling that it was at least a "cosmetic" procedure that would affect nothing, and at best be a great liberating and problem solving benefit.
My sincere and heart felt concern, and sympathy to those who reached out to me. I can imagine - if your scenario is anything like mine - that this is scary, you feel nervous about accepting this as a panacea. Again, I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts.  Below are the questions and my responses to a facebook user who had reached out. I hope this post, as well as my previous posts will be of some help.


Singer: Hello Joe... I'm a 48 year old singer and voice teacher with a frenectomy appointment for next week. I'm both excited and scared. I have only two days before I need to teach, and about two weeks before a big Mozart role. Is that enough time for recovery? 

Joe: Glad to give you more information about my experience. Good of you to reach out, sadly there is not a lot of information out there from or by singers who have had this procedure. Since the procedure is localized to that particular connective tissue there will be no change to your vocal chords or production. I was able to speak with relative clarity immediately following the surgery. My ENT explained that I could speak, sing, and eat as my heart desired. The one note of caution is the pain. The pain is the only aspect that prevented me from immediately going back into work. I was consuming 2 Vicodin every 4 hours or so, while I was awake, for about 9 days.The eagerness, and the fear are both natural, normal, expected. I had those feelings as well.

To answer your questions specifically: 1) Is that enough time for recovery?  
>>I can only speak to my own experience, we all have different bodies. I was in quite a bit of pain for the first week and a half. The bleeding stopped with in 48 of the procedure. As long as you do not need to demonstrate much, if you're anything like me, you could be teaching two days after. As for the Mozart role. It's difficult to advise. Is it staged? Semi-staged? What are the rehearsals like? Is it with Orchestra? Is it highly publicized?

I returned to my ENT for a debriding exactly two weeks after the procedure.

Singer: What was the recovery like and how much of a change did you feel? 

Joe: It was fairly simple: go about a normal day consuming painkillers as needed. It is obligatory to do the simple stretches. Any time I wasn't speaking or sleeping I did the tongue stretches that my ENT showed me. Lift your tongue to your hard palette and avealar ridge. Stick your tongue out of your mouth as far as you can. I even started, by my own choice, to add a third stretch: curling my tongue back so the tip could touch the soft palette. Truly, the most painful aspect is the stretching.

HUGE change. Your timbre, and vocal idiosyncracies will not change. The best way I can explain it is: you'll have MANY more options to choose from - where as before you were limited. The only challenge I faced was working new articulations into old pieces. Primarily the consonants L,M,N,R... a little with D and T, too. But it's not really noticeable to anyone else.

Singer: Do you have less tension now? 

Joe: My tongue is free. There is really no way to explain until you feel it for yourself. The best analogy I can think of is like driving a car: If you've only ever driven a low-end used clunker that get's you from point A to B then you're pretty happy just going about your day. If you then drive top of the line BMW your skills as a driver do not change BUT the experience/comfort change.

You will still be the same singer after the procedure, it will not make you a different singer and wont change anything about your voice (at least it didn't for me). The flexibility and new options you have with your free tongue will surprise you (at least it surprised me). There is some, not drastic, SOME vocal freedom because the release of tension in the front of the tongue meant a release of the sympathy tension in the back/base of the tongue.

Singer: So helpful and encouraging. I have been working on tongue tension every day for 30 years and can't believe it's not my fault somehow! I've had a fine career- just got tired easily singing recitative and can't roll my r's or have clear diction with my mouth really open. I'm having it done with a laser and have been working with an orofacial myofunctional therapist who will work with me afterwards on the stretches as well. It sound like the pain will be worth it. You didn't have any nerve damage or trouble with fine motor control afterwards? That's the only part I'm afraid of.

Joe: That all sounds excellent. You're taking all of the right steps. No, I did not have any trouble or damage with fine motor control following. Now, almost three months after, it's still exciting to stick my tongue out, and do exercises. Lasers sounds exciting. My ENT was some what medieval about it, she used scissors and sharper knives. It was simple and took a total of 5 min. Though I waited in the office till the bleeding subsided. I happen to bleed a lot, others do not.

Best of luck, Kerry. If you have any further questions or need to reach out - please do not hesitate.

I hope that dialogue was of some use to readers looking for support.
As ever, I am happy to share my experience, and be a voice of comfort and support.

Keep singing pretty!
Thank you for reading
Joe

Saturday, April 14, 2018

On the topic of tongue-tie, Ankyloglossia, and Surgery 2 (Facebook user)

Dear readers,

This is the second of three posts in response to three singers who 
have reached out to me in the last few months inquiring about my experience with frenotomy (aka. frenulotomy, frenulectomy, and frenectomy - I, of course, know that there are differences in these terms specific to the procedure, please accept my attempt to be as inclusive as possible). As I mentioned in the previous post: I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts. 

Please see my previous blog entries for a detailed and pictorial documentation of my experience 

1)My 1st blog post on the topic: "Ankyloglossia Day 5" DECEMBER 4, 2016
2)My 2nd blog post on the topic: "Ankyloglossia Day 11" DECEMBER 9, 2016
3)
My 3rd blog post on the topic: "Ankyloglossia 5 Weeks" JANUARY 7, 2017

To re-cap: I was tongue-tied since birth. I had no speech or mastication issues - for all intents and purposes I was an unimpeded average person. The choice to have the procedure done was a difficult one. I was scared. The lack of available information and effects made me skeptical and fearful. It was not an easy decision. I wrote "After discussing the procedure with other singers, teachers, and months of research I came to the conclusion that I should have it done. The surgery might, as an ancillary benefit, proved great freedom at the base of my tongue and in vocal production. The primary benefit is in the mobility of my tongue to articulate consonants and vowels clearly and easily. Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation. Assuming that I do my rehabilitative stretched [sic] to prevent the frenulum from re-growing then I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible - though I do still have my malocclusion a.k.a under-bite)." I had the feeling that it was at least a "cosmetic" procedure that would affect nothing, and at best be a great liberating and problem solving benefit.

My sincere and heart felt concern, and sympathy to those who reached out to me. I can imagine - if your scenario is anything like mine - that this is scary, you feel nervous about accepting this as a panacea. Again, 
I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts.  Below are the questions and my responses to a facebook user who had reached out. I hope this post, as well as my previous posts will be of some help.

Singer: Hello. I have been doing some research online and came across your blog posts where you have talked about your ankyloglossia surgery. I was curious if you have had anymore updates or changes since your last post a year ago.

Joe: There hasn't been any noticeable significant change since the wound fully healed. As I suspected, the surgery is mostly cosmetic. I have not noticed much difference in my singing or speech. In summation: I have more options to articulate but also more options to make mistakes. I am glad I made the decision to do it, but it certainly didn't make anything remarkably better. The end result is I have more flexibility and range of motion, with very subtle changes to timbre.

Singer: The reason that I am asking is because I am studying singing in college and I have a tied tongue myself. I am not an expert on this field at all, but feel like the physical restriction of my tongue has possibly led to an increased physical tension throughout my singing. Additionally, my instructor as well as some of my friends both say that it sounds quite often like I am “sucking the sound back into myself” when I am singing. Do you think that this muffled sound is a potential result of having a tied tongue? Also, I cannot roll my R’s or touch the top of my mouth with my tongue.

Joe: It would be reckless and unfair to you, if I made any confirmation or denial of the questions you asked: not knowing your voice, your technique, or the full context of your challenges/the actual degree of "tied-ness" I cannot in good faith comment. What I can offer are my own experiences, and some suggestions. How long have you been singing? What type of repertoire are you working on? Have you had other instructors? Have you inquired with your or your instructor's ENT? Is there a "voice center" for research at your college or near where you can inquire?

Singer: I have a lesson today and am going to ask my instructor all about it. One of his colleagues (another vocal professor) actually worked at an ENT office himself. Also I am studying under the Blaylock technique and I started singing in high school but was unaware that I was singing incorrectly until I came to college. I have had one other instructor but the one I have now is significantly better than my previous one. As far as a voice center goes, I am unaware if there is one for research or simply near me as to where I can inquire.

Joe: As I am sure you saw on my blog, I had a severe tongue tie. I used the side of my tongue to roll my R and could not touch the roof of my mouth. I can now roll my R with the front/tip of my tongue and I can curl my tongue over its self and touch my uvula. I always had a bright sound so "muffled" was never a concern for me. I would seek the observations and insight of a otolaryngologist. Only a medical doctor familiar with the vocal apparatus can give you more specific information.

User: You can touch your uvula now?? Is that a normal thing that people can do? And thanks for all of your help!

Joe: The otolaryngologist with be able to take photos with a stroboscope or x-ray and diagnose your condition. That doctor will be able to inform/recommend you if your tongue tie, which is the connection of your sub sublingual frenulum to the tip and body of the tongue, is server. It really - in my experience - does not affect the back of the tongue severall,y though I cannot offer anything regarding your experience or condition.

I would say "muffled" might be more related to laryngeal adduction/approximation and/or pharyngeal engagement - but please don't take my hypothesis as a valuable one: again - I do not know you, your voice, your technique, your development, your trajectory, or the full extent of your tongue-tie.
A few other suggestions: Please ask someone one or prompt them before you send pictures of yourself or condition - it is a respectful courtesy, one that I would have preferred you offered. Also, if you can't find a reputable ENT through friends or your instructor or through your college, seek out a vocal pathologist: the vocal pathologist should be able to give you more insight into any possible struggles you may have. Lastly, get many opinions and don't put a lot of faith in the guestimation of people who aren't specialists in the science and pathology of the voice/ear nose and throat.

User: Okay. I apologize for not having asked you before I sent you the photo. I do however really appreciate your advice as I am sure you know yourself that there is not much research on this topic in the regards to its effect on singing.
Thank you for responding and I hope that you have a great day!

Joe: No harm done. I completely understand. Happy to help in any way possible, you're right - it can be a scary scenario. I read about it for 5 months almost non-stop. I am here if you need anything else - I can recommend some ENTs or other resources.

User: Were you nervous or freaked out about the surgery at all? That’s all that I have been thinking about in the instance that I do end up getting it done.

Joe: Yes. I was absolutely freaked out and very nervous.

I hope that dialogue was of some use to readers looking for support.
As ever, I am happy to share my experience, and be a voice of comfort and support.

Keep singing pretty!
Thank you for reading
Joe

Wednesday, March 14, 2018

On the topic of tongue-tie, Ankyloglossia, and Surgery 1 (Christina)

Dear readers,

After a long absence, I have found the time to return. The next three post are geared toward three singers who have reached out to me in the last few months inquiring about my experience with frenotomy (aka. frenulotomy, frenulectomy, and frenectomy - I, of course, know that there are differences in these terms specific to the procedure, please accept my attempt to be as inclusive as possible). I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts. 

Please see my previous blog entries for a detailed and pictorial documentation of my experience 
1)My 1st blog post on the topic: "Ankyloglossia Day 5" DECEMBER 4, 2016
2)My 2nd blog post on the topic: "Ankyloglossia Day 11" DECEMBER 9, 2016
3)My 3rd blog post on the topic: "Ankyloglossia 5 Weeks" JANUARY 7, 2017

To re-cap: I was tongue-tied since birth. I had no speech or mastication issues - for all intents and purposes I was an unimpeded average person. The choice to have the procedure done was a difficult one. I was scared. The lack of available information and effects made me skeptical and fearful. It was not an easy decision. I wrote "After discussing the procedure with other singers, teachers, and months of research I came to the conclusion that I should have it done. The surgery might, as an ancillary benefit, proved great freedom at the base of my tongue and in vocal production. The primary benefit is in the mobility of my tongue to articulate consonants and vowels clearly and easily. Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation. Assuming that I do my rehabilitative stretched [sic] to prevent the frenulum from re-growing then I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible - though I do still have my malocclusion a.k.a under-bite)." I had the feeling that it was at least a "cosmetic" procedure that would affect nothing, and at best be a great liberating and problem solving benefit.

My sincere and heart felt concern, and sympathy to those who reached out to me. I can imagine - if your scenario is anything like mine - that this is scary, you feel nervous about accepting this as a panacea. Again, I cannot stress enough that I am not a medical doctor, I am not a speech pathologist, I am not an otolaryngologist, I am not a voice teacher; I cannot diagnosis, I cannot recommend treatment. I am just a singer, and willing to share my experience and thoughts.  Below are the questions and my responses to Christina who has reached out. I hope this will help Christina, and others who read this blog.

Christina consented to me responding in a blog post; Christina, if you're still out there, I am sorry for the delay - below is my response. All the very best to you:

Christina: I have scowered the internet, searching for information regarding the relation of a tongue tie and the quality of ones voice


Me: I was in the same scenario. There is a shameful paucity of information on this! So glad you found my blog, I hope that I can be at least comforting. I want to be clear that I can only share with you my experience, and it may or may not be unique to me. I recommend getting several opinions from different otolaryngologists, and voice teachers/coaches - seek professional guidance. 

Christina: I believe that I have a moderate tongue tie. I have neck/throat back tension, unable to relax my throat and tongue while singing, a clicking jaw that I find effortful to open completely, and forward neck pasture. It also feels like it takes quite a bit of effort to breathe through my diaphragm. 
When I sing, it always feels like my voice just cant get past my throat completely and my vocal folds just cannot relax to belt. I've had vocal instruction through my university. My vocal coach said I had great timbre and a powerful voice, but it seemed like I just couldn't project it in a stable manner, or like it was blocked. It thoroughly confused her. After pursuing a degree in Speech-Language Pathology, I became familiar with this term, but have not learned anything in regard to it's possible effects on singing. I think this tongue tie could be my culprit.

Me: Christina, thank you for being so brave to share this information, your experience, and your insight. Singing is a tricky activity, and I honestly believe very few people truly understand the mechanics of singing, as well as how the mechanics of singing are affect by human psychology, acoustics, and the individual proprioceptive bio-feedback of an individual. Furthermore, it is such a subjective field based mostly on what some one likes or doesn't like (yes I know it most subtle than that). While I believe singing should and can be "simple," I do not believe singing is "easy."

Christina: Do any of these issues sound like anything you have experienced pre-frenectomy? 

Me: Just for clarity I will want to identify the issues you mentioned: 
- Neck/throat back tension
- Unable to relax my throat and tongue while singing
- Clicking jaw that I find effortful to open completely
- Forward neck posture
- It takes quite a bit of effort to breathe through my diaphragm
- It always feels like my voice just cant get past my throat completely
- My vocal folds just cannot relax to belt.

Neck/throat back tension:
To be honest with you Christina, I notice neck and back tension now, since my surgery. It is possible that the tension was always there, and that the my tongue tie was obscuring, or masking what ever tension was in my neck, and now - as a result of the new mobility - I am able to identify those tensions. 

I have always had some throat tension, and the surgery has not changed that.

Unable to relax my throat and tongue while singing:
As I mentioned above, I have always had some throat tension; I notice it mostly with specific vowels and certain registers. My tongue could not do certain maneuvers being so severely tied, however I never noticed an inability to relax my tongue, as in: let it rest on the floor of my mouth behind my bottom teeth - as opposed to it being curled up in the back, for example.   

Clicking jaw that I find effortful to open completely:
I have a sever under-bite, but it does not prevent me from opening my jaw. I have a bit of TMJ, but I recommend Yoga-Tune-up (myofascial release) exercises.

Forward neck posture:
Again - To be honest with you Christina - I notice forward neck posture now, since my surgery. I have also started using a smart phone, and play up-right bass - it is possible that they are related. I think not, though.

It takes quite a bit of effort to breathe through my diaphragm:
I never noticed this in my pre- or post- surgery singing.

It always feels like my voice just cant get past my throat completely:
I have not noticed this particular issue. Any "stuck-ness" I have felt I still feel, and have not overcome. 

My vocal folds just cannot relax to belt:
I have not experienced this particular issue.

ChristinaDo you feel as if the frenectomy has made a positive difference is your vocal quality/capabilities

Me: I do not feel as if the frenectomy has made a positive difference in my vocal quality/capabilities. Honestly. It has not made a negative difference, to be clear. I wrote in my first entry, and I quoted myself above explaining "Language, and by extension singing, can be logically reduced to the function of three interrelated mechanisms: breath, phonation, articulation...[after recovering] I should have added if not maximum mobility of my articulators (tongue, teeth, lips and mandible.)" I do have added mobility in these areas. The procedure might have added a little bit of color to my voice but not anything truly noticeable to an outsider - but I can say that it has, more than anything else, left me with options for articulation. I can articulate, manipulate and choose different ways to form vowels and consonants. I can now roll my tongue with the tip of the tongue instead of the side. 

I recommend getting several opinions from different otolaryngologists, and voice teachers/coaches - seek professional guidance. There are many vocal centers around the country: NYU in New York, Boston has a great voice center.

I hope this has helped. Best of luck to you, and please do not hesitate to reach out if you believe I can be of any comfort or assistance. 

Thank you for reading,
Joe