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