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
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

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