On the list of things we can take for granted, our voice is high on that list. It’s something that’s just there, until it isn’t.
Dysphonia International has declared April 16th “World Voice Day.” I ran across the notice as I was looking for some corroborative information on a subject that’s often on my mind these days, not just in April, and I thought there’s an intersection here worth exploring.
https://dysphonia.org/world-voice-day/
My public persona is wrapped up with my voice, as a preacher in churches and as a public speaker in general. I am a tall male, which gives my voice a certain impact which I understand others don’t always have, but I have since my teens learned that I’ve had an ability to project and speak in public even in large gatherings and outdoors (thank you, Scouting!) which allows me to gather and direct groups of people to complete certain tasks.
Even my softer voiced interjections I’ve long been able to place into conversations by a measure of vocal control which could cut through some general confusion, or more bluntly, I’ve always been able to make myself heard, and not just by being the loudest . . . but for a long time I was that guy, as well.
In the fall and winter of 2015 I started having sinus infections, one after another. I’ve had multiple sinus surgeries over the years which probably set the stage for my chronic complications, but I’d always gotten over them. Being out in public and greeting folks after church, visiting hospitals and nursing homes and doing school programs, I’ve always gotten my fall flu shot and hand washed before it was cool, but sinus infections are one of those things you can’t always avoid, so I dealt with them.
By 2016 it was bad enough I went to my family physician and got antibiotics; they worked, to a degree, but within weeks the infection surged back. We went through a couple of treatment plans, and then a referral to an ENT as the sinus infections continued to recur . . . and my voice started to crack and choke and “jam up” more and more, even when the infection seemed at bay.
By the time I got to the specialist, he was able to knock down the sinus infection more completely, but my voice was constantly sounding strangled, sometimes choking off almost to a whisper. He asked me to sing “Mary Had a Little Lamb,” and as I’d learned already was oddly true, I could sing with volume and clarity without any problem, but as soon as I stopped singing, my speaking voice was back to being awkward and impaired.
“You have spasmodic dysphonia,” Dr. Tobin told me. I learned very quickly that it’s not terribly unusual, but very poorly understood, in large part because in the history of humankind not a single person is known to have died of spasmodic dysphonia or SD. So it doesn’t get the research money & laboratory attention that cancer or cardiac care does, understandably. But if you are a teacher or singer or . . . well, preacher, you have a major problem, something a bit more than an inconvenience, but spasmodic dysphonia is not even understood to be caused by overuse (we think) even though the majority of patients diagnosed with SD are those who make their living, basically, by talking. It’s suspected that those of us who need our voices on demand are just more likely to seek diagnosis and treatment.
Like me.
Again, much about SD is poorly understood, but the suspicion is that a serious infection and high fever can trigger what’s actually a neurological reaction. It’s not vocal cord damage, trust me. I’ve been scoped so many times they don’t even bother with the anesthetic spray when they put it down my throat, I’m used to it. My vocal cords look wonderful, I’m told, which is a nice thing to hear, I guess. Spasmodic dysphonia is not nodules or growths or strained throat muscles, though I understand why people think it might be. It’s been compared to a kind of Parkinson’s focused on the muscle group that controls the vocal cords, creating the breathy and choked affect you hear with SD.
Some people find relief, albeit for a period of time only, with Botox injections directly through your throat into those muscles. Yes, it’s as awful as it sounds. No, it didn’t help me. They tried twice in 2018, and I’m apparently in a 10% or less of people whose voice actually gets worse with the injections, so that’s not going to be my path moving forward.
What has helped is vocal therapy. Dr. Dawn Lowery is now retired, but the referral to her was a huge step forward for me. As we experimented with Botox injections, she also began instructing me on new methods of vocal control and voice management. After it became clear I needed to go in a different direction, she upped the exercises and direction of how I was going to have to work around and differently with my recalcitrant vocal cord muscles. I think it would be a bit of an exaggeration that I had to learn how to talk all over again . . . but not by much.
It is to Dr. Lowery’s credit that since 2019 most people think I’m “over” my spasmodic dysphonia. I’m back to where I was in early stages, outwardly at least, so I still find myself occasionally explaining to people I don’t have a cold, it’s not that I’m “choked up” as I’m trying to talk, that I’m okay as I work past the spasms that can still grab me by the throat and shake my voice.
Internally, I’ve come a long way in staying on guard and alert to the temptations of trying to talk like I always did, of falling back into casual vocalizations, my neck turned or head down as I say something to someone off to one side: that doesn’t work anymore. I know that, and I stop myself faster, start into an ineffective mode of speaking less often. What I’ve learned is to accept that my voice is impaired, I can’t “power through” an obstruction, and I need to use all my tools with care and focused attention. Turn towards the person I’m speaking to, lift my chin, physically control my throat muscles in ways I never consciously did before.
Along with the singing trick, it’s an almost diagnostic quirk of SD that I can still project fairly well. Speaking in a loud voice in a large room? That’s mostly okay, though it can still catch me if I get lazy. Outside in a windstorm? I have less underlying volume than I once did, but I still have more than most. It’s talking on the phone, or having a close-in, face-to-face conversation where volume is not your friend, where I feel the impact of SD the most. But Dr. Lowery’s tricks and techniques, the vocal control I’ve learned from her exercises, have helped me to control and even strengthen muscles which allow me to work past the dysphonia, and mostly speak without the other person hearing that I have a problem.
The reality is I still do, and apparently always will. If I am doing a preaching engagement, I have to be wary of singing hymns before the sermon, because while I can sing relatively well (not like I did before, but okay), it wears out or at least wears down those muscles, and I have less clear capacity to speak, especially when I want to intentionally soften down my delivery. Contrary to popular belief, not all sermons are best delivered at a constant bellow. But if I want to change up my delivery, singing too much before I speak is a risk I have to manage. I used to offer as a supply preacher to join the choir (everyone always needs another bass who can find the note), but I don’t do that anymore. I have to pick and choose.
And there’s something else I wanted to say last, but which is worth knowing about SD. To a very modest degree it hurts to speak, and to sing. It’s not a piercing pain, although if I let myself be sloppy and excessive in my voice management, it can get there. It’s just that to say or sing almost anything means within a few words or lines I will start to feel a discomfort, a sort of “hand around my throat” which slowly, steadily squeezes. When I slip in my control of the muscles, the hand will tighten up harder. Again, it’s not “pain” for the most part, but the hint of possible pain to come, a discomfort that means there’s no such thing as a casual statement, an offhanded aside for me. If I’m going to speak, and not choke up or feel my voice jam hard in my throat, I need to pause, collect myself, and think through what my neck and jaw and tongue and vocal muscles are going to do. I have to be intentional.
And it’s not something I’d be offended by if you were to think “that’s not all bad.” True. I’ve been used to speaking casually, but with control and a certain amount of command. My hope is I used that gift when I had it responsibly and well, but it’s true I could just have a thought and speak it and also count on it being heard. Now? I have to think about whether or not singing that now will impede my speaking later; if I have a thought I want to share in a meeting or room, I need to watch what I say and how I say it differently than I used to. It is not, at all, all bad. I have to be intentional.
Dr. Dawn Lowery was incredibly helpful in teaching me how to re-find my voice. For the most part, I can speak and use my voice to do most of what I once did. To speak softly to a series of people face-to-face is actually the hardest thing; if I had to spend all day having moderately lengthy phone conversations with people, I don’t think I could do that long-term. Two long phone conversations literally wear me out, vocally, and to some degree mentally. The work to manage my voice in a lower register is something I feel in my throat, and my overall sense of physical weariness after delivering a sermon or interpretive program is higher than it once was. I can do it, but I have to pace myself differently than I used to . . . and be more thankful for the less than I can do, not frustrated by the amount I can’t.
One valuable adjunct to Dr. Lowery’s counsel came from an unexpected source, and that’s what had me looking back a bit. It was just last week, seven years ago, that a friend arranged for me and Joyce to meet the singer Amy Grant before her concert here in Newark, Ohio. There were some complications in what had been intended originally, and we ended up escorted to the end of her band’s dinner in a room directly under the stage at the Midland Theatre.
We introduced ourselves to each other, exchanged pleasantries, and I was explaining my work as a minister in that community, then mentioned my struggles with vocal expression (not quite yet diagnosed as spasmodic dysphonia) and asked how she prepared her voice for a performance.
Well, Amy Grant had much to say on that subject, and we had little time. I fear we may have held up the concert a bit, but it was her show. She talked about her routines, her struggles at different points in her career with voice management, made some suggestions, and spoke very supportively of how it’s effort most people would never think of, around doing your work with your voice. She would have gone on, but the stage manager was getting increasingly insistent behind us, and we all walked up the stairs together, and after a final hug, we darted out a side door into the hall and made our way to our seats.
Just as we sat down, the lights came up, and Amy walked onto stage with the audience cheering as you’d expect. She waited until that faded, then said “Oh, and to the pastor and his wife I was just talking to, I wanted to say, sometimes when you’re getting ready to go on stage and speak or sing? You’ve gotta move your hips.” Which she did, to additional cheers. Then she added “I’m serious! You have to relax the body in order to relax your voice.” Looking right out into the lights where she thought we likely were, she said a bit more softly, but for the whole audience to hear, “Don’t forget that part. Where the hips go, the voice will follow.” Then she swung into her first song.
So I am blessed. To have Dr. Tobin, and his referral to Dr. Lowery for her skillful work; for the vocal therapy as well I got from Amy Grant. Finding my voice again required I learn how to work my vocal cord muscles differently, and it also made me learn how to relax my whole body a little more when I’m needing to work those throat muscles. Or, “where the hips go, the voice will follow.” I am thankful for the voice I still have.
This World Voice Day, this April, I hope you think about how you speak, when you speak, and can be thankful for the voice that you have. It may not be the tones or volume or even the platform you once had, but what voice you have and can use is worth being thankful for. Use it well, because it truly is a gift.
This was fascinating, Jeff. I'm sorry that you've had these struggles and congratulate you on your persistence in finding what relief you have. Wish we could talk in person; would be interesting to observe and to know more about your techniques. I wish you well in sustaining your voice, as you most always have valuable things to say.
Thank you so much for sharing - I will remember all of this sage advice :-) Dr. Dawn’s advice saved my voice years ago when I developed nodules and I still use her techniques today. Blessings to her and you and Ms. Grant and all who lift and share their voices!