Oh Hi, it's her Bobby Pin under the couch cushion. Ali Ward and listen. If you're new around here, we usually do not throw so many two parters your way at once, but this and the Dreams episode both just really deserve them. And we had nearly four hundred questions for this one. So yes, a two parter it is. Also, this is an ologist I was just thrilled to meet after having a patron by the name of doctor Jessica Randolph write in to say please, this ologist is a brilliant,
hilarious surgeon who works on voices. Have her on so a voice surgeon, yes, practicing in this field since two thousand and eight and specializing in voice disorders and airway issues. An expert. So I happened to be in New York and I got myself to the Bronx to meet up with this MD and fellow of the American College of Surgeons who's the director of the Division of Laryngology, ODO, Rhino Laryngology and Head and Next Surgery at Montfiore Einstein
Medical Center. And we met up in the lobby. We stayed masked and we ducked into a small conference room and I learned so much about the voice, and also that we have a lot in common, and that I as a person have grown and I've changed. And I'm leaving the word mucus unbleeped in this episode. I've bleeped it in past episodes because i just can't deal. It gags me out, but I'm living it in one thing
that does not gag me out. Our patrons, thank you for joining at patreon dot com, slash ologies and for submitting questions for the show. Thank you to everyone in ologies, merch Wearing it ologiesmirch dot com has things. Thank you to everyone who rates and subscribes and leads reviews for me to read. Here's one this week to prove that
I read them all. It's from Bess Sarah, who wrote that this show's quirky sense of humor mixed with science is the perfect blend of fun and facts and it's great for everyone, kids too, if they're used to a little cursing, which reminds me that smologies episodes those are trimmed of my filth, and they're shorter and their classroom safe.
So that's Whatsmology's episodes are for. They're for kids. Anyway, Onto the Interview, Part one of it, where we will use our voices to discuss your voices, plus Austin's Elvis drawl, hormones, deep voices, squeaky ones, Tips for singers, free life hacks that will make your skin glow and your brain work better, vocal feminization, surgery, turning back time, anatomy you may not know you have, and more, And then come back next week for whistle Tones Mariah, damage to your voice, box,
throat singing perfect, pitch stress and voice cracks, and more with your new favorite laryngologist, doctor Rohnda Alexander. Oh my god. Okay, so here's your mic. There. They're stage mics, so they're super hardy, So just kind of get up in it, especially since we're masked.
I'm up in the mic. I'm up in the mic.
Perfect, Let me see, let me check your levels.
Recovering theater kid, recovering theater kid, person who loves Broadway, person who sings the soundtrack to six in the shower and hasn't seen it yet and that's her biggest embarrassment.
Literally, My first question doctor, is do you sing so done?
Amazing?
Wonderful?
One first question ask if you can say your first and last name in your pronounce Yes.
First name Ronda, are O Nda, last name Alexander. My pronouns are she her?
No extra h in that Ronda, Nope.
I am the daughter of Ronald and so I am our o Nda.
Oh do any other doctors in your family? How do you become a surgeon? That is just something that I'm cannot even fathom.
It requires. There is a delightful mix of ignorance and perseverance and encouragement, those three together. So it is one of those things where if you knew the full scope of the sacrifice and discomfort that it would be, you might not do it. But the pathway for me began way back in the eighties with first grade, where I was very, very fortunate to be in a scholastic environment where my teachers and my peers and my family all
just really encouraged academic talent. Definitely not a situation where that was not a cultural fit. They were like, oh, this is this is great. We love this. We love when you bring home these report cards with all straight lines. We love it very much. Good job kid. And then you know, high school, I went to university down in Louisiana. I went to Zaba University of Louisiana, a historically black college,
and then I went to medical school. And at that point now I am twenty twenty five, about to turn twenty six when I finished medical school, and I have secured a very coveted spot in the very competitive specialty of odo laryngology, head and next surgery. There are only about two hundred and twenty jobs in the country when you finish medical school. It's gone up a little bit. But the time when I was coming out to twenty was.
It, Wow, two hundred and twenty openings every year to join the established ten to twelve thousand laryngologists in the US. And for context, I look this up. Every year the NBA hires about sixty new players, so your chances are only like four times better than getting into the NBA. But doctor Ronda Alexander is at the top of her field, so.
And I was able to secure a position actually right here. I trained at this same place where I work. Now, you did, I did.
But you were in Houston for a while as well.
Yes, I worked down there for a decade. So after residency, which is five years of pushing your body and brain to the limits, being awake as long as thirty hours or so back when I did it, and finding safety in that and sacrifice and enjoy all of those things together. Then I did a one year FELLA in laryngology which had a bent towards NEU laryngology, so nerve based disorders
of the head and neck and voice box. And then I left New York and I went down to Houston, and I practiced there for over twelve years before coming back to New York.
And you've said so many ologies in the last minute.
So our training that first five years is comprehensive odorhino laryngology,
head and neck surgery. So that's everything from taking tonsils out of a small child with breathing problems or putting ear tubes in so they can hear well, to taking care of cancers of the thyroid or mouth or tongue, to taking care of allergies and polyps in the nose or heaven forbid, also there can be cancers in there that we take care of as well, all the way to cosmetic things like using botox to soften wrinkles and lines fillers to plump up the face and make it
even younger looking, and then my part, which is voice airway swallowing disorder.
We do that.
Did I leave anyone out? Hearing? That's right, so otology and neurootology, that's going to be the specialties of hearing and balance and restoring that. So we have a broad umbrella and our field in general is about how we interact with the world. So we're in charge of hearing, taste, smell, the way your face looks, and the way your voice sounds. So we're really all about how you interact with your environment.
Oh my gosh, what about now? What would you say? A lot of your work now is.
So my work now concentrates in two main areas, and that is voice health and airway health. So voice health is going to be are there injuries or developmental problems in the voice box, anatomy or the way that the person uses it that are getting in the way of them being able to present themselves authentically, confidently and in
a healthful way. And then a lot of I do airway disorders, So that's going to be people who have had an injury or inflammation or surgery on the voice box that has led to a narrow place in particular, And so we do lots of reconstructions and things to help get them so they can live a tube free life.
So most of those folks are going to have a tracheostomy, which is an artificial whole from the skin down to the windpipe or trachea, and so finding ways to get that out because most people just don't want them.
Is There are a part of your job too that deals with why someone can sing or not sing, In particular me, why can't I sing?
So that ends up being in vocology or phoneology. So that's going to be the province of professional singing teachers and coaches. So we work oftentimes in collaboration with them and another discipline called speech language pathology, and together I'm in charge of the anatomy and the medical health. The singing teacher is in charge of technique and maybe style, and the speech language pathologists also overlaps with technique and
also breathing health and reducing things like coughing. And they do a lot of coaching on things like reflex habits to collaborate with us as well. And you sing, I've been known to sing.
Sing did not have any did performance have any influence in which field you went into?
So I think it did earlier than I originally remembered. It definitely played a role in medical school where the patient's problems made sense to me when everyone else was like, who cares if they're missing a half step? And I was like, that makes a difference between whether they get a role or not, and if they don't get that role, that's whether they eat or not. And so like for me, it was a very practical thing, even though it's esoteric and high level and people think, oh, it's only on Broadway,
But same for teachers, same for professional parents. If you can't use your voice with your child, are you able to do your job effectively? No, So everyone who uses their voice as a part of their job is a professional voice user as I consider them. They may not be performance voice users, but they are professional voice users. So heaven forbid to to if Ali gets a voice disorder, which I've heard you have, You've had colds and whatnot, and thought through it done it's pad anyway, lady, It's true.
But like, if you can't do your job without your voice, you're a professional voice user and you deserve the best voice health.
And you mentioned a half step, and I have no idea what that tho. Well musically, okay, is is that like an octave or.
So it's one sixteenth of an octave?
Okay?
Active is eight notes and a half step would be in between.
Okay. See already learning so many things. Obviously I'm not a singer. It's okay, But how does a person make words and sounds like? I don't even know what a voice box is? Is that the Adam's apple or what do we call a voicebox?
So the larynx, which the Adam's apple is a part that you can feel, is composed of a few paired cartilages. Cartilage is kind of that scrunchy version of bones, squishy, flexible. So the single unpaired cartilages are the thyroid cartilage. And that's the one that in people who have had testosterone driven puberty, they're going to get a big prominence that comes out. We call that the thyroid prominence. And that's the Adam's apple.
But just a side note, you can also call it a prominentia laryngia if you're fancy. But don't feel bad about ditching Adam in the Adam's apple name, because since it was likely just a bad translation from some Hebrew term meaning the swellings of a man. But if neither an Adam's apple or a prominentia laryngia are just not striking a chord for you, just call your throat cartilage a goozle, and yes, I will use it. In a sample sentence provided by an online dictionary quote, they served
real good cold beer in those days. It almost froze your goozle pipes. But it pains me to tell you that goozle is a term that actually has its dance card pretty filled with meanings, because, according to another word origin site, a goozle can be any substance with the consistency of thickened gravy, not necessarily going down your goozle, but moving on moving downward.
Below that is another cartilage called the crichoid cartilage, and that one is like the strong beam of the airway, keeping it nice and open for all the parts that need to move about. And now paired cartilages are going to be the a retinoids. These are like sailboats, sail shaped cartilages that do a lot of the moving. The
vocal cords are actually strung from them. Oh, they have a complicated series of pulleys muscles make them move in several different directions to allow the voice box to achieve closure and opening.
And your vocal cords are pretty much right where your head meets your neck, in the front, just below the hyoid bone. What the fuck is a hyoid bone? No one ever told me I had this bone. It's in the front of my neck. It's floating in my neck. A hyoid apparently means you shaped in Greek. And this thing does look like a horse shoe or half a bread crust right under your jaw. Why didn't you tell me I had a floating toast bone that anchors my
tongue to my skeleton. Anyway, that bone is just upstairs from the vocal cords.
So where does the voice come from? It comes from three different parts. The lungs of the power source they send up the air. The vocal folds do the vibrating. That's the base sound, and then the resonators are the throat, the mouth, the lips, to tongue, the teeth, and that's how you shape the sound to be like you. So we'll often describe the act of vocal production that we are an instrument to. So in a piano you have
the body of the piano, that's your resonator. The power comes from when the hammer inside hits the strings, and you're the source when you're banging on the keys. And so similarly in us we have those same three things, a power source, a vibrator, and resonators.
So when people say that my voice is my instrument, they're not. They're they're not dicking around. That's real.
No, it's totally real. Yeah, absolutely, maybe my mom.
And what about different qualities of a voice over time? Obviously, if a kid calls you on the phone, you're like, I know, this is a kid, you know. And then if your grandpa calls you on the phone, it's gonna sound like your grandpa. So what is it about age that changes the quality of a voice.
So, yes, our voice box and our resonators change over the course of our lifespan. When we're young, everything's tiny, and so you'll hear people say children have small voices. It's because they do. Their resonating system is small, and they tend to just be up here. They also haven't gone through any of the hormonal changes which might which will when puberty hits impact the shape of the voice
box and the vocal folds themselves. We actually have hormone sensitive tissues inside of our voice box, and depending upon which hormones we get more of during puberty, the vocal folds make it's thicker and wider, and then the voice box stretches as the thyroid cartilage changes. For those folks who get testosterone proberty, and.
Then if you are, let's say, going through menopause or if you are taking testosterone for you know, gender affirming therapy, how does that change what's going on there as well?
So for my fems who are going through it, durynus down there is associated with dryness up here, really, so your overall moisture levels are going to change as you approach I like to think of that as like the last puberty, as I head into it myself.
Agonizing and agonizing surprise, exciting.
Life is exciting, That's one way. Yeah, So which hormones you're getting are going to influence everything from the texture of your mucus to the thickness of the tissue itself, which kinds of proteins and carbohydrates. It's to be tending to secrete, how thick your vibration layers are going to be all of those are going to be impacted by the hormones that you're experiencing. Wow, And to go back
to the whole lifespan. As we age the same way, our pectorial may muscles and our arm muscles begin to droop and what we call atrophy or lose the body. The vocal folds can do that as well, So older voices will tend to be maybe a little thinner, you may describe it. We call it esthenic because they've lost
muscle bulk. And we have things that we can do to help folks who are in that situation, who still need to use their voice because they may still be working, or just to feel more confident as well.
Yeah, you know, my dad was really sick recently. My dad just passed away. But as he was getting sicker, he was losing a lot of weight and his voice changed a lot, And I never was sure what that was about. And it's interesting to think that his muscles were maybe atrophine.
But also like loss of power. Yeah, that's another thing we have in common. It was my mom in June, my Aloma. Really yeah, no, absolutely, absolutely, we're like little twinkies, the two of us.
Holy shit, up, So sorry. How long was she sick for?
Oh? So she actually was diagnosed when I was a chief resident, so back in two thousand and seven. So we've had we had fifteen bonus years.
Yeah, we had ten with my dad. I'm so sorry.
We're just together in heart.
So to learn more about this cancer I hate, you can listen to the hematology episode on Blood and for my Loma patients, the uncut hematology file on my website has a lot of extra questions I asked for patients and that'll be linked in the show notes. And an extra donation for this episode will go to myloma dot org in memory of doctor Alexander's mom, the late and wonderful Reverend Barbara Alexander. I'm so sorry you lost her though.
Oh yeah, it's had it totally. Had a therapy appointment about this morning. So you know, we just we keep doing stuff.
I've got one on Friday.
Yeah yeah, yeah. It's the rest of our lives and we just we live it.
I'm sure she was so proud of you.
Oh yeah, she's a character.
And my dad are somewhere right now, just like going, hey nice.
She's probably bosting him around too. Yeah, yeah, I'll take it. Yeah, because Grandpad was gentle.
Yes, he was a very Grandpad was a very gentle guy. It was it was interesting not to hear that, you know, as you get weaker and even if you're sick, or you're tired, or you know, is that something that people ever come to you wanting to turn back the clock on?
Absolutely?
Really yeah.
Yeah. They want to get their young, robust voice and the same way they want to get their young robust face. And hopefully we can get them to get their young robust hearing by just wearing the hearing aids. So we can do procedures either under general anesthesia full sleep, no pain, no memories, no moving, or under local anesthesia mild discomfort, with lots of coaching through the event that we that can actually just plump up the vocal cords with injections.
Wow, this is called a voice lift. Who knew, not me, but the gravelly, raspy the grip of time can be plumped up and then the song of youth returns, if that is what you want. And I watched some videos down the glottal hatch of people's vocal chords before and
after a voicelift. I don't know how to describe this delicately, but my first impression of it, it looked the atrophied older vocal folds looked kind of like a vadge that was open wide, and then the rejuvenated ones kind of look like of a gene that was caught midwink, kind of closed up. Speaking of voice and crotches and changes, we're gonna talk a lot more about puberty and gender and vocal matters later on in this episode.
Yeah, they can last anywhere from six weeks to around two years to some that are quasi permanent, but those are usually going to be understurgery because we have to do a little bit more work and you shouldn't be awake for that.
Yeah, yeah, that's a lot. I'm sure the recovery time is at least a few weeks, right.
Well, most of them, I get them talking within two days, and I just give them three rules. No whispering, because whispering is actually really bad for your voice box because you're putting a lot of pressure and squeezing to bank that quiet but strong voice. That was exhausting even just that. No talking on the cell phone outdoors because people forget that they're competing with the noise in the background, and
so they're actually talking louder than they think. And then the third rule is if you can't touch them, you can't talk to them. So no shouting through the house.
Wow, oh my gosh. Okay, now what about coughing. What is happening when you're coughing to your vocal cords? Is it chaos down there? It is?
It's misfortune. Absolutely. They are experiencing a forceful slamming shut followed by an air eruption. And so because we rarely
cough once, they're slamming together pretty hard. And we have seen people who just from a coughing disorder, whether it's pneumonia or unfortunately recently COVID being a coughing disorder, or from even if really hardcore throat clearing, where the banging together actually destroys part of the lining and puts them at risk for a thing called a granuloma, which is an irritation that grows and it kind of makes like a popcorn looking thing and stops your vocal cores from
closing really well. And it's a cycle because having it there is an irritant which makes you cough and coughing makes it worse, and it getting worse makes you cough, et cetera. Et cetera.
Is that how a cough from an illness can become chronic, Like even though you're not infectious or anymore, or you're not infected with say, you know, pneumonia or bronchitis, that cough becomes chronic from that irritation.
Chronic cough comes from a few different kinds of things. It can come from the after effects of an infection, like if you had a sinus or nose infection and it's dripping gross, that'll make your cough. But also there can be nerve based coughs cough from the original issue. But then also we kind of get into the habit of cough and it ties closely to throat clearing where we're all the time, and we actually have certain kinds of rehab where we basically teach you to ignore that stimulus,
to extinguish the stimulus. When you feel like you want a cough, you take a drink of water, or you do a different thing, or you say something, or you just let the air out gently. So instead of going they just go and let the air out so that they're not giving that irritating stimulus again so that we can help break the cycle of the coughing. She's got this incredibly grotesque throat clearing tick.
It's like.
It's like she's sticking for clams.
Well, what's happening with a cough drop?
So, cough drops are doing a couple of things. They often contain menthol, and menthol just kind of like opens up all the passages in the nose, does a little bit of shrinking of how much mucus you're making, so there's less irritant going on when you're breathing it in. It's also soothing and doucing some of the mucus in
the throat. And then the third part is you put any candy in your mouth, you're gonna make more saliva, and so you're getting wetter saliva instead of the thick MUCUSI one that the mental is drying up, and so your throat is just happy that you're getting a little bit more saliva to help soothe it.
Is that cool? Is it cool to have cough drops if you need them?
So they're okay, okay, I just want to like that's one of those things where it's like follow the package directions you shouldn't have a cough drop every hour on the hour for several days. That's like, okay, well, what's really going on here? And examine? Am I drinking enough water? When am I eating? And what am I eating? Am I eating a whole turkey dinner? And then laying straight down and giving myself reflex which is gonna burn my voice box? Oh hello, fast paced people who work in these jobs.
Yes, indeed, I mean, is there something that is better for reflex? Is it better to eat at like seven pm if you're going to bed at eleven and just give your body time to not burp up acid?
Right, So you're gonna transit the food that you put in your belly within three to four hours. And so I try to folks a window. You can eat almost whatever you want. Pay attention to your body and how it responds to different foods, but you want an empty belly and went into bedtime. So last food must be done for my beginners. I tell them two hours because they got to get in the habit and it's so hard. Where it used to there's always a snack at the side of the bed, there's cookies. I went to bed
with toast. I went to bed with the fruit. But especially if you have symptoms of cough, voice trouble, or specifically heartburn, you got to tighten it up empty belly. So really three hours I would love to see before you lay down at all. Now, going thinking back to like my medical school and residency days, if I got home at nine or ten pm, I'm not staying up till one because I have to get up the next morning at five. So that meant making modifications, which we
recommend to folks all the time. So I for years slept in a recliner. Oh if I was having a late day, so I would have my meal and I would have to go right to bed, and so I would just make sure I was at a little bit of an incline, give your head some support. And that's just a modification. Just like you would modify an exercise for your own health. You can modify the things you have to do. You don't always have to sleep in a bed.
I would never have thought of that as like a as a fix for that. You know there are because there have been times when I have come home with my purse still on and microwaved a frozen dinner it's been like this is the picture of like such a just a haggard career woman.
You know it's glamorous. We're both living glamorous sides.
What about does sleep apnea fall under your like surgical interventions at all or so?
In the broader umbrella fields sleep sleep surgery is also a part of odoran alaryngology head next surgery, and so there are surgeries that can be done to reduce the resistance in the nose and also to keep the tension in the tongue and throat at a level that keeps it open. Because sleep acne is really about collapse. Sometimes that's nerve based, sometimes it's bulk based. But regardless of weight bm I, whatever measure you want to choose, it can happen to anyone having that sleep apnea. So it's
the answer is not always just lose weight. Yeah, there are certain that you may need to be done to help reduce the resistance in the airway. Rarely we involve the voice box, but we can do that if they have a condition called Larringo Malaysia Space LA r y g O m A l a CIA Space for editing Loringo Malaysia Laaringo Malaysia is a condition where the voice box collapses under the pressures of breathing in and can
contribute to the sleep acnea. So we can make some modifications to help it stay open and more strong, but mostly for sleep acnea. My concern is again you're breathing against resistance. What happens the chest pressure goes down and the belly pressure sucks up more reflux. So folks who sleep acne is not treated also have more reflux symptoms very commonly.
So double whammy and not good whammies either one of them, but not all. Snoring is related to bulk in the throat and also, as we have discussed on this podcast, BMI is a very loose and kind of shady metric for determining body composition. It was invented by an Austrian astronomer was not even a medical doctor, but even a legit MD can tell you that. Of course BMI does not tell the whole story at all, and it's not
fair to bodybuilders or to me. The day after I have ramen, I'm like a juicy, salty sham wow of a person. But the condition lo Ringo Malaysia, which she mentioned, can also show up in babies who have floppier vocal cords, and it leads to something called strider or noisy breathing, which, out of all of the loud things that a tiny baby can do from either end of their little soft bodies, I never knew that just breathing could be a loud thing, these poor little babes. What should people do if they
have sleep at near their sleeping like shit? They feel like shit? They go to a doctor the doctor's leg just loose some weight and get back to me and it's not that's not the problem. Like, are there any diagnostic things that people should should make sure that they get checked out?
Yeah? So the gold standard testing to diagnose sleep apnea is what we call a polysum nogram or a sleep study, And those can sometimes you're done at home as a screen, or they can be done in a lab where we are checking what are your brainwaves doing to make sure you're a sleep and what stage of sleep you're in. They've got a little band around your chest to see
are you making the effort to breathe. They've got all kinds of heart monitors and blood oxygen monitors to see if you are getting air and then sometimes there'll be a little monitor that kind of is hanging out in the throat to see what the pressure is. And so obstructive sleep apnea, which is the kind that most folks have, is the kind where you're trying to breathe but there's a blockage, and so the sleep study is what's going
to diagnose it. And so if you specifically ask for a sleep study and your doctor will not refer you for that, unfortunately, I would say break up with that person because healthcare is about teamwork. Like I'm the content subject matter expert and you're the expert in your life, and so together we got to sort out what we can do to make your life better.
Who doesn't love to dump an asshole? So don't sleep on that good advice, Say goodbye, find someone better, cut banks, text a crush. We're all gonna die, doctor's orders. What is snoring then, because if clearing your throat and coughing is not good for your vocal cords, snoring's got to be bonkers because you sound like a muppet. It's just like it's the like, what is happening in there?
So snoring is a vibration, usually of the soft palate, the little hang down dingly the bell that we call the uvula.
I don't even know what that does.
So that is it's a part of the throat. We don't we don't really know why we have the hang down bit there, but it is. That part of the palette is a part of closing off the nose so when you swallow food doesn't go up your nose. But that part vibrating is usually what's going to give you snoring.
Really, the uvula vibrating.
Oh yeah, and the whole soft palette. Wow, yeah, yeah, yeah, it's bonkers.
If you want to know where is my so palette? Exactly, run your tongue along the roof of your mouth toward the back until it starts feeling squishy. There you go,
that's your soft palette. So snoring can happen when the root of your tongue and your soft palette kind of flappity flap onto the back of your throat, and so you're vibrating your airway by skimming air sometimes through your mouth because your mouth goes into the windpipe without having to do with that roadblock of that flappity flap palette.
But obstructive sleep apnea takes things a step further with these blockages that pause your breathing for seconds, sometimes in some people minutes at a time, holding your breath while you're asleep and you're gasping and snorting yourself awake for air so many times a night, Which is why that machine that forces air into your lungs but it looks like a space octopus is preferable to actually suffocating on your own throat meat. But your it's not doing damage to your vocal cords.
Not necessarily, but having untraded sleepna is just setting you out for a whole host of troubles. Yeah, and what.
About performers, opera singers, Shakespearean actors who are using their whole diaphragm, which to me, whenever someone is like, just use your diaphragm, I'm like, I don't really fully understand what that means. Is that just an expansion of your lungs. What's happening when people are projecting? Ah?
So, projecting is maximizing both the power source and your resonators and aiming them the right way for the audience, which is why, like when you're watching stage plays that are not miked, or when you're watching opera that's not miked. It's very unnatural because I'm singing to you about you, and I'm facing the other way towards the audience, because we have to aim the sound our resonator towards who we want to hear it. And since you're in the cast,
you already know what I'm saying. You don't need to hear it. The audience needs to hear it. So to understand your diaphragm better, We're gonna put one hand on your toumube tum right below your ribs and just take a natural breath, and what happens to your tum tum?
Thankfully, my tumtumb wasn't already distended with coleslaw or beans or anything.
What do you feel does it go in or out?
I feel like it goes out a little bit.
Yeah, so that's normal. The diaphragm is the muscle that separates your belly cavity with your guts in it, from your chest cavity, which has your lungs in your heart, and so in its relaxed state, that's breathing out exhaled when you breathe in that muscle because it's like a dome the muscle contracts so it gets smaller, and that actually pulls your chest cavity bigger. And so to do that, your tumtum actually should come out to make room for your guts to be that way, and so a good
breath has your tummy coming out. And that's why costume designers are really smart, because almost all of those gorgeous fem opera costumes have an on pure waist because their belly has to move. There is no hourglass shaped opera costume because you gotta breathe.
Wow, I never thought about that. Okay, So there's a difference between using your chest muscles to fill the upper part of your lungs versus expanding your belly with your diaphragm and having your diaphragm do the work to fill the lower lung too. And singers want to get as much air in so they can have more power and they can take fewer breaths too. But on the chill side, several studies are on top of it when it comes to researching the whys of that deep diaphormatic breathing and
how it switches your brain out of panic mode. And in one twenty nineteen Frontiers and psychology paper titled Pulmonary afferent activity patterns during slow deep breathing contribute to the neural induction of physiological relaxation. The authors note that recent evidence suggests that breathing at six breaths per minute promotes
behavioral relaxation. Hope we love that and barrel reflex resonance effects and appears to elicit resonant and coherent features in neuro mechanical interactions that optimize physiological function, as well as support the expression of slow cortical rhythms to induce a functional state of alert relaxation and via nose breathing, recruit hippocampal pathways to boost memory consolidation. I had to do
diaformatic breathing just to get through that sentence. But I know you don't know what that means, and that's okay, because neither do I. But guess how much it costs zero dollars. It's to feel more chill air. It's free. So deep belly breathing is not just for your sister's Lululemon obsessedro made. It also does science things that are great for the brain area. And yeah, it's why you don't see a lot of opera stars lacing their rib cages into bone filled sausage shapes like a lot of
period costumes, less their hearts. I mean, that's their hearts corsets.
I won't do it. I won't do it.
Nope. What about when let's say that you're a sing say you're a professional singer. I remember hearing like Adele having nodes, and it was the worst thing that a singer can ask for. What are those? And why does vocal rest help? So?
Vocal fold nodes or nodules fall under a category of voice box injury that we call phono trauma, or injuries that come from producing sound. It also includes things like polyps and cysts, all of which have to do with the part of the voice box. I gets the most of the energy delivered to it from the vibration effects, and nodes or nodules are on both sides, and they are kind of like a callous that forms. So I think about if you do manual labor, or if you
play a sport. When I was a kid, I played baseball, and so I had horrifying callouses after I had blisters because that's where all the force was going. Now I got good coaching, and my coach said, put on some batting.
Gloves, get yourself some gloves.
Right and are soft again. And so vocal fold nodules are often a sign of not having had enough good technical coaching, and you're kind of pushing through and so you're getting callouses instead of finding where your natural range is and having the right support again from your breath and from your resonators. So those are treated with therapy where we work to improve your technique. Almost never need surgery,
almost never need surgery. But also fem luringies sometimes just have a little bit of a shape like that, And so we've learned that they're not always a problem, not always a disease, not always a pathology. If we looked at a thousand femme lringies, we might see six hundred or so with kind of an hourglass shape where they meet early in the middle. And in maybe fifteen twenty years ago, we just said, oh my gosh, you have nodules. But if they don't have a problem with their voice,
they don't have nodules. Really, they have a fem voice.
Aha, what about surgeries to feminize a voice?
Yeah?
Is that shortening the width of the vocal cords.
So when we do feminizing voice surgeries, the goal is to increase the pitch. Right around two hundred cycles per second is the inflection point where we kind of culturally say, at least in the US, we say, this is a mask voice, this is a fem voice. And so we want to get our particular transpatients, we want to get them above two hundred so that their voice is concordant, similar in line with their physical presentation and their internal sensation.
So to do that, what we end up usually doing is shortening the length of the vocal fold so that that same power is going through a shorter space, so it has to vibrate faster, and so that takes the frequency higher. So shortening the voice box usually by about one third to half while maintaining breathing space, is what's going to get that pitch to go up.
That can help a lot with the dysphoria, with feeling like you're not sounding like you you feel absolutely yeah.
Misgendering is a psychologically harmful experience that isn't always even intentional. When you're in the drive through or on the phone, we make assessments based on that frequency, and you know, on a bad day, I get misgendered. But because overall I'm aligned and cys like I can throw that off one time, but if it's happening all day, all the time, it can wear on a person.
Yeah. So feminization surgery can address the length of the vocal folds themselves, but there are other factors in affirming a voice, and that can include the shape and the
depth of the larynx itself. And a twenty twenty paper titled Vocal Feminization for Transgender Women, Current Strategies and Patient Perspectives notes that the first voice feminization surgery may have been performed by the Catholic Church, which prohibited women from singing in services and instead performed castration on boys to preserve their child pitch for singing in the higher registers
in the Cystine Chapel. Not sure what the consent was back then, but either way, the voice box has a lot of androgen receptors, so the onset of puberty and a flood of testosterone means that the length and the thickness of the vocal chords increase, as does the diameter of the lynx. So think of a flute turning into a trombone. But if you're a person with ovaries but you have a hormonal condition that increases your testosterone, you
can also experience deepening of the voice. And if you're signed female at birth but are on testosterone, your voice box will likely respond to that extra testosterone and deepen your voice. But if you don't have access to testosterone injections or vocal feminization surgery, which can cost up to fifteen grand, there is the non invasive option of vocal therapy, and that's practicing and modulating your voice using your throat and tongue and vocal chords to change the pitch and
even the patterns of your voice. And I was doing some research and found an app called Eva that has video instructions and lessons in pitch and they have a tune tracker and exercises. For trans people who want to modulate their voice without hormones or surgery or just want to practice, there is this app called Eva. It costs around eighty bucks, but she within surgery will it stick?
Though?
I don't know? Why don't you ask Elvis or rather Austin Butler, or really just asked doctor Alexander about Austin Butler, which I did yesterday I texted her. I was like, hey, if a person were to say, train himself to speak like Elvis for a few years, could his voice get stuck like that? Or is it really more of a brain habit? And doctor Alexander wrote me right back. She was like, brain body habit, and the way we speak
is part anatomy and part learned. So sweet, Austin Butler could unteach himself his current voice, but we should ask ourselves, should he? And then she put a smiling emoji with a halo, So perhaps he spent so long learning the voice his muscles have really internalized those patterns. If you want a deeper voice with less effort, you could also just get a cold, which causes vocal fold inflammation and thickening.
But don't do that. No one needs it. And do you find that I'm always so interested that when we have a cold or we sound a little husky, we're like, ooh, I'm like Demi Moore, I'm sul trium whatever, Kathleen Turner. But obviously people who are a mask because of just internalized misogyny. Also just in general, being perceived as having a femme voice is almost like insulting it.
Is because femininity is an insult.
And how have femmes or people assigned female at birth responded to that subconsciously or consciously? A little something we talked about in the twenty eighteen Phonology episode with doctor Nicole Holiday, but you may have heard it on like countless reality programs, et cetera.
Oo, all right, vocal fry. We're gonna go there. Oh yeah, it's super controversial because vocal fry has been kind of like the straw Man argument for aging men hates young woman's voice on radio.
Yeah, something called vocal fry that is creeping into the speech patterns of young women.
Is there anything equivalent in men?
No, there isn't.
But there is harm that's coming to your voice because if you're not using enough air to support, then you're going to be doing a lot of that squeezing and you're putting yourself at more risk for the phono trauma, the injuries to the vocal fold from trying to push through. You would not try to keep running the marathon if you hadn't eaten anything the day before, And that's what
it is. If you're trying to talk without any air power, that's how you get into this zone with the fry, and it's literally asking the car to keep going with no gas. Just take a breath of people.
Ah okay, that's actually very very that's so good to know. Too much vocal fry, which is your vocal cords flapping a little more chaotically than rhythmically, could possibly damage them in the long term. Most doctors say it's probably not going to happen. And also, just today I saw the headline the doomsday clock reveals how close we are to
total annihilation. So I'm just going to urge you to worry about other things, especially if it's just because some guy farting into a leather recliner left a comment on your social media telling you that you sound like a valley girl. Just keep moving, babies. In the topic of sounding the way that we want to be perceived, obviously, if our whole face is a resonator in our neck, why do we sound so different on recordings than we are hearing day to day.
Ah So we both never see ourself and never hear ourself outside of a photograph or a recording, because when you're hearing your voice, you're hearing the vibrations up through your own head, and so you're not hearing what other people are hearing. You're not necessarily hearing that through the
entire mechanism of your ear until it's played back. And that's why it sounds foreign, because when you're talking and learning to talk, you're hearing actually the vibrations directly to your cochlea from your temporal bone inside your head, which is why you can hear yourself hum and it hasn't really gone anywhere, and we only ever see ourselves in mirror image, which that extremely disturbing phenomen on to those filters where they're like, this is how people see you.
I'm like, no, thanks, yeah, no, it's it's I'm like, who's that lady? Or does she look like a Picasso painting straight? Like you know what it's because it's like off, but it's ten percent off, Like what is that?
It's like Uncanny Valley with your own head.
That sucks me, But it's also you know, exploring that, Like listening to this episode is going to be an exploration of accepting myself the way others perceive me and hearing my voice the way others hear me because I rarely hear it.
Yeah, it's a trip for me every time. It's so difficult, even as someone who professionally uses their voice, and as someone who professionally uses their voice and is not so smart about it. I have a question about ice. I have a problem with ice that I love it too much, too much. I have an industrial ice machine in the garage because I was constantly running out the ice in
the freezer. Okay, And I also do some voice over work on the side, and it occurs to me that, like I'm in the booth drinking ice water, they can probably hear the ice clink, and that is probably super unprofessional. What is up with temperatures and what you're drinking? Is ice bad? Is hot coffee bad?
Like?
What are we doing to ourselves?
So the range of temperatures that don't cause you pain are all okay?
Okay.
Ice for some people is about the chewing okay, And for other people is about just getting the water in a more controlled way since it has to melt as opposed to just gulping down water. Also, when we give ourself any cold stimulus in the head and neck and in the mouth, it actually activates the calming part of our nervous system. So you may be oh, treating yourself
in a way that's very helpful. By putting cold in your mouth, it's going to slow your heart rate, it's going to slow your breathing, and so any jitters or nerves you have are going to be suppressed by your nervous system. It's the parasympathetic system.
Wow. So it's like, show me you have an anxiety disorder without showing me an anxiety sort having a big gulf And if you do, it's like, welcome to the club.
But we're all not doing fine.
Yeah, third year of a pandemic and reading headlines about the apocalypse anyone else but yes, I edited this episode during a rainstorm while drinking a thirty two ounce iced tea that was mostly just teed ice. There was so much ice. But next to that iced tea, I also had a mug of hot tea because I'm a chaotic little bitch like that.
And for other folks, like the super hot sensations are stimulating. It gets them going because warmer will tend to push you a little bit more towards the sympathetic the amped up body system in addition to the caffeine.
Does the cold water cause more mucous production or congestion, or does it freeze up your muscles and your larynx.
So it won't freeze the muscles, but it will tend to give you kind of a thicker mucus just because it has less energy in it, and so it's going to be an energy sink. It's going to take heat out of the body, and so that's endothermic reactions. Because I also really love I miss chemistry and math and all that stuff. So it's pulling energy and warmth out
of you. Whereas warmer things, particularly steam, as it's going from liquid to gas, it's a big energy jump, and so it has a lot more energy in it, and it's going to be able to thin the mucus secretions that are in your throat. So steaming is fantastic for the skin of the face. The voice box and the airways love it as well. So you know, everybody who does your nightly facial steaming your body is really pleased with that.
For more on steaming your yoni, you can see the gynecology and urology episodes. Friends. But of all the things you can do with your genitals, doctors report that exposing them to scalding hot gases should be at the bottom of your list.
So we want steam to be something that you can put on this thin skin of the inside of your wrists and it's comfortable. That's going to still be appropriate.
Do you have any hacks for if you don't have a like seventy five dollars facial steamer from ben Bath and beyond.
Yes, it's something that most of us who are housed are going to have. And it's a cup of hot water, legit. Like so, my folks, So we're here in the Bronx and this is of the sixty two counties in New York State. This is number sixty two in health outcomes and economic opportunities. And so I am not recommending go buy one hundred dollars thing to almost any of my patients.
And so I'm like, boil water on the stove, put it into a mug that is safe, Maybe wrap a towel around it and just hold it under your face and breathe it in. And that's a steamer.
Nice.
So if you're on the go, get a cup of just hot water from the deli and that's steaming too.
Oh wonderful. I'm going to start steaming my face. What about I used to drink a lot of your mamate because it is like legal drugs and it is so hardcore. I would drink a cup of your ramonte and be like, I'm going to go run a half marathon I've never run before, Like, I don't know what's in it. There's some catakins anyway. But I read that some studies correlated to people in South America who drink it having higher rates of esophageal cancer and throat cancer, and they determined
it was maybe the temperature of the water. Are there any things having to do with throat cancer that are we should or shouldn't be doing?
So I wouldn't put your mamate or hot things on that list. We've I mean, we've had millions of years of us drinking hot things because they've been important and useful, particularly in the in the edges and the higher latitudes. But the number one thing you shouldn't do to the throat to prevent cancer is inhale a thing that's on fire, got it. So, whether that's to back marijuana, any of the other things that people smoke, we don't want to be breathing in hot combusted on fire fumes into our
voice box. And because we know tobacco is the one that we've studied the most, and that one it can cause cancer from the lips all the way down to the tips of the lungs, and so we just don't want to get We want to stop kids from starting. As far as vaping is concerned, it's good as a transition to nothing as much as possible. The other big contributor to throat cancer kind of higher up around the tonsils in the back of the throat. It's going to be human papaloma virus. And so I'm going to put
in a plug to get your gardasil. Get your HPV vaccine, boy girl, or in between, get your HPV vaccine. I think I just made them a slogan.
You literally did.
I'm going to put in a plug to get your gardess, soe get your hpvvceine, boy girl, or in between, get your hp bvceine, boy girl, or in between.
I mean, because there are some places that girls in certain states were being dissuaded because they thought it would make them sexually active.
Yes, and if they.
Got a vaccine that can prevent cancer. No one who's ever had a paps mirror was I'm sure advocating for that, right.
There are some people in this country who are in systems of bondage which they did not actively choose, and a lot of their identity is wrapped up in it, and attachment to community is wrapped up in it, and it includes some harmful teachings that have come to them from people who even represent my same faith, and I get upset about it. But like the existence of apples does not mean you have to have an apple, so the existence of sex does not mean you have to
have sex. And so no amount of medical care is going to make you have sex before you are ready, and so at least it shouldn't. It shouldn't, and so protecting your child or yourself from a viral mediated cancer. The other activities come from conversation, not from an injection, not at all. And if an injection is enough to set your kid off doing anything, they were going to be doing it anyway. And so maybe it's time to examine the relationship and open up and have some talks
with them about what they're thinking and experiencing. Because no vaccine has ever made me do anything. And I just got a couple in the past couple of years, I didn't change much.
Yeah, and what a breakthrough to have that gardisil vaccine available because that's something that is so HPV is so prevalent in so many people. It can be transmitted in so many ways, that's right. And yeah, it can be lethal for people. So I know several people who have gotten cancer cervical and esophagal. Great news. If you are over nine years old, you can get this vaccine. If you're over twenty six, though, doctors are kind of like,
don't bother, you've probably already been exposed. But folks of all genders can be vaccinated. And if you've got a cervix and have the vaccine, you are seeing a seventy eight percent reduction in cervical cancer. Thank you very much. So ask your doctor and at the very least get your paths yearly. If you can't get the vaccine. Now, we're going to take a quick break. But when we're back, a free tip that will improve your life and your skin.
But first will donate some money to worthy causes. First toomiloma dot org, which has amazing resources for folks affected by this blood cancer. And that is in memory of
Reverend Barbara Alexander. And also a cause of theologists choosing this week is the Laryngology Education Foundation Health Equity Grant Program, which supports endeavors that increase understanding and awareness of how racial disparities impact laryngology and speech language pathology care in the US, specifically for patients of the black diaspora, and it supports initiatives that address these disparities in our communities.
So those donations were made possible by sponsors of the show. Okay, back into it. What about hot water lemon honey? What's that doing?
So again, the steam is the main actor in hot water honey soothes the top parts of the throat, but it's not ever going to touch the larynx in a healthy person because the larynx is the airway. And this is another fun tidbit about the lringopharyngeal complex. This upper throat area, it's the only part of the body we ask to do three things. Other parts to get two responsibilities. But this area needs to breathe, speak, and safely handle foods.
And so the foods go around the side, the air go downs, goes down the middle, so nothing you're drinking directly. Is ever going to go directly into your voice box if you're in a healthy state. If it does, that's a condition called aspiration, where the food and drink is going into the lung direction, and we end up treating that as well. Aspiration. Is anything going into the lung that would that's not.
Air, Yeah, anything which is pretty much you just want air in.
There, only air and some lightly humidified air. So we want it to be warm and moist like the lung likes it to be. And so that's actually one of the functions of your nose is to warm and moisten the air, which is why nose breathing is preferred, because the air has time to pick up all the energy and molecules and moisture. But yeah, anything that's not air or humidified air going into the airway is a no.
No, that's a no. Let's talk about Mariah Carey.
Oh, let's me me.
How does she do it? How does she make noises that some humans can't even hear?
Right, So the whistle tones which I'm going to say that she is the air. To Minnie Ripperton, who's Maya Rudolph's mom from SNL Fame, I did not know. Minnie Ripperton listened to the song loving You. Okay, it's easy because you're beautiful, and then she does those whistle tones also, right, Yeah, that's right. So most of us have at least three registers or form of the voice, so just basically we're usually using our chest voice when we go into what
we call falsetto. That's kind of the head voice, and that would be the difference between one two three and one two three. Like I went up in my falsetto, that's like lower lower pressure and I'm letting it just kind of resonate up higher. My vocal folds are tenser, and they're vibrating faster to do those higher pitches, and I'm not pushing and squeezing. I'm just letting it come out,
so it's naturally quieter, okay. And then the whistle tones are an entirely different thing where they've tightened the voice box so much and they've positioned the vocal folds in the right manner where they're doing a frequency that's just on a next level higher, and so then the resonators are really just shaping it, which is why when people are doing their whistle tones, they're usually just going to
do a single phoneme. It's usually just e or oh, because your articulators are focused on just getting really narrow and letting that sound out, and you can't do a lot of shaping of the sound because everything is squeezing to get it tight enough so that you can do those rapid vibrations at a high frequency that gets up into those whistle notes.
Nice pipes. By the way, do you watch the national anthem and are you like you got this? You got this? You got this? You know, because it's such a difficult thing to sing. Yeah, yeah, And it has to happen before every ball game, every you know what I mean, whenever anyone goes up there. I was like, you got this, you got this? Come on, you got this.
I mean, Fredgie did a great job.
No sad, just dance star spaying.
It was a choice. It was a bold choice, and I'm not going to leave a comment from my party recliner about it now.
So that is one of the most difficult songs because of the range of notes that it covers, and I just I wouldn't recommend it as an audition song for just about anything.
I have so many questions from listeners. Can I ask you one million, one million in two yes, we got them literally at present, three hundred and seventy seven questions. Not a big deal. Thank you, thank you. So that is why this is a blessed two parter. We will be back next week with so many answers to questions you'll be so glad patrons asked. But until then, take a big, deep belly breath or six and ask magnetic surgeons unsmart questions because your life will never be the same.
And you can find doctor Alexander at your Voice MD on Twitter or your Underscore Voice Underscore Physicians on Instagram and say hello there. We are at Ologies on Twitter and Instagram, and I'm Ali Ward on both with one L. I'm Ali Underscore Ologies on TikTok now say hello. You can join patron at patreon dot com slash Ologies, where we have discussion threads each week about the episode. I love to read your reactions and chime in. Ologies Merch
is available at ologiesmerch dot com. Thank you Susan Hale for managing that and so much else. Thank you Noel Dilworth for the scheduling. Aaron Talbert celebrates a birthday this week. Happy birthday, my sister friend. I love you forever. We have known each other since I was four and she admins Theologies podcast Facebook group with assists from Bonnie Dutch
and Shannon Feltis. Emily White makes our professional transcripts and Caleb Patten bleeps them, and Zegredriguez Thomas and Mercedes Maitland of My Gym Media work on Smologies kid friendly shorter episodes, and Kelly ar Dwyer makes the website. She can make yours too. Mark David Christiansen and Jarrett Sleeper did additional editing on this episode alongside lead editor Mercedes Maitland, who has her own Maitland Audio. You can check that out. Nick Thorburn did the music and he is in a
band called Islands. And if you stick around to the end of the episode, you know I tell you a secret this week. I'm gonna be real with you. I'm recording this from bed, and I've worked from bed all day and I don't know why I'm so tired. I'm
getting over not feeling great, still not feeling great. COVID tests are negative, that's good, but yeah, either way, I'm like missing a spark plug or two but a better secret is that Jarrett got falafel as he was driving back from the gym, and for four days our car smelled just ripe, just inexplicably so. And then at a stoplight, I reached under the driver's seat and I found a cold moist and a pretty sizable onion right under the seat.
It was like the size of an earthworm and sticky in that way, but stink here, and I was just so relieved. I've never been so relieved to touch something so smelly, and just to close that stinky chapter. But okay, enough out of my voice. I'll shut it for now. More voice boxes next week they'll come back.
Okay, bye, bye, Focus on your diaphram.
That was a diaphraend