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Oh hi hi, So it's still that bobby pin under the couch cushion. It's Ali Ward. We're back with part two of Laryngology. So if you are tuning in without part one, I don't know what to tell you, go to part one and then we'll see you in like an hour for this follow up featuring wall the wall questions from folks supporting the show at petrion dot com slash ologies. Also, thank you to everyone who rates the show and leaves reviews. I do read them all. Here's
a little fresh proof. Thank you Kate ted Mob who left the review. Been listening since twenty nineteen and it's still my favorite podcast. You've been with me through college pandemic and now through every relocation and long distance flight. Honored to be jammed in your ears. Thank you Kate ted Mon for that. Okay, let's move on Part two.
Thank you to everyone also who let me know well some docs may say like eh to the HPV vaccine after the age of twenty six, you can still request it and probably get it by and probably get it covered by insurance much later in life than that. If you want so, talk to your doctor you totally have my blessing. Also, those beats were made by Jason Scartmalia, thank you for making those. That was amazing. Okay, so get yourself a cup of warm tapwater and let's hear
your questions as I say them with my mouth. We'll cover whistle tones, Mariah, damage to your voice box, the lowest voices, throat singing, perfect pitch stress and voice cracks, and more with surgeon MD Icon and your new favorite laryngologist, doctor Ronda Alexander. Okay, let's start your questions with Gigi and first time question asker Chris Lipford's inquiries about, in Chris's words, what the heck is going on when people sing in the whistle register. I need to know everything,
please and thanks? Okay, I have these on my phone so many. Eric Kaye wants to know. Is it possible to make a sound outside of the human hearing range? Would we know? I don't know. I don't know. Do we need like a bat detector.
So we could detect that with specialized audio equipment. I don't think we've ever tried.
I don't know. I'll look it up. Maybe ultrasonic, who knows?
Huh?
Okay, So I checked into this and according to one BBC report, we can hear frequencies up to twenty killa hurts, but most human beings cannot shriek higher than three killer hurts unless you're Mariah Carey singing her nineteen ninety one ear splitting single emotions so good. So that was from the nineteen ninety one VMA's which experts say was her highest recorded note at a G sharp seven I think, which would be three point three killer hertz? Is that
like dolphin range? Almost? I checked in, and those marine mammal friends of ours can whistle at three point five to ten killer herts. And actually, in looking that range up, I stumbled across an absolute VENN diagram of this aside, which was a twenty twenty one TikTok of Mariah in the ocean singing a whistle tone to a dolphin who seems to react with some kind of surprise maybe glee. I shouldn't anthropomorphize, but speaking dolphin Mariah and setting world records.
But then along came Georgia Brown, which is a stage name for an Italian Brazilian singer who was able to best Mariah and hit a G ten note. So I'm gonna play it. If you have really sensitive ears, just turn down your volume for a second or skip ahead fifteen seconds because it is bonkers you've like, So that would be around a five point five killhertz, like mid dolphin range. So if you're carpooling with dolphins, they loved it.
But those are the highest of highs. There's got to be a low there is, and its name is Tim. Tim Storms, an American country crooner, can sing eight octaves below the lowest piano key, making a sound that is less than a single parts point one eighty nine parts to be exact. So we can't even hear it, but we can fuel the vibrations. And of course I don't have a recording of that because again we can't hear it. But here's an example of Tim's just casual, everyday, non record breaking singing.
The low.
Room.
One of the top comments on that YouTube video is thanks this dislodged my kidney stones. Now, of course, our hearing can change over time, but what happens to our voices over the whole course of our lives? So many of you had this question, including Virginia Bruce, Hannah Lapham, Lana Schuster, Celia Bell, Andrea Crane, Marriage Snowlander first time question askers Laura Roser and Cocoon Soso and Courtney Kay wanted to know are their strategies to prevent our voices from aging?
So to reduce the impact of aging on the voice, stay hydrated, take good care of your voice. Again those three rules. No cell phone outdoors, no yelling, no whispering, And if your voice is in trouble for more than about ten days to two weeks, come see somebody who can talk to you about options.
I need a doctor. I really love this question, Delaney, jen A, Greg Wallach, Bennett Gerber, Jade Walker wanted to know, in Jade's words, voice breaks, what are they? And Bennett asked why does my voice still crack? And then also jen A and Delaney want to know why does being nervous make our voices shake? Like when you watch a ted talk and you can tell someone's nervous a little warribly. What's happening when our voice cracks?
Okay, So there's two different kinds of cracks that I'm hearing in these questions. One is the crack that happens when you haven't made the switch from your chest voice to your head voice, or the falsetto So if you're trying to sing with full power at a note that's outside of what your voicebox is physically able to do. It's gonna be like it's gonna say no, gonna sit down like an angry dog and say no. And that's
when you get the haha while you're trying to sing. Now, the effect that you see when someone's doing a public speaking event, when they're having nerves that's coming from adrenaline or epinephrin, that's coursing through the body. Because all of our threats are now mental and psychological largely instead of physical, our body perceives danger the same way. So there's no difference between I'm about to be interviewed by Ali Ward
and I'm being chased by a tiger. Right, So your body's nervous system again, that's sympathetic nervous system is like, all right, gang, we're in danger.
Everybody get pumped.
Let's do it.
Kidneys, shut off, blood vessels to the to the outside parts.
Clamp down.
We don't want to bleed to death.
Heart.
Let's go to the big muscles in the in the in the close part of the arm, and in the leg. Because we're either gonna run or we're gonna kick a doubles, right, And so that adrenaline feeling is going to make your voice box just a little bit shakier because your breathing is.
More erratic, and that's the power.
There you go the lesson stuck.
And then is there anything a person can do?
What I did before you came was I sat still and I did some breathing exercises to help myself settle in. One of them is box breathing. I love this one very much, where you pick the number and you count in breath hold out, breath hold for whatever that number is.
So in the beginning I usually start with like a three count, and then as I get more relaxed, I can get to a five count because I can hold my breath that long, and those breath holdings are going to activate the balancing system, the power sympathetic system to calm you down.
So deep breathing does work neurologically, it does. Yeah, It's so funny because it's like, if you are freaking out a little bit, it seems so difficult to sit down and have a deep breath even though you know it's going to help. Yeah, same thing as like if you're depressed. If you can get up and walk, it's probably gonna make you feel better. Yeah, but you're like, it's the hardest.
Yeah, the activation energy to do the thing is the hardest part.
Yeah, activation energy, executive function anyone. So we have a three part series on ADHD from February twenty twenty two with doctor Russell brand come again. Oh my god, what the fuck? Russell brand is not his name. His name is Russell Barkley. Russell Brandt is the British guy with the hair that looks like it smells like knag Champa who was married to Katie Perry. Not an evil version, but just you know, Russell Barkley. I had to go step out of the audio booth and look that up
on my phone. I've recently given up caffeine. Let's get back to it, Like I was saying, we have a three part series on ADHD from February twenty two for you, and yes, I will link that in the show notes to make it easier because I get it. I see you. I'm one of you. Speaking of patron, Jasmine Quassa asked, why can I always tell the other person on the
line is also black like me? I know that race is a construct with no biological basis, and that accents and dialects are the things that can be reliably associated with race. And I know that this is a sticky question, they write, but is there something about ancestral origin that can affect the quality of the voice, just like the eye shape and hair textures and how they vary across the planet. So I looked into this and I found a few papers such as do African Americans really have
lower voices? Pitch? Gender and ethnicity in Memphis and another one titled variation in global and intonational pitch settings among Black and White speakers of Southern American English. Guests who wrotem none other than twenty eighteen phonology guest doctor Nicole Holliday, who has been on the show and whom we love so. One of the points that she makes in her research is that aave African American vernacular English sees more pitch variation.
And I texted doctor Alexander between the Part one of the Part two episodes about this question, and she said, sometimes we are tricked. These intonations and flavors in the voice are learned, and often we put on the affectations we think that the audience or other person will connect to best. She continued, I've had at least three accents throughout my life, but I've been the same person the whole time. And she ended that with a heart emoji
because she's the best. Also, we have a melanology episode coming up about race an biology and skin pigment and so much good stuff with doctor Tina Lisisi. So that's coming out in a few weeks, So hang on tight
for that because we'll address that very question. And on the note of pitch being acquired or biological specs, OWL and Tristan de Brunner asked about the sociology between fem and mask voices, and Gabe Nuth said, sometimes someone speaks and I'm surprised by the way their voice sounds, so I often wonder why I even had that expectation in the first place. They were not alone.
R J.
Deutsch said, ask about gay voice, please and thank you, and Alive said, also, mommy voice, is it really an evolutionary thing that sparked human language? You know, speaking in a register that's higher. Red Cedar also said, I've heard rumors that some deep voice guys are totally faking it. And that the gay voice might be more natural. Do you ever have patients who are trying to modify the way they sound for cultural reasons?
Absolutely?
Yeah.
And overall the umbrella term for that is affectations, okay. And so the quote gay voice is about signaling in grouping when you're with your people, right and to find your people, and it can be a way of determining very quickly who is for or not for you with
all of the vocal affectations. And so if you are a vocal fry kind of a talker, people who are irritated are gonna they're gonna gravitate away from you, and you're going to keep people around you who are your in group if you need the or if you're if you're putting on or exaggerating the gay voice as people do call it, that also signals this is who I am. I'm comfortable with who I am, and if you're not, that is your problem, not mine.
M h.
And oh, we just had that theahnose where that's an affectation. The documentary exposed that wasn't her voice. She was up there on the dead stages and such talk at all like this. And then when you catch her aside question, she would talk in her more natural voice. But there are connotations of power vulnerability in group belonging, all of which can be signaled with the voice, And so we're
all doing it. My voice that I'm talking with to you now signals in group, to the family I was born into, because this is around where my mom talked, and so like, this is what I grew up hearing as a woman's voice, and so when mine comes out this way, that's fine. Now. Sometimes maybe if I'm a little excited, or if we're having a very femi time, my pitch might go up a little bit and I might be talking up here. But this is my relaxed
register right here. I probably even did it during this recordings run.
You listen back, you're gonna have to hear it.
Yeah, Like a range of your own pitch is also normal because the voice is an emotional experience also, And so yeah, when I'm super excited, when my mets are killing it and we make the playoffs, my.
Pitch goes a higher. I get excited.
And when things are a little eh, yeah, maybe I'm a little bit down here when I'm giving maybe some disappointing news or I don't want to talk about the thing. I might be down here, but that entire range is natural for me. If it's taking a lot of work, I wouldn't recommend it, because again, then you're putting too much tension on the voice box. If you ever feel pain either in the neck or in the throat when you're speaking, that's an indication for a medical exam immediately.
What about baby talk?
When we see something cute, why does it goes up.
And is attached with the violence called cute aggression? Yes, so that I think is more cultural, it's not physiological. But gosh darn it if babies don't respond to those high pitches, Gosh darn it if they don't love it, and so we do it more.
And just a side note, we side noted about this in the Touthology or Squid episode with doctor Sarah McNaulty. But if something adorable makes you want to destroy a vase or kick your couch, this is indeed what Yale
researchers have studied and dubbed cute aggression. And one hypothesis is that the brain simply cannot deal with that much positive stimulation at once and turn some of it into the opposite, like a negative emotion, which for most people ends up being aggression or screaming or squealing or slapping themselves about the face. But what if you squeal in
the presence of a baby? Do they like it? I don't know, I asked the fourth mentioned called the Internet, and it pointed me toward the twenty seventeen Current Biology study titled mothers consistently alter their unique vocal fingerprints when communicating with infants And yes, parents raise the pitch of their voice around babies across so many cultures and languages.
Even monkeys do it, and scientists think that the exaggerated speech patterns can maybe help babies pick up on communication faster. But I also think that when we see something cute, what happens is there's a variety of ghosts in the room who also see the cute thing, and since they can get away with a lot of weird shit, the ghosts experience that cute aggression and then they try to choke us, and then it compresses our resonators and our larynx,
making us squeal. And that theory isn't proven, but it is correct. So patrons, Sedoni s and Maddy East wanted to know if you're with child, why your voice might sound different to you, And the reason is because it is different. Have you ever seen a pregnant person's feet. A lot of the body swells up and the vocal cords just do not have a get out of swelling free pass here, folks. So that's what's going on. Wacky huh, now,
Earl of gramblecan and Patron David wanted to know. In David's words, am I correct that some health issues can be diagnosed by speech? If so? Has that work, doctor Alexander?
That's how so there are signs that we can hear in the voice. There is a certain category of neurologic voice disorders that are attached to things that go throughout the whole body. Among them includes like Parkinson's disease. The Parkinson's voice tends to be very low in volume, so very quiet and also a little bit garbled or jumbled because they're not moving their lips and face as well. They're resonators and articulators as well, so sometimes we can
get an inkling that way. There are some autoimmune diseases that show up in the voicebox because they make deposits or changes in the shape of the voicebox or even narrow part of the breathing passage, so that'll give us
a hint. And then there are also some nerve diseases of the voice box themselves that I can those of us who are experienced with it, we can begin to diagnose it just on the story and listening to the person's voice, which is one of the tensions of having a voice practice is the person's coming to me with a voice problem or concern and then I ask them to talk. And so they often will come with a family member who wants to talk for them, and I
have to tell them. I know this is a loving attempt to make this easier for them, but me hearing their voice is a part of my diagnostic process. And so as much as you can tell me your story, and when you cannot anymore, will go to your reliable, loving helper. And I always frame them that way as a support, like, I know you're not trying to ruin this, but when they can't tell their own story, we will
absolutely come to you. And I will come to you for any details you think they missed, because the sick person is going to miss things pretty often. So yeah, we have to hear the voice to diagnose the voice.
But let's move on to something more critical, like when your roommate goes to Spain for three weeks and comes back with an accent. Patrons Amy Vagallen, Savannah Maguire, Afa Schaeffer, Jesse Hurlbert, and Jacqueline Pushman asks in Jacqueline's words, do accents have an impact on voice boxes or the other
way around. A lot of people asked about accents and what do they have an impact on voice boxes or do they play a role or is that completely just affectation and that is something our brain is doing.
So that's going to be articulators. Again, the way that we sound, the way that we shape the sound with our mouth, throat, lips, tongue, teeth. Accents are particular lips, tongue, teeth. And it has to do with the fact that when you're young and learning language, your primary language or languages that you get when you're a kid, train how your mouth, lips, tongue,
and teeth move when you're making language. And so if there are some sounds that if you never practiced doing them, it's hard for you to do it when you're an adult.
Oh for sure, so many folks I will listen to Inside Here we Go, Ap Miranda Halsey, Vincent, Meghan Duffy, Aril Van san Emmettwald, Shakira Alahi, Julia Cherka, Mark Hewlett, mccorndog A Bob's Burgers fan, You, Kylie Peerless, down Tween, Rachel Garvey's, Patti Bergman's Beeck's Owl, Meriti Snowlander, Connie Brooks, Julie s Bradley and first time askers Ashley Rivers, Wendy Sue Grover and Louise Combate want to know what happens when you are losing your voice? Where does it go?
Rachel asked if it's normal to be hoarse after shouting or cheering at events. I recently went to Disneyland and screamed my face off, and then my episode that came out that week, I sounded like I was. I should be in the hospital.
That's right. So that's right, young lady. So when you lose your voice, it is because we have lost the ability for the vocal folds to do their vibration, and that can happen from swelling or from new stiffness, something like a blood vessel breaking. So shouting in particular, can put blood vessels at risk in the voice box to break and when well, let's talk about the structure of
the vocal cords. So they've got a lining what we call epithelium, and then just under that is a special jelly layer called the superficial lamin appropria, and that jelly layer is what lets the skin, the epithelium, the mucosa, the lining vibrate to make the sound. While the rest of the vocal fold is changing positions to breathe and speak. This very thin vibration is what's really making the sound.
And so if that gets stiffened by swelling or an injury from a blood vessel being broken, or from chronic aggressive use, then that is the vibrus. Since the vibration is the source of the voice, part of the source of the voice. When the vibration stops, then you get no sound or reduced sound, or reduce reliability of this
because they can't do their normal work. So oftentimes I'll think about like if you buy a very expensive violin and you know how to play it really well, and then somebody puts a wet paper towel on the strings, it's not going to sound good. And that's what happens when we've got a lot of mucus down there, or if somebody puts their hand on the strings, that can be like what the swelling and stiffness are You're not going to get good sound of that violin either.
Wow. And do you think if a person who is screaming on a roller coaster or let's say the Mets win, is there a possibility for like broken blood vessels in there that just need a minute?
Yeah, So this is one of the few times that I do encourage vocal rests when we have a broken blood vessel, which is you have to just let that, you have to ride that out, write it out. And that's real vocal rest, which is like you talk if it's an emergency, like a kid's going to get hit by a car, or someone's going to get burned by fire, and for almost everything else, you want to be silent.
Right, what about crying? Patron Delaney asked, when you're about to cry, why does talking we're trying to talk open the floodgates. And other patrons with this question included our emotionally honest friends Jen, a snarky mermaid multi nine eighty seven Connie E Karringer, Hirfna and the wonderful Greg Wallach, who asked about being for klemped. Does crying mess up our vocal cords?
So crying itself?
Know?
The sobbing though, sob because the sobbing is a mode of modified cough, and so it's yeah, and so it's doing the same trauma to the voice box. So cry quietly.
Yeah, I mean, not that we've cried it all the last couple of months, not at all, or even today totally. It's been out great three years, great, great couple of years. We've been doing great. Yeah. What about did I ask you about burping already? No? Patrons said Shiragane wanted to know why do burps sound the way they do? It would be nicer to have more of a pleasant sound
for off gassing. That last part of the question was more of a comment, but I hear you, is burping just coming from a completely different passageway or why are burps so guttural?
So burping is coming from the esophagus and stomach, So that's air that you shouldn't have swallowed in the first place, making its way out before it becomes a guess Uese emission from blue yes, and so it's socially unacceptable, but better for you than if it makes its way all the way through and you can get lots of discomfort in the intestines. And so it's just that air getting organized and sending itself back up.
And it's bypassing the larynx completely because it's a different tube.
So they are neighbors and they share a foyer.
The foyer that they.
Share is the mouth and the upper part of the throat, what we call the pharynx, and then they divide into the trachea, which is underneath the larynx, and the esophagus, which is for food stuffs and liquids.
How loud can someone burp? It's a good question that no one needs to know. But one hundred and twelve decibels that's the world record, which is about as loud as a rock concert. And I listened to a recording of that and it made me involuntarily ritch, So I'm not putting it in. But speaking of which, how does acid reflux mess up your larynx exactly? Well, your beautiful lips are the doorway to the alimentary canal, which is a long, fleshy pool noodle tube that's made up of
your esophagus and your stomach. You're intestines, your colon, and finally your beautiful little butthole, which is only one sphincter
along that whole journey. Did you hear in your mouth as a sphincter and you have them all the way down like one way doors you have in aesoftgeal sphincter that's a polite barrier between your stomach and your throat, and sometimes it's just a little lax directionally and your stomach acid does kind of like an unannounced backtrack drop in to be like hi, and your throat and your throat is like no, I don't appreciate the visit, and it responds with a sore throat and an irritated voice box.
So how do you avoid this? Experts say, don't wear tight clothing, Maybe consider sleeping in a recliner, which doctor Alexander has done, and talk to a doc about some lifestyle or maybe dietary changes too, but do not suffer with it in silence. Now, what if one of your lifestyle changes is taking up throat singing, which is using the vocal cords and the resonator of the larynx and parts of your lips and jaw to produce a few
different notes at a time. What a hobby. So many cultures do practice this, from parts of Central Asia, like the region north of Mongolia called Tuba, which has developed this continuous circular breathing to sing different notes. It's an aren't known as hume, and they developed it to replicate and then pay reverence to nature. But there are also groups from Japan and Italy and Peru and Indian and
South Africa, China all over the practice throat singing. There are Alaskan Inuit groups that throat sing to lull their babies to sleep, but unshockingly, they were banned from throat singing by religious colonist missionaries who thought that the art sounded satanic. But a few elders preserve the technique and they've been able to pass it along to future generations.
But many patrons wanted to know what is going on here, For example Aaron Gunderson, Chris Curious Bubbery, Michael McLeod Sonia Bird, Sarah King, Emilio, Donnellye Raimos and Nicole Peruzzi and first time question asker is Sherry Denhy and Crystal Simon's So many folks wanted to know about throat singing. Sarah King says, throat music. Tell me how they do it? Please? Does it hurt like Tibetan monks and stuff? Chris Curious asked, what's happening in the voice box? And my brother in
law does throat singing. Shout out to the lovely and talented Kyle Sleeper of Whitefish Montanai and he does not sound human when he does it. What's going on?
So we naturally use our larryings, our true vocal folds as vibrator under certain training. And that's what throat singing
is is very specific training. They're using other vibrators, so other parts of the throat are doing more intense vibration than you and I are trained to do, and so they're able to make multiple sounds at the same time, and also a sound that has a totally different shape, because if you're vibrating some of your resonators instead of just your primary vibrator, then we get a whole different sound.
So training is key for that.
M Yeah, and that's another one. I'm impressed with your brother in law, because that's another thing where if you don't get it early, I don't understand how. I don't understand how you learned that at like thirty.
I asked him for tips and he sent me this video the dogs.
Are going crazy. But I think advice would be, as you're relaxing and as you're vibrating your vocal cords down here, it shouldn't hurt if you're if it's less cookie.
Monster, which would be like, hmmm, it's less that.
It's a little bit lower down and it's a little more relaxed.
Who Also, I was like, Kyle Sleeper, my brother, can I tell people that you're cool and happen to be single? And he said no, And then I was like, but ologize are the best and he was like, I mean, so Kyle Sleeper on Instagram just say Dad says, Hi, Okay, as long as we are tossing out my recommendations, we're going to hear about a few sponsors of ologies coming up who make it possible for us to donate to
a cause of doctor Alexander's choosing. And that's once again 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 the disparities in our communities. So thank you doctor Alexander for doing the show and for pointing us for the Laryngology Education Foundation Health Equity Grant program. Will link them in the show notes, and thank you to these sponsors for making the donation possible.
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Be a antomagt bugger on alu the hearten near the hullah, the hymen a heckol ah ersin it where uraslonsela dani the tain knew those shoes that would kill nag at their hoop la hula, humperodes on udor orlonse is face that gones through Tasha, Tapa, Sierra Nashka, august nav Is Fiugo more hey rick hi a punk ie is called rila a on tudoros or raslanza. If we realed this in the hearn?
Okay, where were we? We were throat singing. So for more throat singing tunes, you can look up performances by Tuvin Throat Singing Ensemble Alash. You can seek out throat singing groups on whatever your favorite music app is, or you can buy music, buy smaller artists on sites like band camp, and look for local indigenous performers that you
can support. So jam it in your brain. Okay. More questions Christine Parker, Graham, Jen Logan, Jesse Rose, Jasmine Fassa, Tanya Emilio, and LeAnn Murray Lean longtime listener, first time question asker, and ask as a singer, I'm curious what's actually happening when a vibrato happens? And is their truth to what their teacher said about always being really hydrated? For singers, always p clear thing is what they heard, But all these folks wanted to know what is vibrato.
Yeah, so vibrato is an additional layer that we put on top where we are gently varying the resonator. So that would be like if you had maybe a flexible piano where you could squeeze it in and out. That would change the frequency in a different way than changing the actual tone that's being struck. And so vibrato you'll see when you watch the voice the neck of someone who's singing with vibrato, you'll see the whole voice box
moving often. And so that is doing some subtle changes to the shape of the resonating cavity, and that's what's changing it. That's what that's what vibrato comes from.
Pee and clear.
It is probably a little bit overachieving, but the more hydration that's available in your body, the more your body can distribute it to the places that need it. And so I would say definitely drink wh you're thirsty, drink a little ahead of being thirsty, and don't cross your singing teacher.
Can you learn vibrato or is it just like some people can use those muscles, some can't.
Oh, so it's something that I can be taught, and just in my practice, I spend a lot of time taking my singers out of it because the way that our machine works to do the imaging of the voice box, we need you to make a single frequency for the machine to work, and so they naturally want to give me all of this and really, I want this a flat tone, and their brains are so focused on making the kind of theatrical sound that lets them be as
long as possible. My I don't need it to be that long, but I needed to make one frequency, please for this machine to work. Stay with me, kid, Yeah.
So a few machines that are an ologist of this ILK might employ are videostrobolaryngoscopy or a laryngeal electromiography. And what they'll do they'll hook you up to it and then they'll maybe make you pronounce those words. And if you can't pronounce them, then they're like your normals. Those are very big words. That's not true. But what if
your voice really though, isn't fine. We covered gender affirming vocal surgeries and therapies in Part one too, but many people asked about just repairing vocal core damage and voice box transplants. And just tune ups. So I'm looking at you Kelsey Simpson, Patrick W. Shan and Ryan, Emily Okerland, Kathleen Daling, Jesse Dragon, Courtney Peterson, don Ewald, Ellen Voss, Nance, Kay Clark, Elia Myers, Paulina Nisheva, Katie Munez, and Patti Bergman.
And first time question askers Adam Silk, emmett Wald and Arianna Laro, who asked voice surgeries what sort of black magic is that? And in this specific case, I think it would technically be be black girl magic, but I'll let the voice surgeon speak to the other questions. What about damaging or repairing a voice boxe somethin host of other people want to know after being damaged, will your voice box repair itself or will you just have to
live with the damage forever? Or are there surgeries to repair it?
So that very much depends on the nature of the injury. So if the injury was something like they were in a car accident and the voice box the cartilage is actually broken, that's going to need medical help. If it is a phono trauma from the way that they use the voice that can be coached often, but sometimes there are parts of that that need surgery is to like a cyst or a polyp. We often will end up
needing surgery. There's a thing called the pseudocyst that we will often treat with anti reflux medication and also good habits against reflux. Get our recliner, guys. But there also can be injuries from medical care that then we have to come behind and fix, so breathing tubes in the throat intubation. Sometimes if there's an emergency like a car accident or you know, Heaven forbid, some kind of medical emergency, that's what we call out in the field, not in
the hospital, not in a doctor's office. The emergency medical technicians are doing their best and so they're just trying to have you alive when you get to us. And so some of the things that they may do with a breathing tube or a feeding tube may do some bumps and bruises of the voice box, and we're here to help rescue that. So contact your local leryngologists for some help.
And with stroke victims, is it the articulators that need to be retrained or have lost some of their functional.
So often with stroke survivors, it is what we call dysarthria, so dis means bad or wrong, and arthria is shaping, so they're going to have oftentimes problems moving the lips, tongue, cheeks, face, and so they're not shaping the sound well. And so again the exam is, yes, I'm looking at my patient, but I'm listening equally hard. Do they have a strong sound but the shape is garbled? Or can I just
not hear them at all? And so I have to disort out is it a problem in the mouth, Is it a problem of their ventures because that also not having teeth impacts the way your lips lie, and that'll change the sound of your speech, but not necessarily the voice. But then we also examine to see if there are
any issues with movement of the voice box itself. So one or more vocal cords can be paralyzed, not usually not from a stroke where the person has recovered, because you have to lose a lot of brain to get a vocal fold, not to move after a stroke, But we always examined to see what's happening.
And is there a lot of hope in terms of rehabilitation for that or is it a pretty tough road.
So kind of the trajectory of the rehabilitation and recovery goes along with the brain recovery. So getting good physical medicine and rehab treatment with physical therapy, occupational therapy, speech therapy are all going to be important as the rest of the body and brain recover. We can additionally get better strength and also making sure that the lungs are working well and they're well supported and they're breathing is organized.
Let's talk about tone and range. Some people want to know. Patron Natalie Prince and first time question asker Hope Shin asked, in Hope's words, why are some people naturally good at matching musical pitches i e. Singing while others aren't? And a flock of Songbird patrons such as Jade Walker, Iris Hutchings, Emily Layfield, Quinn Newman, and Tristandie Brenner wanted to know why it's harder for some folks to carry a tune?
Why do some people just not have, in David Schuster's words, the balance between innate ability and talent and formal training when it comes to range and understanding and replicating tone. There are do some people's resonators just not give them a good idea of what sound they're making.
Oh gosh, we can ask my dad. He's what we call wrong and strong when he's singing. It's precious now, but oh boy, was it embarrassing for about thirty years. So it's outside of the field of laryngology. But there is something in the brain where they're not hearing what they sound like to the rest of us. Yeah, and it's not even a matter of just like that tone difference that you know in the temporal bone or around
the temporal bone. They're just not getting it. And I don't know how they would survive in a language setup that is tonal. So like, don't be one of these people and be born to a Mandarin speaking family, because you're not going to be able to communicate.
Wow. I didn't even think about how different languages rely on tone so much more. Oh yeah, wow, oh yeah. So now onto a question that was just swelling up in the back of the throats of Melanie Lee McKenna, speed, Celia Bell, and me. What about tonsils? Ali Paul, first time question asker, says how much do tonsils affect the voice? Ali's been told I have huge consoles, but no doctor ever suggested they'd be removed. I had mine removed at twenty six.
I'm sorry, Oh god, I was.
It's terrible. Oh it's the worst, and it's a hate crime. It was. Yeah, I got I thought I was getting better, and then I ate a piece of chicken which got lodged in the hole in my throat.
I'm sorry.
It was not a good time.
No, Yeah, we have pretty high hurdles for adult ton selectomy. You really have to earn it because we know it's terrible.
You earned it, Oh I didn't.
And so ton selectomy can't affect the voice because it's changing the shape of your resonator. Again, like imagine you change the shape of the piano, it's gonna sound different. So if you have these big lumps in your throat and we take them out, you have to reorient yourself to how you're shaping your sound. And also it's just really a bad surgery. Yeah, we don't have a good time doing it. So that's why if your doctor is like, I don't think you ton select me, because it's because
we have seen how bad it is. I like to explain, it hurts. It hurts more than you think it hurts. In a way that I can't really explain women who have given birth without any medicine. Tell me to selected me.
Hurts really well as a person who has not had a baby and isn't going to. That makes me feel a little bit more like a badass.
Yeah, yeah, Tom, select me is right up there.
Yeah. I woke up crying, like, like, days and weeks into it. I woke up crying because it was just it like knives. It was just like I had constant knives. A few people want to know even wants to know what happened to Julie Andrews's voice. I guess she had surgery on her vocal chords. A lot of people want to know about Julie Andrews, So Avan asked what happened to Julie Andrews's voice? She had such incredible range. What
went wrong? They want to know? And Bee's knees and first time asker Sarah Rowe also wanted to know more about the sound of music and Mary Poppin' Star and the nineteen ninety seven vocal cord surgery she underwent. So she was doing Victor Victoria on Broadway and had some hoarseness from just the NonStop shows and had surgery to remove nodules she was told she had, although she actually didn't have nodules, and the needless surgery apparently destroyed her
singing voice forever. It resulted in a malpracticed lawsuit to the New York City hospital that performed the surgery. And she's now eighty seven and she hasn't regained her voice. But she spoke to Barbara Walters. A year or so into losing it.
I went in for a routine procedure that I was told would not be threatening to my vocal cords. And since then, as you know, and as everybody's been talking about, I've just been unable to sing.
That's a big question. Will Julie Andrews be able to sing again?
Well?
I can only say I hope. So do you have any thoughts about her?
Thoughts about Dame Julie Andrews. Number one, she's a queen, absolutely absolutely everything from Maria to Mary Poppins to the Queen of Genovia, full support and what happened we believe. Again, I'm not a privy to her medical care and we respect her privacy, but anytime we operate on the vocal folds, remember I describe that superficial lemon appropriate that special jelly layer. Every time we open it or operate into it, we are increasing the risk that there could be a scar
that develops. And if you scar or lose that SLP layer, you can't make that vibration. And that's why she can't sing the way she used to.
There must be a lot of grief, I imagine.
First, yes, you know singing, it is her identity. The voice for me, like the voice is, that's our that's our imprint, that's our real signature. These days, in particular, you know who's on the phone without the caller ID when you hear them. Infants know our voices. Infants know their mum from what they heard inside. So much emotion is attached to the voice, and so that's why, even though I do lots of voice surgeries, I don't take
it lightly. Every time we're operating on the voice, we're taking a risk that the voice will be different in a bad way when we're done. So we have specialized techniques. We do things like ad injection of liquid to float the lining away from that layer so that we can operate on it safely, and just all kinds of things to protect that voice because we haven't developed good replacement
for it yet. Yeah, there's lots of labs that are trying to engineer a replacement for super official lamin appropria, but it's just not there yet.
And remember from part one that the superficial lamina appropria is that layer right under the moist epithelial tissue, and the superficial lamin appropria covers the muscles of the vocal cords. And you do not want to fuck that up and ruin Julie Andrews's life, No, thank you. And also from part one, we covered Adams apples a little in an aside, but listener, Gabe Nuth is not a fan of getting
smacked in theirs. And other folks had questions. Lila mancad Ira Gray Deny Dejournet and cass all wanted to know essentially like what's the deal with Adams apples? And then last, what's your question? I realized we're about to ask what about Atom's apples? Some people want to know why does it hurt so bad when you get clotheslined on the atom's apple like ugh? And then also surgeries for reduction of that does that affect the voice or is that just all kind of a just bulk of cartilage.
So getting a closeline injury to that area hurts because it's supposed to hurt because you're not supposed to do that. No, but it's it's again, it's that flexible, the soft the cartilage, it'll flex, but it can also break. So if you're having pain, please seek medical attention. That's number one. And then when it comes to reducing the prominence of it, that is a part of our gender affirming surgery protocols
that we can do. We make small incisions up under the chin, and we use special instruments to shave that area down so that it's smoother and easier to either camouflage with makeup or just not obvious at all. And we kind of set the surgery up so that we can watch the voice box at the same time to make sure that we're not entering because it shouldn't affect the voice. We affect the voice for our fems in other ways with voice rehab or with the endoscopic through
the natural whole surgery to shorten the vocal folds. But when we're shaving down the Adams apple, our goal is not to change the voice.
So let's get to a critical question. Patron Jessica Janssen asked why can I not sing? While Alexandra Cattoul asked why can't I sing? Antonio Clark wanted to know can anyone learn to sing? Or are some of us just hopeless cases that should keep it to the shower. Likewise, Hester Dingle inquired can one learn to sing nicely? Or am I forever doomed to sound like a squawking cockatoo. Grace Strain, Jolan Bloom, Pepita Lee, t Scott glib Erica Perryandre celest Russo and Meredith snow land Or all had
similar questions. But I'm gonna put it in the first person because I'm also ashamed and desperate. Do I have hope as a singer? My husband got me vocal lessons because we once were in a car on the road trip and he was like, what's a class you would want to take that scares you? And I was like, oh, a singing class. I'm terrified. But I've always wanted to sing, and because of COVID, I've put it off now for like a year, and also because I'm scared. Do I have hope?
So I would say unequivocally yes, okay, appreciate that. And the reason for that is that singing is not always about what comes out m hm, but where it's coming from. So if the sound that comes out of your mouth came from joying in your heart, then you're already a success.
Thank you. I'm going to form a band with your dad.
It's gonna be rough for the rest of us.
We're just gonna do it. It's do us all the time for that other than me and your dad singing. Hardest thing about your job, hardest thing about being a laryngologist anything.
I would say the hardest things about being a laryngologist include sometimes having to tell people they have cancer fuck yeah, and having a surgical non success for getting out one of those airway tubes, and just having to tell them flat out what we tried didn't work and I'm sorry, and not so hard, but occasionally hard is that sometimes, like medicine is one of these things where you walk into a room with a stranger and they ask you a bunch of personal questions, and then some of my
patients they tell me really really bad truths, like about their life or their situation and to be able to balance like my human heart and give them encouragement and also do the medical diagnostic work I have to do, because sometimes I just want to like go down the rabbit hole with them, you know, like whether it's oh, I'm here because I survived an abusive situation and I did have an injury to my voice box, and you know,
what can we do to make it better? All the way to like, oh, I'm back, I'm trying to stop smoking, but I'm just out from incarceration. But I've got this great job. And for me to be able to be present and encouraging and neutral in their lives and be like, well, thank you for sharing that. You know that's not something you can share with everyone, and I thank you for
trusting me with your truth. It's a real responsibility to be authentically here and present with patients so they can tell us the truth and we can get to the root of the matter. So it's sometimes hard, but it's also a privilege to be just that trusted. It can be tough, but we're trying to show up for our patients as real people. So sometimes your doc is having a bad day. Sometimes you're having a bad day, So we want to offer our patients grace, and we hope
that you can offer us grace as well. And you know, I think sometimes people don't always remember that we may have just come from a room where we gave super super discouraging news to someone and then we're coming to something that's either good or mildly frustrating, and we work really hard internally to meet you where you are because for you, whatever we're talking about is serious and it doesn't really matter for that encounter that what I just came from. But your doctor is a person, and so
they have to make that transition. So I hope sometimes if we're like five, ten or even forty minutes late, that people can understand that sometimes the person with cancers twenty minute appointment was not appropriate and I have to stay with them until we get through what they need to get through so that I can go and then tell you, no, you don't need a ton selectomy.
Yeah. Yeah, Oh, that's such a good perspective to give people, especially as you know, people who have recently lost people you know what those appointments are like. Oh yeah, you know, I'm so thankful for the other patients who did wait while I was in a room with my dad. You know, I'm sure you know that too. What about your favorite thing? What is it? What is it that just gets you out of bed?
So Top two is taking out someone's tracky asked me to and they get to have their natural voice with no yucky appliance. Those are their words. And restoring someone's ability to communicate. So getting them back their voice, whether it's with surgery, medicine, or rehab in collaboration with my speech language pathologists, just getting them back their confidence and
their spark. And I love when I can just be like, in the middle of the visit, I'll just go, do you know how much brighter you are than when you came here their first time? Do you feel different because I'm experiencing you differently? And then they go wait, yeah, yeah, and just like helping them identify that insight that the work that they invested in rehabilitating their voice is showing up in their life and the way that they just generally present.
Well, thank you for using your voice. I mean, this is a joy. You are an absolute joy. I'm using my voice to say I love you. I'm so glad that you do what you do well.
I'm so glad that you do what you do.
You're the best. Thank you for doing this. Thank you Ali for sad word. What a great about. So there it is, y'all. Part two asks smart surgeons, unsmart questions and follow doctor Rhonda Alexander at the links in the show notes on Twitter and Instagram. There's also a link to the Laryngology Education Foundation Health Equity Grant program. We are at ologies on Instagram and Twitter, and I'm at Ali Ward with one L on both and I'm on
TikTok at Ali underscore ologies if you're into that. Smologies are shorter, filth free episodes of the show that are classroom safe, so you can find those at aliward dot com Smologies. Those are linked in the show notes. Thank you see Rodriguez Thomas and Mercedes Maitland for editing those ologies. Merch is available at ologiesmarch dot com. There are hats, there are shirts, totes, stickers more. Thank you to Aaron Talbert for adminting Theologies podcast Facebook group with assists from
Bonnie Dutch and Shannon feltis. Thank you every person supporting at patreon dot com slash Ologies. Emily White of the Wordery makes professional transcripts and Caleb Patten bleeps them. Those are up at our website at aliward dot com. Slash ologies, dash extras linked in the show notes. Noel Dilworth does all of our scheduling and so much more. Susan Hale handles the merch and a million other things. Kelly R. Dwyer works at our website and she can make yours too.
Nick Thorburn wrote and performed the theme music. Jared Sleeper is both handsome and an assistant editor on this episode, and huge thanks to Lady of the North Canadian and lead editor Mercedes Maitland of Maitland Audio. I wonder and a joy she is. And if you stick around until the end of the episode, I reward you with a confession. And this week it's that it's during snake and time. People.
It seems like once a year I'd get the rare pleasure of sticking a velgrow tipped wire that I got for seven dollars down my shower drain and then just birthing from the muck something that looks like the child of a squirrel, and a sock covered in hair, a jellyfish made out of hair. It's disgusting. And I love it. I love it. Let me tell you, let me tell
you some all right. I never ever want you to look up reviews for something called a drain snake or a drain weasel on say Amazon, because if you click on those customer ratings and reviews and you scroll down and then you look at the gallery of customer images, never do that. I did it. I did it because I wanted to see. I wanted to see what clomes out of other people's drains.
I need to see you so gross, a disgusting goblin gene, and I just needed to see what else comes out of people's dread.
Oh it's catharsis and it's horror. And it's no longer a secret now you know.
Ooh okay, byebye, Sorry.
I'm gonna put in a plug to get your gardessan, get your HPV boy girler in between, get your hp be scene boy girler in between.
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