Freshman voice student Lilly Bateh was excited to see what shape her vocal cords were in, despite the rigid scope that Richard McHugh, M.D., assistant professor of otolaryngology and co-director of the University of Alabama at Birmingham Voice Center, held in his hand.
Within a few seconds, and with little to no discomfort for Bateh, McHugh, a laryngologist with a specialty in voice, was looking at Bateh's healthy vocal cords as they were projected onto two screens in the room.
McHugh is trained to provide medical and surgical options and evaluation for voice problems and any other problems involving the larynx. He and fellow co-director Dan Phillips, Ed.D., a speech pathologist, are trained in the care of the professional voice. From trial lawyers to teachers and even people who work a drive-thru window, the Voice Center cares for people who cannot do their jobs without their voices.
This recent Saturday clinic, at which 11 students were examined, was part of an annual free screening the UAB Voice Center offers to students in the voice program, part of the UAB College of Arts and Sciences' Department of Music. The service is also offered to voice students at Samford University. Why would the Voice Center, part of the UAB School of Medicine, see voice students free on their days off? Because the screenings are an important way to help with the Voice Center's overall goal — to create a better environment for voice health and voice medicine throughout Alabama and the Southeast.
"These students are at the beginnings of their careers," McHugh said. "They certainly have amazing vocal training through their professors at UAB, really topnotch; but they are kids in some senses. They are young adults, still exploring their voices. So, if we can bring them in and use this wonderful method called video stroboscopy to evaluate their vocal folds as well as listen to their voices, and just do really what is essentially a quick screening, but very focused, we can identify problems."
Video stroboscopy can be performed with a flexible scope through the nose or a rigid scope through the mouth. The basic idea, McHugh says, is that the body brings the vocal folds together and apart while the lungs push air through the folds, and the resulting vibration creates a certain pitch — the higher the pitch, the faster the vibration. The video is made using a strobe light, linked to the pitch or vibration level by a sensor held to the neck. It blinks in relation to the pitch the person is putting out by holding a constant "eeee" sound. The light blinks, and it acts like a motion picture, showing a frame roughly every 30 seconds. The Voice Center also teaches its residents about stroboscopy.
It is really exceptional to have such a strong performing arts program that is also part of a comprehensive research university, with an internationally renowned medical center, says Patrick Evans, D.M., chair of the UAB Department of Music. This collaboration is a good introduction for students learning to care for their voices.
"A couple of times they found pathologies on students' vocal cords, which were then addressed," Evans said. "But students, most of whom have healthy vocal cords at this age, now have a video and audio recording of their cords healthy, so if they do have pathologies at some point in their musical careers or just in their lives, then they have a baseline against which to measure. That kind of collaboration has been especially good for our vocal students, but actually for all the students in the Department of Music."
Potentially any problems detected on the students' vocal cords can be worked on with their voice professors, and in rare cases they may require medical treatment. For instance, allergies might be a problem and may require treatment. Probably one in five people screened has some sort of problem, McHugh says.
Inflammation from voice overuse is another problem. As young adults stretched between vocal practices, and with many of them also in acting classes in the UAB Department of Theatre, they may go to a crowded cafeteria that is loud and raise their voices talking with friends. Students in the UAB Marching Blazers may yell their support on the field or courtside. They may also work in addition to classes and rehearsals. That means their vocal load over the long day can be amazingly large, McHugh says.
"In some cases this can lead to vocal nodules," McHugh said. "It can sound terrible, and singers always react and cringe when they hear the words vocal nodules. We try to not only characterize the nodules, but provide a means to give them hope that they can progress with a good career. Nodules usually mean they have to be more careful, and along with their vocal instructors, we teach them exactly what careful means."
Careful means not screaming or straining the voice, which can cause the nodules to enlarge.
"It creates basically little bumps; we consider them to be like little callouses on the mid-region of the vocal folds," he said. "When you produce voice, there is supposed to be a nice smooth wave, and these little bumps in the middle make the vibration a little aberrant, a little bit breathy. If you are going to yell, you might have to realize that that could cause the nodules to become more inflamed, and they could grow some, and if they grow, they might not shrink back down."
McHugh advises those who use their voices professionally to be careful in natural, everyday situations, such as when yelling or screaming at a football game. In addition, hydration, appropriate vocal technique, not smoking, and being sensitive to dryness or throat clearing or cough, as well as warming up before singing or using the voice and potentially warming down afterward, are important to vocal health.
If they ever have a professional career, singers must be careful with such things as meet-and-greets before and after shows, and how they prepare for the show.
"For instance, if there is no time for dinner, are they eating late at night? That could then lead to reflux, because if you are eating and then trying to sleep, reflux is another inflammatory condition that could cause further nodule problem," McHugh said. "So what we teach is really sort of a comprehensive vocal hygiene regimen and an understanding of how they have to take care of their voices."
Evans, who has sought McHugh's care himself when faced with illness and an important upcoming performance, says singing is both an art and a science, and many times students get the art part of it, how to develop their voices. However, he says, it is also important to know the mechanism of the voice, the tissues and musculature involved, how the breathing apparatus works, and how to take care of the vocal cords.
"It's not everywhere that students get the opportunity to have both their academic unit — the Department of Music, with voice professors Won Cho, Kristine Hurst-Wajszczuk and Paul Mosteller — working alongside someone like Dr. McHugh, in the same institution," Evans said. "Dr. McHugh has worked with our voice faculty, and he has come to our convocations and talked with our students about the importance of their vocal health. It's really important for everyone to hear."