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Gina Ellen Vocalist
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Hey guys, I was wondering if anyone could help.

I had a new student today that used to sing but during her pregnancy, completely lost her voice for a few months from the gas and air and her voice (and speaking voice) has never been the same since. Being a relatively young and inexperienced teacher I haven't come across this before.

She can keep pitch but her tone is very breathy. Usually I would start with some breathing exercises then move on to some adduction exercises starting with some glottal onsets to get the closure. I just want to make sure that this isn't going to damage anything. I've explained to her that obviously i'm not a doctor and can only do what I think will help.

So my question: has anyone come across this situation before and do you know exactly what has caused the lost voice and what muscles would have been affected?

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Did they put a tube down her throat? I know several people where that has been an issue. They put the tube down the throat and screw something up with the chords. One of her chords may not be working as it should. She should probably have it scoped.

Just what I've seen from others over the years.

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The voice gets very diffrent during pregnancy, and still is for à while after the pregnancy. I dont think it's serious, i think she should just Wait à while and it Will probably get back to normal

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Hey guys, I was wondering if anyone could help.

I had a new student today that used to sing but during her pregnancy, completely lost her voice for a few months from the gas and air and her voice (and speaking voice) has never been the same since. Being a relatively young and inexperienced teacher I haven't come across this before.

She can keep pitch but her tone is very breathy. Usually I would start with some breathing exercises then move on to some adduction exercises starting with some glottal onsets to get the closure. I just want to make sure that this isn't going to damage anything. I've explained to her that obviously i'm not a doctor and can only do what I think will help.

So my question: has anyone come across this situation before and do you know exactly what has caused the lost voice and what muscles would have been affected?

Gina Ellen: Yes, I have heard of it. If by 'gas and air' you mean that they entubated her for the delivery of the baby... I understand what you mean.

Entubation involves putting a tube through the glottis, between the vocal bands. This motion is not natural to the bands... it kind of pushes them apart from their middles, but without the normal motion of abduction which is controlled by the interarytenoid muscles.

This can lead to some mild bruising of the vocal bands, and a hesitation on the part of the person to fully adduct the bands post-procedure. THe bands very often recover very rapidly, but if the person has re-conceptualized their speaking voice to be breathy, they will continue to do that even when the bands are ready to fully adduct and resume normal phonation.

Put another way, your student learned to 'limp' vocally in response to the situation, and while the muscles are likely now ready to resume normal function, she still thinks she has to limp.

The exercises you have in mind are perfectly appropriate, and are excellent to use for an assessment of adduction function as well.

Personally, I like the 'very soft cough', or glottal click, as a starting point. The click is done with 1/2 breath, on the gesture of an inhale stopped midway, and with minimal subglottic pressure. You just want to hear the little pop that occurs with a tiny amount of breath opening the glottis from its fully-shut position. If she can do that at will, then it is perfectly fine to extend that to very soft glottal onsets. If she can do the glottal onset fairly readily, you should proceed right away to re-balancing the onset, and from there on to sustained vowels in the lower range, that is, below middle C.

Why the lower range? You want to learn if the muscles within the bands themselves (vocalis and TA) are responsive. The lower notes cause these muscles to shorten and thicken. Use a gutteral /ae/ (hat, cat, mat) for the exercises. If the tone is ugly, firm and bright, its a good sign. This can be encouraged by saying that these are 'vocal noises', and 'not singing' if she has an aesthetic aversion to them.

If all is well there, then transpose the exercise up a 6th, and repeat. Listen for the quality of the onset. If its rough, then the coordination may take a bit of time to return. If its a clear, instantaneous onset to a clear tone, then you can use sirens in both directions to reconnect and recoordinate.

Also, its important to note that preganncy and the birthing process changes a woman's experience of her body. How she feels 'support' will have changed.

I hope this is helpful.

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wow, thanks steven. I couldn't have asked for a more thorough and helpful answer.

I have used the soft cough/click with other students (i've been it before in another one of your posts) A great one for feeling that suspending the air or supporting too. They usually get it after a week or 2 and the only way I know how to describe it is to actually demonstrate it. Do you have any suggestions as to how I can explain how to do it. The intant reaction from students is 'how are you doing that?!'. Or is the best way just to keep attempting til I can tell them they have got it?

That sounds like the most likely thing that has caused her problem. That would also make sense that she mentioned she used to be able to sing really low notes but can now only go down to an F3 comfortably. She said she used to get a lot lower.

The support thing is an important point too. She teaches yoga and martial arts so isn't unaware of her diaphragm and can take low breaths with no problem. The concept of physically control the air does seem new though.

Thanks so much for taking the time for a detailed response, It has been very helpful

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I have used the soft cough/click with other students (i've been it before in another one of your posts) A great one for feeling that suspending the air or supporting too. They usually get it after a week or 2 and the only way I know how to describe it is to actually demonstrate it. Do you have any suggestions as to how I can explain how to do it. The intant reaction from students is 'how are you doing that?!'. Or is the best way just to keep attempting til I can tell them they have got it?

Gina Ellen: As much as I write about these things, doing a little demo is 10x faster.

However, there are other ways to teach it, even in written form:

The person lays down, back on the floor, knees bent so that the soles of the feet are flat on the floor.

A heavy book is put on the abdomen at the level of the navel.

The person inhales, and sees the book 'lifted'.

While the book remains lifted, the student does the 'soft cough' maneuver.

I hope this is helpful.

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That sounds like the most likely thing that has caused her problem. That would also make sense that she mentioned she used to be able to sing really low notes but can now only go down to an F3 comfortably. She said she used to get a lot lower.

When she says lower than F3, is that from her own vantage point or was it compared to some instrument in standard tuning?

The reason I ask is because there were times I thought I was sounding low and gravelly and in playback, it was nothing more than my voice being tired and a little "raspy" but still around C3. That is, the sensation in my head and my own body sense was that of something low and full but independent analysis proved something different. We cannot hear ourselves as others hear us.

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My advice is that you orient her to an ENT, and that you work in parallel with the diagnostics, if during the treatment she is allowed to sing.

Specially if a tube was used, as it was said. The condition of having a gap is not the same as an airy emission, it requires attention and will probably go away with speech therapy. The tube is not gentle on the folds, its really worth checking.

GL for you and for her.

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Steven- Thanks for that info, again, very helpful :)

rowns - yes, is was just her saying she used to be able to go lower. When we did a basic range check she could comfortably get to an F3 and said she used to get lower. That's a good perspective on it, thanks.

felipe - I did suggest this to her but she didn't seem keen?! it has been about 5 years since it happened. I think the best I can do is monitor the progress carefully. Thanks for the GL :)

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