Ted Mau, M.D., Ph.D.
Can you offer some tips for everyday voice care?
There are a few simple things. If you experience soreness or pain when you use your voice, you should back off and not keep pushing. For example, if you’re having a cold and you’ve lost your voice, that’s a really bad time to push your voice. Staying hydrated is also one of the basic elements of taking care of the vocal folds. Also, if there's a voice change that lasts for more than three or four weeks, then it would be reasonable to have someone take a look to make sure there’s nothing worrisome.
Is it true that whispering is harder on your voice than speaking?
Whispering is OK in principle. When you whisper, the vocal folds don’t touch each other. But when people try to whisper to replace their normal voice, they tend to push in order to be heard, and that takes a lot of hyperfunction from the muscles around the larynx to produce that forceful whisper. Because of that hyperfunction, a forced whisper is not a good behavior. A soft whisper is fine but often not very useful because people can’t hear you.
Is there training available in the proper way to use one’s voice?
Absolutely. Most of it involves the speaking voice – singers, especially the classically trained ones, know the good techniques for singing, but very few people are trained to speak. For people who talk a lot, including singers doing interviews or interacting with fans after concerts, or the aspiring opera singer who waitresses at night, the speaking voice is a huge component of their total voice-use burden. We help those people optimize the efficiency of their voice production. If they’re chronically inefficient, they’re using more tension in their larynx and pushing harder. That can lead to vocal fold damage.
How do you examine the larynx in an awake patient?
We do laryngoscopy, and that can be done in one of two ways. The more common way is with a tiny flexible scope that goes through the nose. The other way is with a rigid scope that goes into the mouth and sits on the tongue. With the rigid scope, 80 percent of people don’t need any local anesthesia because if patients position themselves correctly, the tip of the scope should not trigger the gag reflex.
If something is wrong with the vocal folds, does that always mean surgery?
Just because there’s something on the vocal folds doesn't mean it should be removed. Even though we’re a surgical specialty, there’s a huge behavioral component to treatment. For lesions induced by voice trauma, we address the cause of the trauma – in other words, what is the source of the voice overuse? Some of the changes we see on the vocal folds are reversible through behavioral changes.
Can you tell me about your surgical techniques?
The two big categories of surgeries I do are transoral/endoscopic and open-neck surgeries. For the transoral/endoscopic ones, we work under a microscope and use tiny instruments and precision lasers. For the open surgeries, the main one I do is called thyroplasty with arytenoid adduction for vocal fold paralysis. We put in a small implant to push a paralyzed vocal fold to a better position for voice production and suture the vocal fold anchor to do the same.
“Vocal fry,” or creaky voice, has been attracting media attention lately. Is this a medical term?
Yes. Vocal fry describes a register below normal register. Both men and women do this, but it is especially common among women who work in a high-end professional environment where they feel like they have to drop their voice to sound more authoritative. The fry register is not a comfortable zone of voice production, so staying there constantly is counterproductive; it takes more effort and energy. I think most people who do that do it subconsciously.