Ologies with Alie Ward - Laryngology Part 1 (VOICE BOXES) Ronda Alexander

Episode Date: January 26, 2023

Voices! Singing! Anxiety busters! Breathing! The absolutely magnetic, charismatic Laryngologist and surgeon Dr. Ronda Alexander makes her long-awaited Ologies debut to chat about why we sound the way we do, hormones and voices, Elvis accents, opera singing, kid voices, turning back time vocally, coughing, sleep apnea, acid reflux, vocal fry, Mariah and more in this stellar two-parter. Come back next week when we answer so many burning questions.Follow Dr. Alexander on Instagram and TwitterA donation went to the Laryngology Education Foundation Health Equity Grant via this linkMore episode sources and linksOther episodes you may enjoy: Phonology (LINGUISTICS), Rhinology (NOSES), Neuroendocrinology (SEX & GENDER), Gynecology (NETHER HEATH), Urology (CROTCH PARTS), , Phallology (PENISES), Eschatology (THE APOCALYPSE), Hematology (BLOOD)Sponsors of OlogiesTranscripts and bleeped episodesSmologies (short, classroom-safe) episodesBecome a patron of Ologies for as little as a buck a monthOlogiesMerch.com has hats, shirts, masks, totes!Follow @Ologies on Twitter and InstagramFollow @AlieWard on Twitter and InstagramEditing by Mercedes Maitland of Maitland Audio Productions, Jarrett Sleeper of MindJam Media, and Mark David ChristensonTranscripts by Emily White of The WordaryWebsite by Kelly R. DwyerTheme song by Nick ThorburnHPV Vaccine Ditty Remix on SHORT Notice by the Extremely Talented Jason Scardamalia

Oh, hi, it's her bobby pin under the couch cushion alley ward and listen if you're new around here We usually do not throw so many two-parter is your way at once But this in the dreams episode both just really deserve them and we had nearly 400 questions for this one. So yes a two-parter it is also this is anologist I was just thrilled to meet after having a patron by the name of dr. Jessica Randolph right in to say please this all just is a brilliant hilarious surgeon who works on voices Have her on so a voice surgeon. Yes practicing in this field since

2008 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 neck surgery at Montefiore 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 leaving it in one thing that does not gag me out our patrons Thank you for joining at patreon.com slash allergies and first submitting questions for the show Thank you to everyone in allergies merch wearing it allergies merch.com has things Thank you to everyone who rates and subscribes and leaves reviews for me to read here's one this week to prove that I read them all It's from best Sarah who wrote that this shows 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 small and cheese episodes

Those are trimmed of my filth and they're shorter and their classrooms safe So that's what small and cheese episodes are for their frickets Anyway on the interview part one of it where we will use our voices to discuss your voices plus Austen'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 dr. Rhonda Alexander Okay, so here's your mic there. They're stage mics, so they're super hardy Just kind of get up in it especially since we're masked 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? Well done amazing

First question ask if you can say your first and last name and your pronouns. Yes first name Rhonda our own da last name Alexander my pronouns are she her no extra h in that Rhonda. Nope. I am the daughter of Ronald and so I am our own da 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 a delightful mix of ignorance and perseverance 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. Mm-hmm, but the pathway for me began way back in the 80s 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 Oh, and then you you know high school. I went to university down in Louisiana I went to Xavier University of Louisiana a historically black college and then I went to medical school and at that point now I am 25 about to turn 26 when I finished medical school and I have secured a very coveted spot in the very competitive specialty of otolaryngology head and neck surgery

There are only about 220 jobs in the country when you finish medical school It's gone up a little bit but the time when I was coming out 220 was it wow 220 openings every year to join the established 10 to 12,000 Laryngologists in the US and for context I look this up every year the NBA hires about 60 new players So your chances are only like four times better than getting into the NBA But Dr. Rhonda 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, right? 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 30 hours or so back when I did it and Finding safety in that and sacrifice and joy all of those things together Then I did a one-year fellowship in laryngology Which had a bent towards neuro 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 12 years before coming back to New York And you've said so many allergies In the last minute so our training that first five years is

comprehensive odorhinolaryngology 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 disorders We do that did I leave anyone out hearing? That's right So

Otology and neuro otology 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 a 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 hole 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 phonology, 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 reflux habits to collaborate with us as well And you sing I've been known to 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 I know 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're a professional voice user. So heaven forbid tata if Allie gets a voice disorder Which I've heard you have you've had colds and whatnot. Yes 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 means musically Is that is that like an octave or so it's one sixteenth of an octave

Okay, I'm 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 Does a person make words and sounds like I don't even know what a voice box is It's not the Adam's apple or what do we call a voice box? So the larynx Which the Adam's apple is a part that you can feel Is composed of a few paired cartilages cartilages kind of that scrunchie 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 gonna 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 laryngea 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 laryngea 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 cricoid 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 arytenoids These are like sailboat 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 horseshoe 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 are the power source. They send up the air the vocal folds do the vibrating That's the bass 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. Oh 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 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 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 a 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 life span when we're young everything's tiny And so you'll hear people say children have small voices is because they do Their 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 may get thicker and wider and then the voice box stretches as the thyroid cartilage changes for those folks

We get testosterone puberty 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 Drainous down there is associated with dryness up here Yeah, so your overall moisture levels are gonna change as you approach I like to think of that as like the last puberty. Mm-hmm as I head into it myself Agonizing and agonizing surprise. It's exciting. Um life is exciting

That's one way of putting 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 going 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 pectoral 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 aesthetic 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 sick or 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 atrophying But also like loss of power. Yeah, that's another thing we have in common. It was my mom in June myeloma. Really? Yeah, no Absolutely 100% we're like little Twinkies the two of us. Holy shit. I'm so sorry. How long was she sick for?

Oh, so she actually was diagnosed when I was a chief resident. So back in 2007. So we've had we had 15 bonus years Yeah, we had 10 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 myeloma 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 myeloma.org in memory of Dr. Alexander's mom the late and wonderful Reverend Barbara Alexander I'm so sorry you lost her though. Oh, yeah

It's um, had a totally had a therapy appointment about this morning. So, you know, we just we we keep doing stuff Mm-hmm. I've got one on Friday. Yeah Yeah, it's the rest of our lives and we just we live it. Mm-hmm. I'm sure she was so proud of you Oh, yeah, she's a character She and my dad are somewhere right now. Just let like going. Hey, nice She's probably bossing him around too I'll take it. Yeah, his grandpa was gentle. Yes He was a very grandpa. It was a very gentle guy

It was it was interesting though 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? Oh, 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 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 cords before and after a voice lift. 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 vag that was open wide And then the rejuvenated ones kind of looked like of a gene that was caught mid-wink kind of closed out speaking of voice and Crotches and changes we're going to talk a lot more about puberty and gender and vocal matters later on in this episode

They can last anywhere from six weeks to around two years to some that are quasi permanent But those are usually going to be under surgery because we have to do a little bit more work and you shouldn't be awake for that 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 make 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 miss 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 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 cords 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 Etc. Etc. 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 a nose Infection and it's dripping gross that'll make you 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 coughing 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 to 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 you 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 digging for clams well, what's happening with a cough drop so cough drops are doing a couple of things They'll 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 reducing 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 mucusy one that the menthol is drying up And so your throat is just happy that you're getting a little bit more saliva to help sooth it Is that cool? Is it cool to have cough drops if you need them so they're okay? Okay, we 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. 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 reflux? 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 reflux? Is it better to eat at like 7 p.m. If you're going to bed at 11 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 give 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 when it's bedtime So last food must be done for my beginners I tell them two hours because they 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. There's I went to bed with toast I went to bed with a fruit But especially if you have symptoms of cough voice trouble or specifically heartburn You got to tighten it up empty bellies. 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 9 or 10 p.m. I'm not staying up till 1 because I have to get up the next morning at 5 Yeah, 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 is a fix for that You know there because there have been times when I have come home with my purse still on and microwaved a frozen dinner Oh, yeah, 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 lives What about does sleep apnea fall under your like surgical interventions at all or so in and I in the broader Umbrella field sleep sleep surgery is also a part of odor on a laryngology head neck surgery Mm-hmm

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 apnea is really about collapse Sometimes that's nerve-based. Sometimes it's bulk based but regardless of weight BMI 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 surgeries that 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 laryngomalacia

space L-A-R-Y-N-G-O M-A-L-A-C-I-A space for editing laryngomalacia laryngomalacia is a condition where the voice box collapses under the pressures of breathing in and can contribute to the sleep apnea So we can make some modifications to help it stay open and more strong But mostly for sleep apnea 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 apnea is not treated also have more reflux symptoms very commonly So double whammy and not good whammy is 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 laryngomalacia 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 apnea? They're sleeping like shit They feel like shit They go to a doctor the doctor's leg just lose 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 to diagnose sleep apnea Is what we call a polysomnogram or a sleep study And those can sometimes be 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 asleep 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 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 on 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 health care 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 dingley the bell that we call the uvula I don't even know what that does. Uh, so that is uh, 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 the that part of the palate 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 palate Yeah, yeah, yeah, it's bonkers If you want to know where is my soft palate 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 palate So snoring can happen when the root of your tongue and your soft palate 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 road block of that flappity flap

Pallet 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 it's not your it's not doing damage to your vocal cords

Not necessarily, but having untreated sleep apnea is just setting you up for a whole host of troubles. Yeah And what about performers opera singers? Uh, shicks peering 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? 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 mic'd or when you're watching opera. That's not mic'd

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 tum tum right below your ribs and just take a natural breath and what happens to your tum tum Thankfully my tum tum 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 and 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 tum tum 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 umpire waist because their belly has to move There is no hourglass shaped opera costume because you got to 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

diaphragmatic breathing and how it switches your brain out of panic mode and in one 2019 frontiers and psychology paper titled Pulmonary aphor and 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 dope, we love that and Barrow reflex resonance effects and appears to elicit resonant and coherent features in neuromechanical 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 diaphragmatic 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 $0 to feel more chill air It's free. So deep belly breathing is not just for your sister's lululemon obsessed roommate 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. Bless their hearts. I mean bless their hearts corsets. I won't do it. I won't do it. Nope Uh, what about when let's say that you're a singer 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. Yes. What are those and what why does a vocal rest help? So vocal fold nodes or nodules fall under a category of voice box injury that we call phonotrauma 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 that 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 callus 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 calluses 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 now my hands 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 calluses 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 laryngeas Sometimes just have a little bit of a shape like that And so we we've learned that they're not always a problem not always a disease not always a pathology if we looked at a thousand fem

laryngeas We might see 600 or so with kind of an hourglass shape Where they meet early in the middle and in maybe 15 20 years ago we just said oh my gosh, we have nodules But if they don't have a problem with their voice, they don't have nodules really they have a fem voice What about um surgeries to feminize a voice? Yeah, is that is that um shortening The the width of the vocal cords. So when we do Feminizing voice surgeries the goal is to increase the pitch

Right around 200 cycles per second is the inflection point where we Kind of culturally say at least in the u.s. We say This is a mask voice. This is a fem voice. And so we want to get our Particularly our trans patients. We want to get them above 200 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 folds 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 a 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 with feeling like you're not sounding like you you feel Absolutely. Yeah, misgendering is And a psychologically harmful experience. Um, that isn't always even intentional When you're in the drive-thru 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 cis Like I can 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 2020 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 childhood pitch for singing in the higher registers in the cysteine 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 cords increase as does the diameter of the larynx

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 assigned 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 15 grand There is the non invasive option of vocal therapy and that's like practicing and modulating your voice

Using your throat and tongue and vocal cords 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 and 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 80 bucks, but cheaper than surgery. Will it stick though? I don't know. Why don't you ask Elvis or rather austin butler or really just ask dr 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 dr. 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 I'm always so interested that when we have a cold

Or we sound a little husky. We're like, oh, I'm like to me more. I'm I'm sultry. I'm whatever kathleen turner But obviously people who are a mask because of just internalized misogyny also just in general being perceived as having a fem voice is almost like insulting it is because femininity is an insult Yeah And how have fems or people assigned female at birth responded to that Subconsciously or consciously a little something we talked about in the 2018 phonology episode with dr. Nicole holiday But you may have heard it on like countless reality programs, etc Oh, 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 it's your 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 phonotrauma the injuries to the vocal folds 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 song with the fry And it's literally asking the car to keep going with no gas. Just take a breath people. Ah, okay. That's actually very bit That's so good to know so 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 ourselves and never hear ourselves 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 Um, and we only ever see ourselves in mirror image Which that Extremely disturbing phenomenon 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? Why does she look like a Picasso painting to me? Like, you know It's because it's like off but it's like 10 off like what is what is that? It's like uncanny valley with your own That sets me But it's also, you know, exploring that uh, 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 to 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 voiceover 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 ourselves any cold stimulus in the head and neck and in the mouth It actually activates the calming part of our of our nervous system. So you may be 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 disorder. I just have like a big gulp. And if you do it's like welcome to the club We're all not doing fine. Yes 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 32 ounce ice 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 mucus production or congestion or does it freeze up your your Muscles in your larynx. So I won't freeze the muscles

But it will tend to give you kind of a thicker mucus just because it 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 oh, 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 face 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 your of the inside of your wrist

And it's comfortable. That's going to still be appropriate. Do you have any hacks for if you don't have a Like $75 facial steamer from bedbath 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 like I I'm so we're here in the Bronx and this is Of the 62 counties in New York state. This is number 62 in health outcomes and economic opportunities And so I am not recommending go buy a hundred dollar 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 yerba mate because it is like legal drugs And it is so hardcore. I would drink a cup of yerba mate and be like, I'm gonna go run a half marathon I've never run before like it. I don't know what's in it. There's some Catechins 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 remate 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 tobacco marihuana 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 was the one that we've studied the most And that one 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 and the back of the throat It's going to be human capillomavirus. 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. I you literally did 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 boy girl or in between I mean and 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 pap smear

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 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 Gardasil 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 have I know several people who have gotten cancer cervical and esophageal Great news if you are over nine years old You can get this vaccine if you're over 26 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 78

Reduction in cervical cancer. Thank you very much. So ask your doctor and at the very least Get your pass 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 we'll donate some money to worthy causes first to myloma.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 theologist 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 u.s. 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 the steam is the 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 laryngopharyngeal complex this upper throat area It's the only part of the body. We asked to do three things Other parts 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 down 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 the food and drink is going into the lung direction And 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 like 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, any 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, that's Mimi. 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 mini ripper tin Who's my rudolph's mom from snl fame? I didn't know that mini ripper tin listen to the song loving you Okay, um, 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 forms 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 my vocal folds are tensor 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 o or o 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 fergie did a great job No

There It was a choice It was a bold choice and I'm not going to leave a comment from my farty recliner about it No, 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? Um, one million and two. Yes We got them literally, um at present 377 questions. Not a big deal. Thank you. All right. 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 dr. Alexander at your voice md on twitter or Your underscore voice underscore physician on instagram and say hello there We are at oligies on twitter and instagram and i'm ali ward on both with one l i'm ali underscore oligies on tiktok now Say hello, you can join patreon at patreon.com slash oligies where we have discussion threads each week about the episode I love to read your reactions and chime in oligies merch is available at oligies merch.com. Thank you, susan hale for managing that and so much else

Thank you. Noelle dillworth for the scheduling erin 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 the oligies podcast facebook group with assist from bonnie dutch and chanon feltas Emily white makes our professional transcripts and kelo patent bleeps them and zeke red rigas thomas and mercedes maitland of my gym media work on small angies kid friendly shorter episodes and kelly art wire makes the website she can make yours too Mark david christensen and jared sleeper did additional editing on this episode alongside lead editor

mercedes maitland who has her own maitland audio you can check that out nick thornburn 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 cova 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 uh, jared 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 stinkier 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 up for now more voice boxes next week though. Come back. Okay. Bye. Bye You Focus on your diaphragm that was a diaphragm