Saturday, December 3, 2016

Open Wide and Say “La!”

By Jacqueline Mitchell

Thomas Carroll brings his love of music and singing to his practice as an otolaryngologist

Thomas Carroll

“Fortunately, most people never have voice problems, but for those who do, the fix is often a simple change in how we approach our natural speaking voice and not a surgical procedure,” says Thomas Carroll, with a patient at Tufts Medical Center. Photo: Alonso Nichols

When performers in the musical production of The Lion King—in Boston for a spring run at the Opera House—were straining their voices and needed a tune-up, Thomas Carroll was the man they called. He advised them on how to care for their voices and helped them achieve peak vocal performances.

Carroll, an assistant professor of otolaryngology at Tufts School of Medicine and director of the Center for Voice and Swallowing at Tufts Medical Center, brings more to his work than his training as an ear, nose and throat specialist, though.

He has loved music his whole life. The son of an elementary school music teacher, he has lent his voice—a high baritone—to church choirs, a cappella groups and even rock bands with equal enthusiasm. Even as a music history and theory major at Oberlin College, though, Carroll knew he wanted a career in science that would allow him to work with people. “Medicine seemed to fit the bill,” he says. “It was a difficult decision to leave music by the wayside.”

But as a medical student, Carroll realized he could combine his two interests through otolaryngology. Ultimately, Carroll trained in laryngology—a sub-specialty of otolaryngology that treats disorders of the larynx.

Commonly known as the voice box, the larynx houses the vocal cords, specialized folds of tissue and muscle that produce sound as air passes over them. Stretching or contracting the vocal cords, as well as shaping the mouth, lips and tongue, changes the pitch and sound of speech or song. The larynx is also integral in swallowing; a healthy larynx moves up and out of the way as food and liquid pass by, preventing them from entering the airway.

“Tufts hasn’t had a voice-specific practice for about a decade,” Carroll says. “We literally look at vocal cords all day.”

Training Everyday Voices

In addition to professional performers, Carroll also treats a fair number of ministers, professors and broadcasters, as well as students from the Berklee School of Music who aspire to become professional actors and singers. “These are people who were never trained to use their speaking voices—everyday people. By the end of the day, their voices are tired,” says Carroll. “Many professional singers even need to brush up on their speaking techniques. Nobody teaches us how to use our speaking voices efficiently.”

Lecturers, teachers and public speakers often forget to breathe, says Carroll, and they run out of breath by the end of a single sentence. Forcing sound out without good breath support, he says, is stressful for the voice.

Professional singers spend years learning the proper way to produce a healthy singing voice and can distinguish between their upper and lower vocal registers. Most people who have never had vocal training, however, especially those born in the United States, tend to lower their vocal pitch to sound more authoritative. Carroll says that one technique that patients often work on with a voice pathologist, an expert who specializes in voice rehabilitation, is improving the efficiency of their voices by speaking at a healthier, often slightly higher pitch, with more breath support and energy—similar to the way singers are taught to sing.

“Many people could benefit from speaking like they’re singing, by using a resonant voice with good breath support, as well as good posture to align the vocal cords with the rest of the body,” he says. “Fortunately, most people never have voice problems, but for those who do, the fix is often a simple change in how we approach our natural speaking voice and not a surgical procedure.”

Overuse of the vocal cords can result in symptoms that can indicate a range of conditions, from simple dehydration to early stage throat cancer. “Hoarseness and vocal fatigue is not normal. The solution is usually simple; give your voice as much rest as possible and drink lots of water,” Carroll advises. “But if it’s something you think about daily, or the problem lasts more than three weeks, get it checked out. It’s rarely something bad, but the right diagnosis and treatment early on can give you a healthier voice for a lifetime.”

Better Treatment Options

For those coming to the voice clinic, Carroll offers a “one-stop shop” for patients, borrowing the idea from the University of Pittsburgh Medical Center, where he did his fellowship training in laryngology. When someone comes into the clinic, Carroll and one of Tufts Medical Center’s three speech and language pathologists evaluate the patient together, rather than scheduling two separate appointments. The coordinated exam saves the patient time and allows Carroll and pathologists to devise a treatment plan together. “It’s a more efficient way. It gets us all the information we need,” says Carroll, who thinks the model is unique in Boston.

Thanks in part to his high-tech arsenal of tools, Carroll is able to diagnose and treat a variety of problems in the clinic. For early-stage vocal cord cancers, for example, Carroll opts for surgery when the cancer can be excised completely with limited complications. Patients treated early enough to avoid radiation therapy often have excellent voice and swallowing outcomes, he notes. “I approach the surgical removal of early vocal cord cancers with as much thought to voice preservation or restoration as I give to actually removing the cancer.”

Beyond the common problems caused by overuse, Carroll’s practice is also skilled at restoring speech and swallowing to patients whose vocal cords have been damaged during surgery and intubation. Post-op patients whose vocal cords have been traumatized often have difficulty swallowing, and the inability to eat only prolongs their recovery time.

The ability to talk, sing and, of course, swallow are “huge quality of life issues,” says Carroll. “It’s a wonderful thing to give somebody their quality of life back. Understanding how important singing and a healthy voice has been to my life allows me to understand and sympathize with my patients’ frustrations. It motivates me to get them back to vocal health and makes my work extremely rewarding.”

Jacqueline Mitchell can be reached at jacqueline.mitchell@tufts.edu.

Posted September 01, 2010