LINDA DESSAU: Why did you decide to focus on the voice problems of singers?

BRIAN HANDS: As an ear, nose and throat resident, options for training in taking care of voices is limited. After a few years of practice, a board member of the hospital where I was working offered me the position of voice doctor to the Canadian Opera Company. I quickly became fascinated and passionately excited by performers who use their voices—the purest sound [humans] can produce. I loved doing it. At that time, in Toronto, "Cats" and "The Phantom of the Opera" were beginning their production. Touring singers from all over the world would call the Canadian Opera Company for referrals if they had voice problems while they were in Toronto; eventually, rock singers, movie people and theatre people from Stratford all started being referred. This is the work I get the greatest enjoyment from, and I try, now, to limit my practice to only voice problems. I identify with the strong emotional aspects involved in performing; I love the creative arts.

I believe in taking a mind/body/soul approach and using elements of energy work, chakra therapy, color therapy and yoga. I find the performers find these approaches easy to relate to.

I start with a Western medical method of taking a patient's history and doing a physical assessment. And once that's done, I deal with the emotional and spiritual aspects of the person.


I appreciate that my clients see me as non-threatening, like a friend, not a conventional doctor who just wants to label them and get them on their way. I see [each of] them as a whole entity and not just as a medical problem. Most voices don't have pathology, or a physical ailment. The singers are so relieved to hear that their vocal cords are fine!


After a few short minutes in my office, we're usually able to get to the deeper problems—emotional "baggage" that may have been with them since childhood.


This brings more relief—the fact that someone is listening to them and understands them. I've heard many times, "How do you know so much about me, when we've just met?"


Another joy for me is facilitating, for these singers, the cathartic release of their pain through singing.


LD: What are the most common vocal disorders?


BH: Muscular tension dysphonia or supraglottic hyperfunction—excessive muscle tension in muscles above the larynx. Common symptoms are pain after singing, inability to hit high notes, difficulty in passaggio (transitioning between the different registers of the voice), constant clearing of the throat, pain in neck and head and tightness in the jaw.


LD: What’s a myth about singing that you’d like to correct?


BH: The myth that some people should just mouth the words because they 'can't' sing . With training, anyone can sing!


LD: What happens when a singer comes to your office for treatment?


BH: We take an extensive physical history, find out about any allergies, examine the neck and throat, and look inside the mouth by using either a flexible or rigid endoscope. Frequently, we use a sophisticated video exam called a videostroboscopic evaluation of the larynx. After all of these procedures, we decide on a form of treatment. The most common course of action is reassurance that there's no structural damage to the vocal cords, coupled with talking about the underlying emotional issues that are bringing on the physical symptoms. Sometimes treatment involves speech therapy, and, occasionally, speech therapy and medication. It's rare that a patient needs surgery.


LD: Is a vocal disorder a lifelong issue?


BH: No.

LD: Why not?

BH: Because once someone has mastered the proper breathing technique, [s/he will] eliminate the physical symptoms that led them to the clinic in the first place. Breathing needs to establish a deep connection between the third chakra (solar plexus) and the second chakra (creative energy) by planting their feet firmly on the ground through the first chakra. With those connections in place, the patient can deliver a breath from the third chakra with inspiration from their heart (fourth chakra) and then to their fifth chakra (larynx, throat chakra). Often, the trouble is that the spiritual connection (seventh chakra) has been broken and their intuitive center (sixth chakra) recognizes this. And, thus, there is a backlog of energy at the fifth chakra—an incoordinate activity with too much tension in the area around the larynx (leading to the muscle tension described earlier).


LD: What are the three most important things a singer can do to prevent vocal disorders?


BH: Breathe correctly, drink lots of water, and warm up every day.