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Ouch, It Hurts When I Sing!

When I first set out to write this article about voice problems in singers, I was looking for two experts from contrasting fields of medicine ? "medical" and "holistic". What I found, instead, in the first practitioner that I interviewed, was a delightful mixture of the two.

The following biography of Dr. Brian Hands was taken from the website VOX Cura, his Toronto clinic. There is a link to the website at the bottom of this article.

"Dr. Brian Hands, M.D., FRCS (C), is a member of the Royal College of Physicians and Surgeons in his field of laryngology, sits on the Board of the Canadian Voice Foundation, is a member of the Voice Foundation in the U.S. and is on the editorial board of The Medical Post.

Brian Hands' life-long passion for the arts, combined with his medical practice as an ear, nose and throat specialist, has led to a growing practice among performing artists of all disciplines. He is voice consultant for the Canadian Opera Company, Stratford Festival, the major theatrical companies, Mirvish Productions and the former Livent as well as major record labels."

I hope you'll enjoy reading about Dr. Hands and his work treating singers with voice problems.

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 voice ? the purest sound a human 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 use 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 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? Why or why not?

BH: No, because once someone has mastered the proper breathing technique, they'll eliminate the physical symptoms that lead them to the clinic in the first place. Breathing needs to establish a deep connection between the 3rd chakra (solar plexus) and the 2nd chakra (creative energy) by planting their feet firmly on the ground through the 1st chakra. With those connections in place, the patient can deliver a breath from the 3rd chakra with inspiration from their heart (4th chakra) and then to their 5th chakra (larynx, throat chakra). Often, the trouble is that the spiritual connection (7th chakra) has been broken and their intuitive center (6th chakra) recognizes this. And thus there is a backlog of energy at the 5th 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: 1. Breathe correctly 2. Drink lots of water 3. Warm up every day

For more information about Dr. Hands and the VOX Cura clinic, visit their informative website at

This article was originally published on the Muses Muse Songwriter's Resource website (March 2005)

(c) Linda Dessau, 2005. All rights reserved.

Linda Dessau, the Self-Care Coach, helps artists enhance their creativity by addressing their unique self-care issues. Feel like your creativity is blocked? Sign-up for the free e-course, "Roadblocks to Creativity" by visiting

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