Anthony F. Jahn (MD): an interview about vocal health for singers

Anthony F. Jahn es un otorrinolaringólogo de renombre internacional, residente en Manhattan. Director de los servicios médicos del MET Ópera and Jazz en el Lincoln Center de Nueva York. Vuelca su interés especialmente en la voz profesional. Sus pacientes incluyen cantantes de música clásica y moderna. En la presente entrevista en inglés habla de su labor. Muy recomendable su lectura para cantantes, profesores de canto y personal sanitario que trata a los profesionales de la voz. 

- You have been linked to the world of singing for many years. When and why have you decided to help singers? 
I grew up with music- both my parents were professional musicians, and I have played the piano all my life. I chose otolaryngology as a specialty because of its relevance to hearing, and to the singing voice. As a young physician, I began working with Dr. Eugen Grabscheid, a Viennese doctor who took care of many of the top opera singers in New York, and I was hooked.

- How does the singing patient differ from one who is not? What may consider a MD who treat singers?
Singers have a very difficult profession. Their voices are held to a very high standard, much higher than a normal  speaker's voice, and must work every time. Their career depends on their voice- it is not like a college degree that, once you have it,  entitles you to work in your profession,  but it is tested and judged every time they sing. That is a lot of pressure. 

Also, singers, especially those who travel, have a difficult personal life to manage. Their families may be far away, they live out of a hotel room, and they need to depend on the kindness of strangers. Often, their entire livelihood, and that of their families, depends on what comes out of their mouths every night. They may be generally emotional and often somewhat fragile, and their psychological well-being is connected to the voice. To treat singers well, in my opinion a doctor should know something about music, and appreciate what these performers do. Above all, I think you need to love singers, listen to them with an open mind, and understand their situation.

- As Metropolitan Opera House MD, could you explain what are the main work in the opera house? 
The Metropolitan Opera House in New York is the largest opera house in the world, with a seating capacity of 4000. We have a physician in house every night, for every performance. The job of the doctor is to take care of any emergencies, whether on stage, in the pit, or in the audience. When the MET used to tour to Japan, we would provide a doctor to travel with the company, to make sure that everyone is healthy, and to interact with local doctors and hospitals in case of a more serious emergency. As house doctors, we treat everything from a vocal emergency on stage to someone slipping and falling in the audience.

- You have been helping singers in the treatment of specific pathologies for years. What advice would you give to a singer who thinks he may have a vocal problem? What are the most common problems?
The short answer is, any time the singer thinks they have a problem, it needs to be evaluated. We need to trust the "owner" of the voice, since they monitor their voice constantly, and are often the first to recognize a problem. Apart for respiratory infections, the commonest problems I see have to do with over singing. Excessive muscle tension is common, and can both cause and result from vocal fold swelling. The important thing is to deconstruct the chain of events that have led to the presenting symptom of dysphonia. The ideal treatment comes from understanding what is going on functionally, rather than just visually on endoscopy. The best treatment involves addressing the cause and not the result. Treating vocal fold nodules with steroids may give some momentary relief, but it doesn't address the cause, which could be inadequate technique, inappropriate repertoire, singing in the wrong fach, over demanding schedule, or a vocally damaging day job, among others.

- Do you consider, in general, that singers and singing teachers have enough information about the functioning of the voice in physiological and anatomical terms?
I think that, in America at least, voice teachers are more and more knowledgeable about the anatomy and physiology of singing. There is, however, a potential danger here, since we all are seduced by what we see on that video, and lose track of what singing really is- a matter of function and not appearance, The video image doesn't identify every problem.  While every teacher should know about the anatomy and physiology of the vocal tract, learning to sing is a series of functional behavior modifications which is still well taught through hearing, proprioception, and imagery. A combination of both approaches is ideal.

- Many singers and students suffer, throughout their careers, some kind of vocal pathology, do you think they are conveniently faced from institutions (schools, theatres, etc.) and understand these problems? 
This varies from one institution to the next. I consult for several schools, but not  every school has a laryngologist readily available. In my mind, the ideal situation would be if the incoming students are given a lecture or two on anatomy and physiology at the beginning of the year, and are also screened with laryngoscopy, to give them a base line, as well as to identify early on any existing or potential problem.

- What do you think about interdisciplinary work between physicians, voice therapist and teachers of singing? What should it be based on?
I think this is really the greatest development in voice management over the last few decades. As a physician, I learn constantly from voice therapists, as well as my patients. The most important aspect of this not just the sharing of information, but the discussion that results, which benefits everyone- speech therapist, laryngologist, and, most importantly, the patient.

- What professional projects do you have related to voice and singing?
We're working on the management of laryngeal and pharyngeal tension using acupuncture, which seems to be very effective, immediately perceptible, and has no side effects. By treating muscle tension in other areas of the head a neck, we can reduce the elevated muscle tension in the larynx. We are just now also looking at the connection between previously undiagnosed ankyloglossia (tongue tie) and tongue tension in singers.

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COACH VOCAL de referencia internacional. Titulada oficial Superior en Pedagogía del Canto con Matrícula de Honor y Premio Extraordinario Fin de Carrera por unanimidad. Titulada en Canto, Piano e Ingeniería. Académica de las Artes Escénicas de España. Dir. Vocal Center. Vicepresidenta del Capítulo Iberoamericano de la Región Internacional de la National Assoc. Teachers Singing (EE.UU.). Miembro European Voice Teacher Association. Deleg. Asoc. Española de Profesores de Canto. Dir. Asoc. de Músicos Profesionales de España-CV. Experta en Técnica Vocal. Especializada además en voces infantiles y juveniles. Autora de las exitosas publicaciones: Claves de la Voz y el Canto, Guía Práctica para Cantar (núm. 1 ventas Amazon), Guía Práctica para Cantar en un Coro, La Voz sí que Importa, Cómo enseñar a Cantar a Niños y Adolescentes. Asesora vocal y Directora musical TV. Prepara asiduamente a participantes de concursos de televisión. 0034 651315263 "¡Cantad felices!"

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