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2nd grader with chronic laryngitis

 I have a 2nd grader who is a very enthusiastic singer. She has a good voice and is very energetic. The problem? She seems to have chronic laryngitis. Her voice is always airy and she has a very hard time focusing her tone. She tells me she her voice is gone almost once a week. I did a little voice check with her today and her voice cuts out and shakes on anything above a D. She seems to be using her neck to try and "muscle" her way through singing. I am kind of at a loss as to how to help her. Do you think it is possible she could already have some sort of nodule? If it is simply overuse by a young child (yelling on the playground, excited talk, etc), what can I do as her vocal teacher to help her learn to use her voice in a healtheir way so she doesn't do any long term damage?
Replies (15): Threaded | Chronological
on November 7, 2013 3:29am
Hi. My partner the speech language pathologist suggests that she see an ENT first to rule out any medical issues.
Applauded by an audience of 1
on November 7, 2013 4:52am
Hi Rachel - my experience is that this could be allergies and not nodules.  She should be seen by an ENT for sure and then an allergist.  Hopefully, she is being encouraged to hydrate often and carries a water bottle in her backpack.
My best,
Bill Adams
Fort Bend Boys Choir of Texas
on November 7, 2013 5:33am
Does she come from a large family in which she is competing for attention at home? Do her parents speak loudly habitually? This sounds like a habit that has been long established. Try to teach help her lighten up and take all the stress and weight out of her voice - floating lika a balloon - use sound effects with light high sirens for her to mimic you, make a game out of it. Try to get her to experiment singing lightly and bouantly in her head voice.  It sounds like she has been pushing her chest voice up and doesn't know much about her head voice, but it is difficult to know wihtout actually hearing what she sounds like.  Are there any high quality children's choirs nearby? You might find a resource there as well. Good luck!
on November 7, 2013 8:03am
Treat this as seriously as a coach would treat a broken limb on the playing field.
Get in contact with her parents and strongly encourage them to get her to an E.N.T. specialist as soon as possible!  In each situation that my staff and I have encountered this problem, have brought it to parent's attention, and they have followed through, there have been positive results in getting a diagnosis, treatment, and professional training (speech therapist) to set the child on a course to "save" thier voice.
We only get one set of vocal folds and as far as I know there are no replacements available.
You can make a difference in her life!
Best wishes
Applauded by an audience of 1
on November 7, 2013 8:55am
Have her ears checked.
Voice issues are sometimes caused by problems with our ears.  If there is a particular range of pitches that she has trouble singing, it may because of ear damage in that same range.   We can only sing a pitch if we can hear the pitch.   If we can't hear the pitch, that can be the source of the issue.
Nick Page
on November 7, 2013 3:57pm
I would speak with her parents about taking her to the doctor/or ENT specialist. I also have known many students over the years who had this raspy airy sound from Reflux(it is quite common). I would really let the parents know you are concerned and that a visit to the doctor is in order. 
Applauded by an audience of 2
on November 8, 2013 6:24am
  1. Her parents should be notified to immediately see an ENT to rule out any issues in that area
  2. You should suggest to her parents to do a complete physical, make the doctor aware of the problem. A suggestion to have them run a thyroid test would be a good idea as hyperthyroid conditions may induce the same symptoms. 
  3. I suggest rest from ALL SINGING for at least 1 week and have he come to YOU  to retrain and remove bad habits such as: a) oversinging out of range b) lack of warm ups before singing and warm downs after singing c) bad breathing technique 
  4. Discuss the amount of sleep the student gets - much vocal repair comes from sleep. 
  5. Discuss the amount of water intake the student gets - keep the voice wet
  6. Have a heart to heart talk with the student (I suggest with the parent) to make sure she understands that the voice is her instrument and she must protect it by changing how she talks (no yelling) and keeps the voice wet and warm.
By doing all of these things, you should discover the problem and fix it. Keeping the student confident that this is a temporary thing is important since all vocalists freak out if the voice is not there, understandbly!
Seta Majkia
Prodigy School of the Arts
on November 8, 2013 8:43am
While what many write here is correct, they are also quite incorrect. Let me explain.  A young child's throat heals quickly.  Her on-again/off-again sore throat, her raspiness, her shaking, and cutting-out are all symptoms of a consistent physical ailment.  The ailment is NOT on-again/off-again.  It is a constant physical ailment.  Our friends here are quite correct in suggesting an ENT.  However, I would go a better route.  Is there a large enough city in your area to support an opera company?  If so, contact them and see which ENT their soloists use.  If several, see which doctor is mentioned most often.  Check these doctors on the internet and see with whom they are affiliated.  Make your choice of those doctors.  These doctors are singing specialists and, as such, know more about the singing apparatus, how it works, and what problems exist if certain physical features are not present and correct, etc.  They are worth their weight in gold to a singer.  And what if there is no opera company in your area?  Then, I would locate the nearest opera company of repute and go through the above process.  Armed with this information, I would then go to the parents and tell them what I have noticed, what the child has said, and tell them what you have discovered about a singer's ENT.  The problem is now their problem.  You have accomplished all that you can.  I had an eighth grade soprano student with this same type of problem.  I gained the names of five local ENTs who were admired by the opera company.  I researched their history and one ENT seems to stand above the others.  I suggested that ENT to the parents.  My wife also developed a problem.  She does not sing.  I took her to this same ENT.  He was exacting and marvelous.  Yes, see an ENT, that is, see a singer's ENT, and ENT who specializes in the health of classically trained singers.  As Barbara Doscher would say, "Above all else, do not damage the voice."
With a voice of singing, declare ye this, and let it be heard: Alleluia!
John H. Briggs, Sr.
MM in choral conducting
Clinician and Guest Conductor
on November 8, 2013 2:20pm
Sounds to me like a classic VOD - Vocal Over-Doer.  In children it is often caused by loud talking, crying, yelling or screaming, or singing too loudly.  But most likely not from the singing.  I've read lots of good advice here.  Be sure you don't scare the child.  Be encouraging, warm and friendly.  This type of child is often a passionate musician.  Maybe she needs a violin or piano lessons for a while to give her a 'voice' while her physical voice is being retrained.  You, her parents, a singer-friendly ENT, and a speech or voice therapist will be the team she probably needs to help her make this change.  Best wishes to all of you.  She is worth it!
on November 8, 2013 11:48pm
Good on you, Rachel, for your sensitive concern for this girl’s voice!
Based on your description of her vocal symptoms, she has a quite serious voice disorder, and definitely needs to see a very empathic, voice-experienced/trained ear-nose-throat (ENT) physician for examination and diagnosis—perhaps an ENT that specializes in pediatric voice disorders. You and other ACDA-member ‘posters’ have graciously indicated several diagnostic possibilities, but there are several other possible diagnoses that are not well known in the voice and choral education communities, including some that are more serious than the ones mentioned (e.g., vocal fold polyps or cysts, congenital laryngeal webs, congenitally very large palatine and/or lingual tonsils—sometimes not diagnosed by pediatricians).
I notice that you live and teach in Minnesota. I, too, live and work in Minnesota. If you could let me know what town you live and work in, I may be able to provide contact information for the nearest voice-experienced/trained ENT physician to you for when you communicate with the girl’s family.
You may not know who I am, Rachel, and wonder if this Leon Thurman guy really knows what he's talking about. If so, good on you again. In March of 2008, I started a sole proprietorship business in Minneapolis: The Leon Thurman Voice Center. From December, 1995, to November, 2007, however, I worked as Specialist Voice Educator with my speech/voice pathologist colleague, Carol Klitzke, at Fairview Voice Center, a unit of Fairview Rehabilitation Services, University of Minnesota Medical Center, Fairview. A number of ENT physicians in the Twin Cities, Greater Minnesota, and several surrounding states referred their voice patients to us, partly because we had a laryngeal videostroboscope and could take high-magnification video photographs of their patients’ vocal folds and lower throat areas. The ENTs provided medical/surgical treatment for their patients’ various diseases, disorders, injuries, and anatomical malformations. We cooperated closely with them in the therapeutic care and optimum functional recovery of those patients, many of whom had used their voices extensively, vigorously, and inefficiently. As a result, they had developed a wide variety of voice use disorders.
I also was principal author and co-editor of a science/evidence-based 'encyclopedia' of voice, perhaps the most comprehensive book on voice that has yet been published, Bodymind and Voice: Foundations of Voice Education. It's not a commercially published book, but was published by two nonprofit organizations that have kept the purchase price low, The VoiceCare Network and the National Center for Voice and Speech. It's printed in three bound volumes and its 18 authors cover just about everything anyone would want to know about voices and teaching. One whole section of 14 chapters is titled "Health and Voice Protection" and the authors include three ENT doctors, an allergist-immunologist, an endocrinologist, a speech/voice pathologist (Carol), an audiologist, and me. Info can be perused on VoiceCare's website.
In your post, you asked, “(W)hat can I do as her vocal teacher to help her learn to use her voice in a healthier way so she doesn't do any long term damage?” A suggestion for you: I highly recommend that you attend a particular 2014 summer course that addresses (among many other leading-edge perspectives) how vocal/choral music educators can determine when a student’s parents need to alerted that their child needs to see an ENT physician for examination. The course is presented annually by The VoiceCare Network, is titled “Bodymind and Voice” (guess what the course's textbook is), and is held at Saint John’s University in Collegeville, Minnesota. My speech path colleague, Carol, is one of several faculty for the course. Check their website for relevant information.
Be well, Rachel, and a standing ovation to you for helping your student and her parents get the help they need for her voice!
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on November 11, 2013 4:01am
Thank you everyone for your succinct and specific advice! Funny enough, we have met Leon. One of my best friends is one of your students/patients. She was the first one I went to with my questions! So I trust you 100%, I have seen your work! Thank you again, it looks like there are some conversations to be had and recommendations to be made over the next couple of days. 
on November 9, 2013 10:31am
It sounds like something significant is going on!  I'd definitely start by sending the child to an ENT who specializes in voice--the top singers in your area will know who's good.  The ENT will likely have people on staff who can do the appropriate voice therapy, and figure out what lifestyle change need to be made.
Good luck!
Jay Lane
President, McClosky Institute of Voice
on November 10, 2013 7:07pm
I had this problem in college. I was fortunate to be referred to a laryngologist who specialized in the issues of singers. I was also lucky that I saw him before developing nodes. I spent a year working with a speech pathologist. As I corrected my issues with my speaking voice my singing voice improved. One person who has written about this is Dr. Morton Cooper. You might want to check out what he has to say. I agree with those who have said that this child needs to see an ENT (I would specify laryngologist). It may be that she needs to rest from singing and deal with her speaking voice if it and her singing voice are ever going to be healthy.
on November 11, 2013 8:44am
I affirm all of the above!  (As a professional singer, voice teacher, choral director who has also taught music classes for this age.)
While you wait for all this to transpire (parent meeting, ENT appointment, etc. ... ) have you considered using some of your class time to introduce/review [briefly, with fun activities] voice technique?  Joy's balloon and siren ideas are great; I use them frequently.  If you bring a balloon to class and let them take turns feeling how the bottom of it stretches as you blow it up, them you can teach them how to "Fill up your [ their]  breathing balloon." about 3 beats before they sing a phrase.  (5 beats at fast tempos.)
It is so easy for us to become involved with the "upper things" - vocal folds and their action, placement, vowels, etc.... We do well to have our first focus on the breathing.  You might try:
Purchase a wide, elastic belt.  Try to find one that will stretch from just under the rib cage to just above the hips.  2-4 incles for a 2nd grader.  Luckily these are in fashion now.  I found one at N.Y. and Company for less than $15.  Discount stores may be a good source.  You may find that you can purchase a strip of elastic  large enough for this age at a fabric store. )
Get a volunteer  to come forward.  ("Raise your hand if you want to learn to sing like a pro!" ;) Have them choose a friend who also comes forward.  (The friend is only there to catch/support them, should they overdo the leaning and fall froward.)  If the young lady in question ["Mary"]  raises her hand,   I recommend calling on some other enthusiastic child first,  letting Mary be the 2nd volunteer, so it will not seem that this lesson was focused on her/her issues.  Also, Mary might learn better from first observing, where she is not so self-conscious/anxious to please.  (If possible, call on a child who is wearing something rather stretchy/close-fitting, so the others will observe the mid-section muscle movement.  This is trickier to demo with a big bulky sweater...  )
To the others, to keep them involved: "Watch and learn!  ;) "  Be sure you arrange the room so they can see.
Wrap the back of the belt (the smooth, elastic part) around the front of their mid-section, so that you are holding [firmly! ;)] the clasp/buckle, a few inches behind their back.    If you use simply a wide piece of elastic, you can wrap it around your hands for extra security.
Have them lean slightly (keep body straight, notice this is "lean", not "bend") forward, and say, "Help the belt stretch a little."  This will begin to get them where they can feel where support muscles are.
 (Meanwhile, if others are restless/inattentive, they can pair up and one child can, with their fingers, be the "belt" for the practicing breather, who faces away from the "belt" person.  No tickling allowed; they can draw on their inner adult here.)
As they settle into that,  have them lift the roof of their mouth like a parachute over an updraft, and let the bottom of their throat lie like a hammock.  "Now sing..."  and you demo "Happy Birthday"  or "My Country "Tis.."  or a song they all know, that is a sustained phrase.  "Stretch the belt a little as you sing the phrase."
Few people realize that singing is initiated with how we take in, and control the breath.    Especially if we are energetic/hyper, we tend to think "I'll sing  that note/word!"  and we basically forget about breathing.
Lesson two might review this, and  then ask, "What about when we talk? Are we breathing the same way?"
While I do affirm all that's posted, I'll include one slight caution:  An ENT who worked with singers/actors said that the body/respiratory system naturally drains gallons of mucus daily, which is a natural hydration.  Drinking water in excess sort of washes that out.  Sometimes it is necessary - dry room, wind, recovering from a cold -  but needn't be overdone.
I'd love to know how this turns out/what you discover!
Best wishes for you, "Mary", her family and her singing!
Applauded by an audience of 1
on November 13, 2013 6:30am
Years ago, I had a young student with same problem.  His speaking voice always sounded hoarse and he was a loud speaker.  I expressed my concern to his mother but didn't know if she would take it seriously.  Years later, she told me that his voice eventually cleared up and he didn't have nodes as I feared.  He went on to sing in high school and even sang in a barbershop quartet.
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