Speech therapist Natasha Curham has a positive approach to the common voice disorder, muscular tension dysphonia (MTD). She assured me that it can be successfully treated. Muscles are involved. With practice, muscles can be strengthened, better coordinated and used more efficiently. Brain has learned to overuse these muscles: brain can learn a better way. I summoned the wisdom of my Feldenkrais teacher: "Do less, make less effort."
The voice review: Rachel could do better
First Natasha gathered my case history and tested the current state of my voice. She found "roughness, breathiness and mild aesthenia (weakness) ... creak quality in conversational and reading voice ... breath support slightly lower than expected ... reduced pitch range with increased gravelly quality at low pitch ... reduction in control of volume at times ..." In other words, "Rachel could do better."
I learned a lot about anatomy in the speech therapy sessions and I learned and practised exercises of three different types.
Gym programme for the voice
- First I learned ways to decrease muscle tension, any time any place. New ways to take a breath, sigh, yawn, and clear the throat.
- Secondly, I practised the "gold standard" fix-it exercises for times when my voice is scratchy or creaky. These involve controlling the amount of air you breathe out while making certain sounds through a straw in water.
- And thirdly, I was given vocal function exercises to do twice a day, every day, regardless. This is tried and true practice backed up by solid research. A daily programme has been shown to strengthen and balance all the laryngeal muscles, increase resonance, and improve muscular control and flexibility. This is a gym programme for the voice, with a physiological schedule and shape: "ee" (warm-up) "whoop" (stretching), "boom" (contracting), "knoll" (power).
As with any gym programme, knowledge is not enough. You have to actually do the time. And I do. I care that much.
Altogether I spent four sessions with Natasha, and since then I've become much more confident about my voice. It does get tired sometimes, and old-lady-voice reappears. But it's not an unpredictable enemy waiting to destroy me; it's a reminder to drink water, take a silent little breath, yawn and sigh, and keep up the exercise regime.
I have evidence already that the regime is working, and every confidence that it will continue to do. I know my brain has to unlearn bad habits, just as my body does. But it all depends on me, now.
How do you do, body
Perhaps the greatest benefit has been an immediate growth of awareness. Before visiting Peter the ENT specialist, I had no idea how much tension I was holding in my jaw and throat. After a simple diagnosis and brief therapy, I could actually see muscles twitching in my cheeks and neck. I never attained the Deirdre Barlow level of neck tension, but we were sisters under the crepy old skin. Now I consciously relax not only cheeks, jaws, neck and shoulders, but my larynx. I can pop my vocal chords open and shut at will. I can tell my larynx to lie down like a good dog, and it does.
Nevertheless, Natasha had more to offer. She suggested I get in touch with Peter Chum, a physiotherapist specialising in performers with voice problems. "I've worked on the inside. He'll work on the outside," she said.