Special Considerations for Professional Voice Users Before Surgery
Disclaimer: While I am a speech pathologist, I am not your speech pathologist. The information provided below is my own experiences and opinions. If you have medical questions on a personal level, please seek guidance from your medical team.
Did you know there are special considerations to make regarding your voice before you have surgery? Read on to make sure you’re up to speed before any future procedures!
The Backstory
As a singer and professional voice user, I avoided surgeries like the plague. I’ve refused removal of my wisdom teeth and gall bladder to avoid intubation. I’m not advocating to avoid necessary surgeries – nor am I trying to scare anyone about the risks of intubation. That being said, there really wasn’t another choice but to go under the knife to have my appendix removed in January 2019. Read on to learn about the special considerations I took into account.
I finally had no choice but to go under the knife to have my appendix removed in January 2019.
I arrived at a hospital emergency room in Delaware on New Year’s Day while we were visiting family for the holidays. There was a good deal of pain, but it was in my upper right quadrant – appendix pain is usually in the right lower quadrant. The ER doc felt it was probably a kidney stone – not ideal, but treatable with pain meds, or ablation. When the CT results came back that I had acute appendicitis, I cried.
When the CT results came back that I had acute appendicitis, I cried.
The First Decision I Had to Make
The surgical resident on-call came to talk to me. He said my options were antibiotics – with a 30% fail rate – or surgery. At first, I signed the consent form for surgery. As I sat waiting for the attending surgeon to come in, I realized a 30% fail rate meant a 70% success rate. I started to like those odds (and not needing to worry about intubation!) The ER nurse came when I pushed the call button, and I told her I had changed my mind.
It took another several hours, but I was eventually brought to a room and set up on IV antibiotics. I figured, if the antibiotics worked, I could make it back home where I knew everything was covered by my insurance and I’d get to choose my surgeon. Instead, I woke up the next morning to another resident asking me how I felt – I wasn’t any better. Surgery was my only option.
I was never scared of the actual surgery (it’s a fairly benign procedure – done so frequently every year). It was a fear of intubation. When a person is intubated, a tube is placed into the mouth and throat, through the vocal folds, and into the upper trachea to maintain a patient’s airway during surgical procedures. Some procedures allow for a laryngeal mask airway – which doesn’t go between the vocal folds. But for abdominal surgeries, they need to be able to control the patient’s breathing, so intubation is necessary (this was explained to me once by a surgeon I spoke with about taking out my gall bladder – I didn’t do it because of my fear of intubation, and I haven’t had a biliary colic since).
The Surgery I Couldn’t Avoid
I was on edge for the rest of the day until they came to get me at 1 in the afternoon to take me to surgery. The surgeon met me, and I assured her I didn’t have any concerns about the surgery she was going to do, but I really wanted a few minutes with the anesthesiologist to talk about my concerns as a singer. I did explain to the surgeon that I was a singer – this is important to tell every doctor with whom you come in contact because they may make different decisions with this in mind.
The anesthesiologist and nurse anesthetist both met with me right before the surgery. They put my nerves at ease (well, enough so that I agreed to continue on with the surgery). They agreed to use a glide scope and a number 5 intubation tube (this is a very small tube and reduces the risk of damage to the vocal folds). The glide scope would mean they could see my vocal folds while they were intubating me.
They agreed to use a glide scope and a number 5 intubation tube…
My Post-Op Outcome
Upon waking after the surgery, there was small amount of pain, but I was anxious to try my voice out. I did lip trills in the Post Anesthesia unit! Normal voicing was achievable for short periods. I was fairly certain my vocal folds were fine. The short duration was likely related to the decrease in breath control from the anesthesia and the pain with breathing.
I was lucky (and probably a typical outcome for this particular anesthesia team). When deciding on an ER, I picked the best hospital in the area, and had a good surgical and anesthesiology team. As a speech pathologist, I see the cases when patients aren’t as lucky as I was. I made sure to use the special considerations below.
If You’re a Professional Voice User, Please Keep the Following 3 Things in Mind:
Always tell all medical professionals you use your voice for a living – it may not seem like it, but this is an important piece of information for all of your doctors/surgeons, nurses, therapists, etc., to know.
When surgery is necessary, ask to speak with the anesthesiology team – even if it’s right before your surgery. Stress that you’re a professional voice user, and you want them to keep this in mind during the entire procedure. You can ask that they use a glide scope and the smallest endotracheal tube possible.
If you do notice voice changes for more than a day or two after surgery, ask for a laryngology consult to check things out. Don’t delay. It may significantly reduce the voice’s recovery time because you won’t have given the brain as much time to form a habit of vocal strain.
Want to learn more about how to care for your voice to keep it in good shape? Consider taking my course about vocal wellness!
Was this article helpful? Are there other special considerations you’ve had to make in the past? Let me know your thoughts or questions in the comments.