Published on September 21, 2016
Pleased to post an interview with Carly Cantor, MS., CCC-SLP, voice pathologist, singing voice specialist. She is a musical theater guru~~
TVF: Where do you currently practice/teach?
CC: I currently practice at the Columbia University's Otolaryngology Head and Neck Surgery Department with Dr. Michael Pitman and Amy Cooper, M.S., CCC-SLP
TVF: What is your main patient population?
CC: I mostly see voice patients of all sorts (i.e. typical voice disorders, VCD, chronic cough, reflux, etc), with singers included. I also very much enjoy seeing pediatric voice patients. Occasionally, I see dysphagia patients and laryngectomy patients as well.
TVF: Where did you complete your education/training in voice and who have been your mentors?
CC: I went to graduate school at New York University where I was lucky enough to meet Shirley Gherson, M.A, CCC-SLP who works at the NYU Rusk Institute of Rehabilitation. She mentored me throughout my whole time at graduate school and has continued to mentor me now from afar and be an integral part in my success in this field. I then completed my final graduate externship and Clinical Fellowship at the Blaine Block Institute for Voice Analysis/Professional Voice Center of Cincinnati under Dr. Wendy LeBorgne, Ph.D., CCC-SLP who has been a mentor of mine in this field since I was 13 years old and is the reason I got into field of voice.
TVF: What motivated you to dedicate yourself to the field of voice?
CC: I have not yet mentioned that I am a singer/performer myself and I have been performing since the age of 4. I actually went to Northwestern University for undergrad and majored in Musical Theatre. When I was 13 years old, I had been a camp counselor for the summer (and was belting my heart out to Kelly Clarkson's new album every day in the car) and lost my head voice. I thought for sure I would never sing again. That's when I was sent to the Professional Voice Center of Cincinnati and was diagnosed with nodules and met Wendy LeBorgne. I went through therapy for a few months and it changed my life. I loved going to therapy because Wendy was so positive and my sessions were amazing. I thought the vocal mechanism was so cool. I had always been a good student and loved getting good grades, but I never actually liked learning...except for about the voice. When I got to high school, I asked Wendy if I could observe her during the summers, and I did that during a few of my high school years and one summer during college. I knew that I wanted to work for Wendy someday....I still think in disbelief some days that I actually do this for a living. I love my job.
TVF: What comes to your mind as one of the most pressing issues in contemporary voice disorders?
CC: I would have to say that the way music editing has evolved, is becoming more and more of a risk for voice disorders. Our young singers hear these nearly impossible vocal tasks on the radio and don't realize that this has been edited or the singers have been given some help and they aren't replicating it over and over again. Whenever I give a vocal health talk to young singers, I always use the example of "Let it Go" from Frozen. How many of us know kids that sing this over and over and over again? Also, how many of us know the video of Idina Menzel trying to sing it live? The recording and the live don't match. So our kids should be warned that if they sing it over and over again, some risk may come.
TVF: Do you think this is an international issue or specific to your country?
CC: I am honestly not as familiar with other country's music styles currently as I should be......but I have to believe this is an international issue. I know at least in Japan, their pop music is extremely edited.
TVF: Do you have research interest(s)? Would you tell us in layman’s term, what your research is about?
CC: I have always had so many questions about voice, but never really understood how to put them into actual research questions. Since I've been a clinician in a practice, I've had some help solidifying them. Currently, I am working on a research project that looks at pediatrician's ability to appropriately recognize hoarseness in children's voices. Other questions of mine include why some smokers get some type of minimal vocal fold effect, while others get something like polypoid degeneration. But I know that's probably not something that can be answered right now. Things I like to look at that are reasonable to research currently, usually have to do with auditory perception, as I think it's so interesting how people, including voice experts, hear sound differently. For example, I love talking about mix voice and how people describe it. I'd love my next research project to be something involved with mixing using both auditory data and actual stroboscopy data.
TVF: Which vocal myth would you like to dispel?
CC: I'd like to dispel the myth that a shot of alcohol is good to take before performance. As a past and current performer, I definitely bought into a lot of the myths such as drinking 10 packs of throat coat tea per day, and coating my throat with singer's saving grace, but the alcohol one I never got even as an uneducated singer. Alcohol is dehydrating and being dehydrated can cause excess friction to the folds, which in turn can cause swelling to the folds. The only benefit to a shot of whiskey may be if the singer has severe performance anxiety ;)
TVF: What is your most memorable voice case?
CC: This question is hard, but I would have to say my most memorable case was a little 8 year old girl I had who was presented with dysphonia and severe sore throat/neck tenderness. She had reportedly fallen off of a Teeter Totter and gotten hit in the throat with one of the handles. Right after that incident, she became completely aphonic for approximately three days and was complaining of a sore throat. They took her to the doctor and found out she coincidentally had strep throat. Our ENT who flex scoped her initially diagnosed her with a left vocal process granuloma??!! A rigid scope was also attempted by my colleague who saw her for her first exam at our clinic, but the little girl could not tolerate the rigid scope, so we did not get those images. The granuloma diagnosis was such an unexpected outcome! The 8 year old patient got put on my schedule and we began working together on strategies to reduce the granuloma (i.e. decreasing throat clearing and decreasing coughing and staying away from juices and pizza sauce and other acidities as able for an 8 year old). We also began working on voice because she was very pressed and breathy. We did some SOVT exercises, with and without resistance, and some resonant voice therapy to try and improve vocal quality and decrease excess supraglottic compression. Every time she came in, she complained that her throat hurt to the touch and that she was worried someone was going to touch it. In the meantime, her voice quality was not improving at all. After about three sessions, I decided to bring her to the myofascial room and try some myofascial release/laryngeal massage. It quickly became evident to me, that she was experiencing a combination of significant myofascial pain and a sort of laryngospasms because when I would touch her ever so lightly, she reported that it "hurt and felt like she couldn't breathe like when she got hit in the throat." When I taught her laryngeal control exercises, she said the feeling went away and she tolerated a harder touch. Long story short, I saw this patient 1 to 2 times every week for two-three weeks doing only myofascial release and reminding her not to throat clear/cough. We also talked about eliminating phonotrauma and conservative voice use as able. This patient was not much of a yeller, but she was a "weird voice user" (i.e. she loved mimicking people in strange voices that was very phonotraumatic. So we worked on showing her personality in a less phonotraumatic way). During the middle of all of our sessions, she allowed me to try the rigid strobe again and after many tries, we got a very limited view of her folds showing that the left vocal process granuloma was causing the left true vocal fold to be erythematous and very limited in vibration which explained the voice issues more, so I also started her on modified vocal function exercises on SOVT with resistance. After about two months of the above mentioned therapy and lots of tears/hugs from both this little girl and her mother, she walked in one day with a significantly improved voice, so we performed a re-strobe and the granuloma was completely resolved.
I'll never forget this case because the little girl was so compliant and worked so hard and it was such a strange case that made me think on my toes nonstop and work way outside of my day to day routine!
TVF: Do you have a vocal pet peeve and why?
CC: It would definitely have to be disengaged singing. I don't mean falsetto or head voice or a strong CT dominant voice, I mean that really weak, back focused, non-resonant singing that is often done in the mid-range/chest range. I have worked with a lot of older patients or completely untrained singer patients who sing for me for the first time and the first thing that comes out of their mouth is this sound. It’s immediately the first thing I work on with a combo of resonant voice work into "speaking singing" exercises. That's not to say they have to become belters or contemporary singers or that I'm trying to change their style at all...but that type of singing is just inefficient singing and it’s fatiguing. When I hear singers in a show sing like that, it’s over for me…it drives me NUTS.
TVF: As a voice pathologist/educator/researcher, what keeps you on your toes?
CC: Singers that are more skilled as vocalists than I! I know that I can still teach them things about their voices and about vocal health because I know more about the mechanism and how to keep it healthy...but any time I get a singer in the room as a patient and we get to the singing voice therapy part of our sessions, I always end up second guessing myself because of their vocal skills. But I always end up knowing exactly what to do and how to help them. But being a young clinician still, that definitely keeps me on my toes to keep learning, researching, and keep my own voice and skills in shape. I still take lessons myself and continue to perform not only to keep my own voice healthy, but to keep gaining current knowledge to help my patients.
TVF: What advice do you have for aspiring voice pathologists?
CC: Networking is the key in this field. It’s a small field filled with talented individuals! Go to conferences, meet people, and observe at clinics! Gather any and all information you can from voice pathologists, laryngologists, voice teachers, etc. Meet people and stay in touch! People in the field are busy but friendly!
TVF: What advice would you like to give to the general populace about voice care? How about to the professional voice users?
CC: To the general populace I like to give a few simple rules...
1. There is no need for excessive soda intake. Yes, everyone needs a cup of coffee or two in the morning and if you are someone who loves soda and you want one every now and then for a craving, fine. But, to be drinking more than one can of soda per day is completely unnecessary and can be a huge cause of reflux issues.
2. Don't yell at sporting events or concerts, or sing along at concerts for that matter. Just don't do it. No one can hear you anyway and it’s a waste of voice use/phonotrauma. Using your body to demonstrate cheering is way more effective in those scenarios.
3. Water is important. If you hate water (as many of my patients complain of), then start with flavored water...but over time it’s important to transition to regular water as those flavored waters can be very acidic. Water doesn't have to be the only form of liquid intake, but it does need to be an integral part of liquid intake in order to allow for adequate hydration.
4. Voice naps are wonderful! If you did accidentally overuse your voice...give it a rest for an hour or so. Even if you didn't overuse it per say, just give it a short rest every once in a while. It’s a great way to keep it healthy.
To the professional voice users:
1. All of the above applies.
2. Aside from all of the knowledge we know about how to keep a singer's voice healthy, I like to tell my professional voice users to be prepared with knowledge about their voice i.e. what are red flags of a problem, what can be problems, how do you fix them, etc...but most importantly I like to tell them that mostly everything can be fixed! A neurotic, nervous, singer is going to get themselves into more trouble than one singing freely without inhibition. Having been an injured performer myself (more than once), I like to calm professional voice users down while at the same time making sure they understand the severity of an injury.
TVF: Who are your favorite singers?
CC: My favorite singers really change all the time. The voice types I like are definitely contemporary and they are those smooth buttery voices that are very agile and effortless...like right now I could listen to Jeremy Jordan or Tori Kelly sing all day. I also really love Elle King's voice when I am listening objectively because she's so distinct and cool, but sometimes the voice pathologist in me can't help but only focus on the rasp in her voice and get distracted ;)
TVF: What sparks “joy” for you as a person?
CC: For me, "joy" equals, sitting at home on the couch after a long day with my fiancé, watching TV, eating a snack that usually has peanut butter in it. Life is busy and I enjoy the quiet time.