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This is a case of a 24 year old male professional singer who has noted gradual loss of vocal range over the past year. He has had increased demands over that period of time but is studying with a vocal coach. He feels that he is technically proficient, and this is reaffirmed by a conversation with the vocal coach. There has been gradual onset of a ‘rattle’ or ‘gravel’ sound in his voice that he cannot avoid. This is now present in his speaking voice in addition to his singing voice. He used to only experience hoarseness after performances or a lengthy studio session but now feels it is more consistent and takes longer to recover. He has no medical problems but smokes marijuana once a day, in the morning, through a vaporizer. He is fastidious about keeping it clean and is very particular about his diet. He is gluten-free and does not consume any reflux triggers. He has been tested for allergies and is negative.
On exam, he has a rough-sounding voice. Singing task testing demonstrates strain in the upper register and increased raspiness. Higher notes are only achieved with increased volume; he is unable to sing softly in his upper register. Videostroboscopy was performed and is presented here:
The video demonstrates significant vocal fold edema (swelling). It is moderate in nature and is prohibiting normal vibration and closure. On inspiration, there is visible inward displacement of vocal fold mucosa, because it is so swollen it becomes “floppy” and can be pulled in with inspiration.
This patient is suffering from moderate laryngitis. Laryngitis simply means inflammation of the larynx; it is not a true diagnosis. Diagnosis must be focused on the cause of the laryngitis. Is it overuse? Reflux? Allergies? Careful questioning did not elicit any other source of this patient’s laryngitis aside from his marijuana use. Smoking, even once a day, can cause this degree of laryngitis. Young singers often find they are able to accommodate the swelling but as the mid-twenties approach, the recoverability of the voice seems to diminish. Symptoms begin to develop. For example, the untrained voice often becomes tired and effortful in this age group. Smoking cessation was recommended and the patient has decided against the recommendation. Follow up will be provided as available.
To learn more about Dr. Reena Gupta or marijuana and the voice, please visit www.voicedoctorla.com.
