Hello everyone and thank you for reading! I am the current intern at the Groovy Garfoose, with only a month left! It has been such a long journey and I am excited to continue my journey to becoming a board-certified music therapist. As a music-therapist-in training, my journey has been more of a struggle since I discovered I had some major vocal and auditory issues. I would like to share some of this experience.
The first major issue started early in high school and involved a strained feeling in my voice when I sang. By sophomore year of music therapy coursework and clinicals, I started to feel a painful, uncomfortable swelling feeling in the back of my throat as well. It became so bad that I could barely sing, and ended up on vocal rest. I quickly made an appointment with a doctor who I was told was a voice specialist. I waited 3 weeks for the appointment, missed 2 performances, and when I arrived he wasn’t a voice specialist at all. I was extremely frustrated, got no answers, and continued on in my degree. I let myself believe that I probably didn’t need a specialist and I’m probably just overthinking my issues.
In January of 2019, I realized that I really, truly, needed help before my internship started in August. I couldn’t sing without extreme tightness and pain, and felt like I could be doing permanent damage. I saw an actual voice specialist this time, thankfully. He discovered I had no vocal nodes and there was no surgery needed, but had no additional answers for my symptoms.
In addition to my vocal issues, around this same time during my final semester, I had somehow acquired tinnitus – a ringing or other repetitive noise in the ears that can be a precursor to hearing loss. Whenever it would happen for me, there was a rumbling noise like water in my right ear so loud that I couldn’t hear anything for 10 or more seconds. There was no “loud event” in my life I could think of that might have caused it.
The bad news didn’t end. Once the rumbling of the tinnitus stopped after a few months (it only shows up occasionally now), I discovered my hearing was extremely sensitive. Loud noises make me dizzy and feel a hard-to-describe pain in my ears. Lots of noise such as large crowds at events overstimulate me. Quiet but repetitive noise like electricity buzzing in the walls or my wrist watch ticking send me over the edge. I had been wearing special musicians ear plugs at loud events since the tinnitus began, but there’s only so much that they can do once the symptoms began.
All of this to say that I was very worried. I was trying to become a music therapist to help others, but I could barely sing and am oversensitive to noise?! I began to ask myself the hard questions: should I continue, or is my body telling me this isn’t for me? Are these things manageable over time or is this going to be a hardship for me forever?
Better News
As my vocal problems were not improving, I saw the previous voice specialist a second time and he gave me no new information, and seemed in a rush to get me out the door. Wonderfully frustrating! A couple months later I had a break in my internship and I went to see a new voice specialist at the Cleveland Clinic on November 25th. Within 10 minutes of the appointment starting, she had given me a diagnosis: muscle tension dysphonia. I finally had some answers! She also said the magic words “this is treatable”.
Throughout my internship I have had voice therapy with her every other week to retrain my muscles not to tense up when I sing. It ended up being a side effect of my childhood perfectionism: I was trying so hard to push out the correct pitches that I was straining the muscles of my throat and the base of my tongue, which became muscle memory every time I sang. I am still in the process of working on this, but I now have the tools I need to work on it on my own, and I feel so much better. Some days are still difficult and I will have to learn to adapt my session plans around this so I don’t strain myself. However, if I keep working hard on my technique and re-training those muscles, eventually I won’t have to worry about difficult voice days much at all.
Managing Stress and Accomodations
As for the auditory issues, things are not improving.
On February 25th, I saw an ENT with a specialty in the “E”. She quickly diagnosed me with hyperacusis. This is often related to tinnitus, and she said that the tinnitus, hyperacusis, muscle tension dysphonia, and a variety of other health conditions on my chart could all be very well related to one thing: anxiety and stress.
“Hyperacusis can’t be cured, so you’ll just have to manage your stress,” she said.
As music therapists, we know how important it is to manage stress and anxiety. Stress can lead to many serious health problems – as I now understand personally. However, I felt I was handling my stress pretty well overall. The questions came back- am I in the wrong program? Do I need a quiet and relatively stress-free environment to cope?
I decided no, definitely not right now. I will just have to make accommodations for the rest of my life- and that’s a reality for millions of people with varying disabilities and chronic conditions.
Some accommodations I have already made in my personal life have affected my life minimally. I no longer wear an analog wrist watch- the ticking is unmanageable when I’m alone in my quiet apartment. I always wear earplugs at music events, parties, and noisy restaurants. I have rerouted my quarantine walks so I am as far away as possible from noisy traffic – especially motorcycles.
Some things I can’t predict and protect myself from at all times. For example, if I’m out on errands and a loud car drives by, I could be in pain and oversensitive for the next 8-12 hours. I remember almost passing out from the pain at my college graduation ceremony when someone next to me in the crowd did a loud whistle-cheer for their graduate.
How to Continue as a Music Therapist
In regards to my professional life of music therapy, I don’t know all my accomodations yet. Especially now, given all the changes in the way we work as music therapists during the pandemic. Virtual sessions over Zoom are extremely overwhelming for my ears, especially if there’s any sort of microphone feedback, even if it’s very quiet. Before the pandemic, in-person sessions were sometimes too much for certain spaces and instruments, especially group sessions.
I’m not fully aware of every single noise or situation that will negatively affect me, but I will have to keep working on that. The answers to the hard questions now are:
Should I continue?
Yes.
Are these things manageable over time or is this going to be a hardship for me forever?
I will have to see, but for now, yes.
Why am I telling this story?
I wanted to share my story so others can learn from these experiences. I have three main takeaways from my experience.
Consider Your Clients’ Experience
I challenge everyone to be more mindful of which instruments or situations may be more grating to the ears of people with hearing loss or sensory processing disorders.
For me, tambourines, bells, and sometimes maracas and ocean drums can make me uncomfortable, especially in a small, closed space or echoey space. The maracas can sound like loud radio static, the bells cacophonic and chaotic. There are some ways to adapt handheld instruments for clients, such as putting some cloth athletic tape over rhythm sticks. This dampens the sound without making it too quiet.
Something else important to your own vocal health as well as clients ability to hear and process the session is using a personal amplification system. This is a double edged sword however, because amplified vocals and feedback from the equipment can also be very painful for after long sessions.
Take Care of Your Voice and Prevent Damage to Your Hearing
Now that I have gone through voice therapy, one of the most important parts of my day is a long vocal warmup. This is something I think music therapists can forget about in the hustle and bustle of our profession, or just plain aren’t given the time/space to do. I know this is something we all know, but just a healthy reminder since we use our voices so much.
Another important part of my vocal strain that I worked on in voice therapy is the tone of my speaking voice. I usually talk in a pretty low tone which can lead to vocal fry, and would leave my throat in pain after a few hours as well. Keep this in mind as you’re waking up and getting ready for your day before a long day of sessions.
As for your ears, please wear ear plugs when you can! I’m talking concerts, working with machinery, anything that could expose you to high decibels for a long period of time or even in short bursts. I want to remind you that tinnitus and hyperacusis are currently incurable, and although we can’t predict when a loud event might trigger this, having earplugs can protect your auditory health. The pair I have are from amazon and came with a tiny carrying case for my keychain. I take them everywhere!
Advocate for Yourself
The most important part of this journey was acknowledging that something was actually wrong, and having the strength to be vulnerable and ask for what I needed, even if it meant trying multiple times to be heard. For you this might mean you need to finally schedule that doctor’s appointment or even inform superiors or other supports in your life what you might need if you’re having an off day. Of course we may not immediately get the support we were looking for, but every time you speak up for your needs it will become easier to advocate for yourself in the future.
In conclusion, we must be mindful of what our bodies are telling us. We need to understand our own limits and take the necessary steps to stop pushing ourselves toward irreversible damage. As music therapists, we must be vulnerable enough to admit we are not perfect and might need the help of others, just as our clients benefit from help from us. We want to be able to do whatever we can to provide the best music therapy services, and of course that means we have to take care of ourselves first.
Thanks for reading,
Leah
Paulin J., Andersson L., & Nordin S. (2016). Characteristics of hyperacusis in the general population. Noise Health,18, 178–184. doi: 10.4103/1463-1741.189244.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187659/
Hyperacusis Info from the British Tinnitus Association:
https://www.tinnitus.org.uk/hyperacusis