I would like to express how honored I am to do this interview. I have been an associated member of the New York Singing Teachers Association for more than 20 years and had the pleasure of associating with many of its members. As a voice care professional in New York City, it has been my singular privilege and pleasure to take care of so many singers from all genres. I hope some of the comments I make below can be of help either during your career or during a minor crisis.
What would you consider to be the main focus of your career, or your “specialty”?
The main focus of my career is the development of laryngology as a subspecialty within the field of otolaryngology. As you may or may not be aware, otolaryngology requires five years of additional residency training after completion of the medical degree. A subspecialty in laryngology, specializing in voice and swallow disorders, is something that is recent. Only within the last 20 years have we had a fellowship training program in laryngology. As someone who was interested in the larynx, it was necessary for me to focus my practice and energies independently before fellowship was available. So although I am not fellowship trained, I have focused my practice and academic interest in the area of laryngology since the completion of my residency. It has been my passion.
How did you discover your calling for your specialty?
I well remember the very first time I looked at the vocal folds in vibration as a 3rd year medical student with Dr. Stuart Strong. This was in 1977, when I was a 3rd year medical student. You can imagine what a surprise and revelation that was. We never studied that in medical school! My readings from that exposure led me to discover that the first person to look at the vocal folds was none other than Manuel Garcia, a well known singing teacher who published many papers on how to sing! We as otolaryngologists came to looking at vocal fold vibration only during the latter half of the 20th century. That was when I thought I could contribute as a physician interested in this new area of laryngology and voice disorders. When I finished my otolaryngology residency, the field of laryngology was in its infancy and the routine observation of the vocal folds in vibration was rare. I thought that I could make a difference. I focused my academic interest in this subspecialty.
How did it start?
In 1983, I had the good fortune to start in Syracuse, New York, with a group of like-minded physicians, PhDs, and singing teachers.
We started the first voice clinic in the mid-80s. At that time, we were all tenured people at SUNY Upstate who were paid to do research! The team was the first clinical voice clinic in the country. This was a multidisciplinary team composed of Dr. David Brewer (MD), Dr. Raymond Colton (PhD), Dr. Jeanina Casper (PhD), and myself. Eventually, we hired a research coordinator and a singer to join our team.
In those days, it was not uncommon for us to see just 6 patients for an entire afternoon. Each patient would be referred for a slot to see 4 or 5 different clinicians for 45 minute each. Each one of the clinicians had a different job. My job was to perform the videostroboscopy. Dr. David Brewer’s job was to perform the fiberoptic laryngoscopy. Dr. Raymond Colton’s job was to obtain acoustic and aerodynamic measures. Dr. Jeanine Casper was a speech pathologist and did therapeutic probes. We also eventually had singing teachers that joined our team from the local Tri-City opera system.
At the end of this grueling session, the patients were required to stay til the end of the day so that we as a team could get together and have a multidisciplinary conference similar to that of a cleft palate clinic. During the conference, we would present our own data and the synthesis of the voice problem. This allowed us to give a recommendation based on the group consensus of the case. I believe this was a very good multidisciplinary approach to voice problems. Little did we know that this was quite revolutionary at the time. It has become the standard in voice care today.
As a team, we attended the Voice Foundation meetings from the 1980s and I remember those as the most collegial, social, and academic gatherings of the beginning of my career.
What do you love the most about your work?
I really enjoyed that, as a clinician, I can continue to provide unique insights on pathology of voice production that I have gathered through my career and help patients with voice disorders and swallowing disorders. Not a single day goes by where I have not made a difference.
In your opinion, what qualities do you feel make an “excellent” Vocal Pedagogue?
Having worked with many vocal pedagogues in my career, I feel there are many qualities that would make an excellent vocal pedagogue. The qualities that I have found most prized are curiosity and an open mind. Curiosity to be not satisfied with the dogma that has been passed along in teaching is critical in exploring new approaches for vocal pedagogy. An open mind is critical to explore new techniques to facilitate voice production in young and established singers. Although it is important to have therapeutic authority in order to work with singers, it is also important to be humble enough to know that one does not know everything and that ongoing training and retraining is necessary to become outstanding in one’s field.
Can you speak to the importance of having mentors?
The importance of having a lifelong mentor cannot be overstressed. Early on as academic faculty, it was important to have a mentor. My early mentor, Dr. Brewer, took me to the Voice Foundation meetings and introduced me to his colleagues. At that time, I was surprised that he engaged me to be on panels and other activities at the Voice Foundation. During mid-career, a mentor is especially necessary, as often there are career decisions such as academic research versus clinical focus. Not only is it necessary to have mentorship, it is important to be associated with colleagues of like minds within your specialty. That is why meeting by travel continues to be important. That way during meetings and other non-formal gatherings one can bounce ideas off each other. We have tried to foster that feeling through the American Laryngological Association by having a candidate group where a mentor-mentee program has been established. It fosters communication between established laryngologists and young fellowship-trained laryngologists and clinicians.
How have mentors influenced your life/career?
Having research and clinical science mentors have certainly helped me to direct my area of interest. For example, Dr. Colton was one of the first to use the Rothenberg mask for measuring subglottic pressure and flow. Clearly this was his research interest, but that interest prompted me to look at vibratory physiology and quantification of vocal fold vibration. This resulted in my Triological thesis on quantification of vocal fold vibratory patterns. Since that time, additional interest in understanding vocal physiology has prompted us to move forward in using high-speed video for study of vocal fold vibration in voice production as well as in vocal pathology. All this started because of the simple need to understand what a research PhD was talking about.
Can you tell us about some of your mentors?
Some of the lifelong mentors that I have had the privilege to associate with have been in academia. Dr. Stan Shapshay has been a lifelong mentor since residency. He was also my chairman for a few years when I was faculty at Tufts University. During our 40+ year of association, he has always been willing to talk shop and advise me on academic pathways to achieve my goals. In addition, he was instrumental in getting me on the various committees of the national societies so that I could move forward in my academic career. I attribute me being the president of the various national organizations in otolaryngology to his interest in my academic career.
Another clinical mentor has been Dr. Hugh Biller. He was an outstanding clinician who taught me a way of thinking about the larynx and what surgical possibilities are possible. I think about how he would think about a clinical problem to this day.
Two other mentors when I was the resident were Dr. Stuart Strong and Dr. Charles Vaughn. Dr. Strong was the chairman of the department, and he would always ask the residents “Why are you doing that?” Dr. Charlie Vaughn on the other hand always asked the residents ”Why are you not doing that?” From these two people, I learned to question why as well as to ask the question why not.
Building Blocks – Questions About Ten Key Areas of Voice
When it comes to breathing, what are the most influential tips, insights or research findings that you would like to share with our audience?
Much of what I learned about breathing is from observing Phyllis Curtin in her master class seminar over 2 years. In 1994 and 1995, I was very fortunate to be able to audit her master class for two years. One afternoon per week during the academic year, I went to Boston University and observed her master class. Boy did that open my eyes. She taught us the importance of respiration and imagery in singing. I can now appreciate that singing is not just about sound production at the throat.
When it comes to the larynx, what are the most influential tips, insights or research findings that you would like to share with our audience?
The most amazing organ of the body responsible for sound production continues to be an area of fascination and research. The importance of interaction in breathing, oscillation source, and resonance continues to be an area of interest. Initially, we were primarily interested in recording vocal fold oscillation. Now we appreciate that vocal folds do not participate in vibration in isolation and that the entire system must be part of the integrated approach to understanding voice production. Thus we have done high speed videos using a fiberscope to look at fast phonation gestures such as staccato voice and glissando.
When it comes to the vocal folds, what are the most influential tips, insights or research findings that you would like to share with our audience?
I think the most important component of understanding vocal fold oscillation is that vocal folds cannot oscillate without lubrication. From doing many years of observation, as well as research, it is very clear that our understanding of mucosal hygiene is only at the beginning. Understanding the viscoelastic properties of the vocal fold cannot be done by understanding just the physical aspects of vibration. It must be done at a clinical level using experimental models such as using drugs, environmental changes, and therapeutic probes. This must be coupled with advanced state-of-the-art instrumentation such as high-speed video, phonatory airflow analysis, and even high flow and anemometry.
When it comes to acoustics/resonance, what are the most influential tips, insights or research findings that you would like to share with our audience?
I have always been impressed that singers with damaged vocal folds can still sing. This points to the fact that years of singing caused them to develop compensatory capabilities using acoustics and resonance that allows them to go on even when the primary source generator is not working to full capacity. More research must be done in this arena.
When it comes to registration, what are the most influential tips, insights or research findings that you would like to share with our audience?
I am certain that you would not want an ear, nose, and throat physician to open up the discussion regarding registration. This is especially if you have a mixed audience of classical and contemporary music singers reading this. I would like to plead the fifth.
When it comes to vocal health, what are the most influential tips, insights or research findings that you would like to share with our audience?
Having a good understanding of vocal health by a singer is critical to a long-lasting career. Almost all my well-established singers will have good days and bad days related to their vocal health. They, as voice professionals, will have learned how to manipulate their instrument and the singing characteristics to be able to go on. With that said, vocal health and avoidance of injury is critical to a long career. Allergies, acid reflux laryngitis, and phonotrauma are the big 3 that contribute to poor vocal health. This will produce thick mucus, sense of swelling, and inability to phonate at a very low phonatory threshold. Therefore, understanding your risk factors related to health and vocal exposure is critical to a long career.
When it comes to style, what are the most influential tips, insights or research findings that you would like to share with our audience?
During the pandemic, we have seen very many singers switch between different styles. Much of this is necessary in order to continue to remain fully employed. We have seen classical singers switch to rap as well as Broadway singers switch to cruise line singing (all honorable careers!). Therefore, it would be erroneous for me to believe that a classical singer should stay a classical singer. However, it does not come without major knowledge and adjustment in the singing. For that, I will leave that to better educated vocal pedagogues.
When it comes to posture, what are the most influential tips, insights or research findings that you would like to share with our audience?
Only by attending many years of Voice Foundation workshops and other voice seminars devoted to professional voice have I learned the importance of posture, alignment and kinesiology. As I see singers with muscle tension dysphonia as well as neck pain, I am increasingly referring these patients for osteopathic manipulation, physical therapy, and mind-body work.
When it comes to teaching methods or communicating complex ideas about singing, what are the most influential tips, insights or research findings that you would like to share with our audience?
I leave that to all the faculty that present at the Voice Foundation
Final Thoughts (Words of Wisdom, Books, Resources)?
If you are reading this, you must be one of the special people that are interested in expanding your horizons in voice care. The field, especially voice production in singers, is ready for better clinicians and scientists. When I met with Jeanette Lovetri more than 25 years ago in New York to explore professional development programs for the New York Singing Teacher Association, I made it clear that professional certification is not the first goal but the final goal. What is clear and necessary at the beginning is a desire for a sense of excellence based on science and the art of singing and teaching of singing. Therefore, further development of the field will depend on a core cadre of like minded individuals. This core group is critical in continuing to develop the field of voice science in singing. I encourage all of you reading this to form an organization of like minded individuals with a charge to advance the science and clinical care of singing teachers through your organization. Perhaps this can be through a singing science interest group. Have regular meetings that are based on science with curious and opened-minded people. If you do this consistently, your world will flourish.
Please note that Peak Woo is not affiliated with VocalPedagogy.com and we do not disclose contact information. We hope you enjoy the interview!