Diplophonia

Even though Alan Lindquest was not trained specifically as a vocal therapist (the profession was in it's infancy at the time.), he did become a very important pioneer in that field. His unending dedication and hard work toward helping those with vocal damage inspired many to study the effects of these vocal exercises on the damaged voice; including my friend Dr. Barbara Mathis of Lamar University in Beaumont, Texas. I remember not too long ago, I was listening to a tape of Lindquest working with an extremely damaged voice. This woman literally could barely phonate at the beginning of the session. He continued to be positive yet diligent in his work with her throughout the hour. Even though it was extremely difficult for her to execute the exercises throughout the first half of the lesson, miraculously she began to find a solid tonal quality toward the middle of the tape. Lindquest's love of people and convincing positive attitude inspired this woman to succeed.

My friend, Dr. Barbara Mathis, performed her doctoral research with the use of the Lindquest exercises on extremely damaged voices. She documented the vocal progress through the use of the fiberoptic camera. It was in the office of Dr. Van Lawrence, then laryngologist for the Houston Grand Opera, that Dr. Mathis made such groundbreaking discoveries using Alan Lindquest's vocal exercises. She is now respected as one of the finest vocal technicians in the country.

I acquired this particular tape of Lindquest working with a damaged voice in 1993 while visiting his widow, Martha Lindquest, in Virginia. I had contacted her many years after my study with Lindquest and she was gracious enough to have me come and visit her. She shared many photographs and tapes of Lindquest both teaching and performing. There were several aspects of Lindquest's teaching on this tape that struck me as exceptional. The first aspect of his teaching that impressed me as exceptional was his great patience with the client. This woman suffered extreme vocal damage, yet his supportive kindness was present throughout the tape. Another aspect of his attitude was his determination that she could definitely be successful if the exercises were performed correctly. This belief became more and more contagious as the hour progressed. You can actually hear this woman's attitude change during the hour greatly because of his positive input toward the work plus the undying belief that success was inevitable. Lindquest beautifully executed his exercises using Garcia's 'coup de glotte'.

I have worked with many damaged voices in the 30 years I have had access to this vocal work. I have not once found a voice that could not benefit from these exercises. Recently, I had the opportunity and experience of working with two young singers suffering from the same vocal dysfunction; diplophonia. Diplophonia is a condition whereby the vocal cords produce more than one note at the same time. It is defined as a double or multiple tone, usually associated with differential tension of the vocal folds. As you will read later, these two singers were both successful in solving their vocal difficulties.

Case Study #1

Lyric Tenor: Diagnosed 9 years ago. The original vocal dysfunction subsided after a short time until 3 years ago. Throughout the last 3 years, this young man has been to multiple voice teachers, voice therapists, and laryngologists. He has had abdominal surgery to tighten the valve just above the stomach in order to correct the condition of reflux. Also, he has had vocal cord surgery for the realignment of the right vocal cord. Neither of the surgeries was successful in solving his vocal dysfunction called diplophonia.
This young man contacted me several months ago through this web site. He asked several technical questions and I was able to answer him with some concrete solutions that have proved to be successful. The primary reason that I was familiar with the condition was due to the fact that I had worked with a young mezzo with the same condition. He immediately contacted me regarding his success at practicing without the diplophonia interfering with the purity of tonal quality. It was at that time that he decided to come to New York and study in my studio for 4 days. Within the first 5 minutes of vocalization I was able to see much of the problem. His jaw was thrusting forward which was causing incredible pressure at the root of the tongue. He also suffered from a high larynx. (See article on damaging vocal techniques.) The resulting vocal difficulty was several pitches sounding at one time caused by muscular diplophonia. At the end of his previous therapy, he was told that nothing else could be done. In fact the singer was basically blamed for the condition. The vocal therapist simply said you are 'doing something' (nothing was explained in terms of a solution.) and until you stop, the condition will continue to be a problem. At this point, this singer was at the end of his rope and was desperately seeking solid vocal help that would allow him to recover his beautiful tenor voice. It was timely that he found my web site and we had the opportunity to work together. In a matter of 4 sessions this young tenor could vocalize to high E-flat above high C. Through the use of the Caruso scale he was able to realign his passaggio without any interference of the high larynx. The thrusting forward of the jaw was yet again the culprit of major vocal trouble for this young singer. Dr. Barbara Mathis has proven through her research that the vocal cords do NOT approximate closely when the jaw is thrusting forward out of its socket. We are all fortunate indeed that she spent so much time and energy performing her vocal research through the use of fiberoptics.

Upon his return to Michigan, this young tenor began to develop problems yet again. At first, I was concerned that I had missed a piece of the puzzle in his vocal distress. He returned to New York for a second set of lessons and the problem was completely solved. I took him to Dr. Anat Keidar, voice pathologist for Dr. Anthony Jahn's Laryngology Office. Indeed she gave him a clean bill of health and confirmed that the problem was a direct result of a high larynx accompanied by tremendous tongue pressure. The next few lessons were life altering in that the voice began to open beautifully from working toward a lower larynx position. The registers began to blend and the voice had NO sign of diplophonia. It is critical that voice therapists (i.e. Dr. Anat Keidar) and teachers realize the importance of a lower larynx position and the vocal healthy benefits that result. I am speaking of a slightly low larynx without pressure in the root of the tongue. It is important that both the tongue and larynx pressure be addressed simultaneously and corrected. This singer was soon singing arias with great beauty of tone and vocal alignment. Muscular diplophonia is quite easy to correct if the focus of instruction is directed toward tongue and larynx release. I have encouraged this young singer to work toward becoming a master teacher, especially considering that he has had a lot of vocal problems himself and knows the journey back to vocal health. This is another situation whereby a young singer was encouraged to 'lighten the voice' by raising the larynx. It is critical that university and conservatory teachers address this chronic problem which occurs repeatedly in young singers. In this case this attitude of 'lightening the voice' artificially has almost cost a young man his voice permanently, calling for great extremes such as unnecessary vocal cord surgery and abdominal surgery for reflux. I would hope that vocal therapists, teachers, and laryngogists would become more aware that muscular diplophonia is correctable and it need not cost someone their voice.

Case #2 Mezzo Soprano

In the summer of 2000, a young mezzo from the Western region of the United States first contacted me. She had received both her Bachelor's and Master's Degrees as a performance major from a prominent university. Yet she was still suffering from this condition called diplophonia. When she explained it to me on the telephone, I remembered that I had once worked with a Broadway singer who suffered this condition years ago. She wished to make the trip to New York to study with me and see if anything could be done about the diplophonia. I agreed that I would be happy to work with her even though I could make no promises for success.

It is a continual shock to me to hear what some singers are told by professionals in the field. When this mezzo was only 26 years of age, a laryngologist had told her that she probably would not be able to become a singer. One vocal cord was shaped differently from the other. (Most singers do not have two perfectly aligned vocal cords.) At her first session in my voice studio, I noticed a thrust of the jaw yet again accompanied by a high larynx. Also, there was absolutely no body support under the voice, so the singer was beginning the tone (see article on onset or attack.) with the lifting of the larynx instead of resisting the breath pressure with the lower body muscles. We began to work diligently and within the first few minutes this singer could begin to phonate without the diplophonia (multiple pitches). At the moment clear phonation began to happen, the singer became completely shocked and surprised to be able to make a clear tone without the condition of diplophonia presenting itself. She has returned for multiple sessions and the progress has been steadily moving in a positive direction. This singer also fights the condition of reflux (stomach acid under the vocal cords.) and when this condition is controlled along with the release of a slightly down and back jaw position and lower larynx position, the diplophonia disappears. This is yet another testimony of the work of Alan Lindquest that was passed on to me by him in 1979. I also studied with Virginia Botkin, student of Lindquest, at the University of North Texas. Having multiple exposure to these concepts has given me the ability to help singers with this condition and I am grateful for the study, which has offered me this knowledge.

During the vocal sessions with these two singers, I realized the great benefit of the Flagstad 'ng'. While instructing these singers in this exercise it was extremely important to help the singer release the root of the tongue 'wide' instead of 'bunched'. When the root of the tongue is bunched, the diplophonia was much more present and it became a common part of instruction to help the singer past this vocal difficulty. I usually had the singer visualize the root of the tongue as 'wide not bunched'. This never failed to work during these sessions if accompanied by a lower larynx position. Usually tongue pressure is a partner of breath pressure and contributes to the vocal problems mentioned above.

The Fear Reflex: Physical Reaction

The fear reflex in singers is a fascinating part of human behavior to observe. If a singer has had a specific vocal difficulty, then the minute the fear reflex happens, the old problem comes back almost immediately. This is where Alan Lindquest was brilliant. He was convinced that the emotion of joy combined with laughter could help almost any singer overcome vocal difficulty. In actuality, it is a distraction from the old neurological reflexes that are stored in the muscles. Overcoming the fear reflex through the use of the 'joyful surprise breath' and other images aligned with this emotion helps the singer to overcome the old vocal habits through bypassing the 'fear reflex'.

The psychological factor is critical when working with vocal damage. While the desire for success is there, the old fear reflex can return and distort healthy vocalism.

I am now in the process of documenting these case studies on recording and I believe that the Lindquest exercises can help many singers with such vocal damage. If one has this condition of diplophonia, it does not mean they will never be able to sing again. When major tongue pressure is present at the root of the tongue, the body has to push breath pressure to force phonation. However, the result is usually lack of clear phonation.

For those who are suffering from diplophonia, I suggest they contact Dr. Anat Keidar in the laryngology office of Dr. Anthony Jahn in New York City.

Characteristics Accompanying Muscular Diplophonia

(1) Bunched and tight tongue which sits pressure on the larynx.
(2) Tremendous breath pressure to try and force phonation.
(3) Absence of register blend.
(4) Vowel distortion.
(5) Jaw forward.
(6) High larynx position.
(7) Inability to sing soft.
(8) Difficulty in taking a low and relaxed breath.
(9) History of 'placing' the voice too forward.
(10) Emotional fear reflex, usually starting at one given pitch. Usually accompanied with a sudden push or breath pressure resulting in a severe gag reflex at the root of the tongue.

(c) David L. Jones/2001

Please direct questions to info@voiceteacher.com