Vocal Vitality: Innovations in Voice Care

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology - head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology. 

Today I'm excited to be joined by a colleague from outside of Cleveland Clinic, Dr. Nick Klein. Nick leads The Voice Studio of Dr. Nick Klein. He's also the co-organizer of the Northwest Voice Conference: The Art and Science of the Performing Voice, which took place at the end of April.

Dr. Klein, welcome to Head and Neck Innovations.

Nick Klein: Thank you for having me. Excited to be here.

Paul Bryson: Well, hey, if you would, let's start by having you share some of your background on yourself for our listeners. Our audience is everyone from medical professionals to potential patients. So feel free to just tell us a little bit about yourself.

Nick Klein: Sure. So primarily I'm a singer and voice teacher. I am based here in Cleveland, Ohio. I grew up in Cleveland, Ohio. I did some schooling, bachelor's degree and master's degree in music education down in Columbus, Ohio. I taught public school for seven years.

Following that, I actually had a vocal injury myself that took me out of my classroom. After recovering from that, I decided that I wanted to go pursue more schooling to get into more professional level singing. And I wound up at the University of Washington out in Seattle, studied with both Tom Harper, who's a world-renowned tenor out there, and Dr. Kari Ragan, who is on voice faculty or was on voice faculty and is a singing voice rehabilitation specialist who works with the University of Washington Medical Center Laryngology Department. So I have been connected with her for a while, moved back to Cleveland to take an academic position.

But now I'm freelancing at my independent studio, The Voice Studio of Dr. Nick Klein, and I'm also doing some singing and voice recovery work myself.

Paul Bryson: Well, Dr. Klein, it's great to have you on the podcast. I wanted to just start by asking, tell us a little bit more about being a singing voice specialist.

Nick Klein: So being a singing voice specialist is a really unique opportunity. It's a privilege. We get to work with singers who have some type of a diagnosis for vocal fold injury or disorder. So whether it's muscular tension dysphonia to some type of a lesion or whatever the case might be. And we get to be a part of their journey of recovery. So we take them from the medical side of that diagnosis and working through their speech therapy, and we try to build them back up to their efficient, sustainable, functional, healthy singing.

Paul Bryson: Well, it's great to have you back in the city. I know just from hearing your background, I mean, you've kind of touched upon all facets of the performer's journey from training to performing to having additional training to teach others and direct others. And then also recovering from a vocal injury yourself.

Nick Klein: Yes. I've been really fortunate that even in unfortunate experiences I've always gained and learned something from it, and it gives me really unique perspective. Especially in this endeavor where I am working with singers with vocal injuries, having experienced that myself.

Paul Bryson: And this can be speakers and singers across the age and professional spectrum too, from younger aspiring performers to more established people that may be quite veteran in their craft.

Nick Klein: Yeah, absolutely. I mean, I work with a wide variety of singers. The majority of my singers are pre-professional or professional singers, but I have adult avocational singers. But I think that when it comes to the work that I'm starting to do, anyone can have some type of a voice injury regardless of whether you're a professional voice user or not, whether you're a child, a teenager, or an adult. So I think that it's really, really relevant to everyone.

Paul Bryson: Well, tell us a little bit about how the conference went. What are some of the main takeaways and maybe just sort of the overall agenda of the voice conference?

Nick Klein: So the conference is really unique in that it is an interdisciplinary conference for laryngologists, speech language pathologists, voice teachers and professional singers who all gather in one room for two days straight of just all the information you could possibly want about the voice, some of which is really research heavy and some of which is exclusively performance based. So this year we had four keynote speakers because it was our 10th anniversary of our conference, which was really exciting. So we had Dr. Ingo Titze, who came and did a presentation on SOVTs and straw phonation, but then he also gave a presentation on how to achieve different aesthetic qualities between whether you're singing classically or in a contemporary belt style.

Paul Bryson: Yeah. And for our listener, Dr. Titze is a very well-regarded speech language pathologist and scientist. And then as you're hearing Nick talk about this, there's many styles and performance qualities of people that may walk into the Voice Center or have a voice problem.

Nick Klein: So fun fact, actually, because it was our 10th anniversary conference, we had a reception following the first night of the conference, and there was a concert, and the concert opened with Dr. Titze singing Sweet Caroline. And I did have the honor of accompanying him on the piano, which was just so fun.

Paul Bryson: That's great. That's great.

Nick Klein: Yeah. So the rest of the conference, like I said, lots of information. Dr. Lucian Sulica was there from the Sean Parker Institute for the Voice in New York City, and he talked about, he was advocating for more science, less art in the care of the performing voice and how there needs to be more research done in all regards. And I'm sure you have thoughts and opinions on that. He took us through some case studies about hemorrhage in the vocal folds and why there are these medical textbooks that say, that's going to be the end of someone's career, or the voice will never be the same. And he's like, but do we have any research to support that? And then he presented all these studies that don't actually point that way.

Paul Bryson: Yeah. I mean, it kind of goes a little bit, I see it as sort of something that goes both ways. As sort of the medical-surgical-science test person it really helps us have some empathy to our performers if we understand the craft and the art of it a bit. Being able to ask the right questions about repertoire, about performance demands, about styles of music, even work schedules. And then I think on the flip side of that, the more educated that a singer or speaker can be about their instrument, I think the better questions they can ask, the more buy-in they may have from a treatment and rehabilitation standpoint. So I think these sorts of multidisciplinary gatherings where it's both art and science, I think we were able to learn sort of both ways.

Nick Klein: Yeah. Well, and it was interesting. There were a number of questions that popped up later throughout the day that they asked saying, we focus so much on the medical aspect of voice recovery or voice injury. And the questions actually charged Dr. Sulica and Dr. Moradi with what do you as medical professionals caring for the voice want from or need from us as the voice teachers or singing voice specialists also helping care for the same voice, but coming at it from a very different direction? And their answers were really interesting. So I'd be interested to hear yours as well.

Paul Bryson: Yeah, I mean, I think I was just saying a few moments ago, I think it really depends on understanding the demands of the performer because not everything is the same. Sometimes you're trying to get somebody ready or prepared or recovered for an audition that's three months away. Sometimes somebody's on tour or with a show that may be only in town for three weeks, they're able to step back from the show but need to get back on tour within a month. So I think understanding what is required of each performer, understanding what their intermediate term goals and obligations are.

I see it very much as we have all this stuff on sports medicine. We have a center for sports medicine and rehabilitation here at Cleveland Clinic, just like the soccer player that wants to be able to be ready for the fall season after an injury, we're going to have a tenor or a soprano that needs to be ready for auditions in the fall or for a senior recital at Baldwin Wallace or Kent State, or their showcase if they're going to be trying to get a job in the city or in industry.

So an industry is tough because the science guides us, but it's not one size fits all. So depending on what the demands are, you have a sense for how much you might want to slow somebody down, but you have to find what's a reasonable thing that achieves short-term goals, but with the long-term goal of having health and longevity in what they're pursuing.

Nick Klein: Right. Well, and so in my practice I often pull from exercise physiology principles for my recovery work, even my regular voice rehabilitation work, but specifically for the voice recovery work. And it was really affirming to me, but also really interesting to hear, again, Marci Rosenberg, who's a speech-language pathologist and the author of The Vocal Athlete was speaking, and Leda Scearce, who wrote the Manual for Singing Voice Rehabilitation, were both speakers at our conference. And they both multiple times throughout their talks referenced these exercise physiology principles and how we have all this sports medicine and exercise rehabilitation research that we should be using to inform our practice of voice recovery or voice rehabilitation. But depending on who you're talking to, it doesn't always do that.

Paul Bryson: Yeah. Let's break it down. Let's talk a little bit more about when you think about being a singing voice specialist. I mean, there's lots of pathways. But to just level set, so in the Cleveland Clinic Voice Center, patients, as you know, will work and see the laryngologist or voice-focused speech-language pathologist. And a lot of times we'll talk about a treatment plan, often non-surgical and rehabilitative, but sometimes surgical followed by rehabilitation. So share, if you will, the unique opportunity that you have as a singing voice specialist as part of the team.

Nick Klein: Yeah, absolutely. So I think first off, I have to talk a little bit about the singing voice specialist because it's an evolving role or credential, and I don't even using the word credential because it's not a regulated thing, and there's no certificate or anything like that to call yourself a singing voice specialist. So anyone hypothetically out there can say, oh, I'm a SVS and I do this work.

So one of the most important things that was emphasized at our conference this weekend is that to be a singing voice specialist, there needs to be collaboration with a medical team in a clinical setting. If you are not affiliated with a medical team or communicating with whoever your client's doctors were, then you are not doing the work that you need to be doing to do the best service for your client.

Paul Bryson: Yeah, I would agree with that because I have a feeling you're going to have maybe more insight a good amount of times about, I talked earlier about short and intermediate term needs, but you may have more insight into what the actual physicality is to what is needed.

Nick Klein: Right. Well, and then also being able to take the things that are happening in the speech or voice therapy with the SLP and adapt those things into applicable exercises for their singing that's going to rehabilitate that portion or get them back to the level of singing that they were doing before.

So for me, what I feel like the role of the singing voice specialist is to really bridge the gap between the medical aspect of it. Which, like you said, hopefully most of the time that's nonsurgical, it's treated with voice therapy, and then they're transitioned over to singing voice recovery. I don't use the word therapy or rehabilitation since I'm not a licensed medical provider, but it means the same thing. We're trying to restore and rebuild that efficient, sustainable, healthy function after some type of dysfunction or injury.

But so, whether it is after surgery or not, I am trying to make sure that I communicate with the team, whether it's the laryngologist or the SLP, to know what has been done, what they feel like are the next steps, so that I can really adequately comprehensively design a recovery plan that incorporates the same things that they were working on in their speech therapy, and then bridge them back to the singing. So if that's flow phonation exercises that we have, and then we can put that to pitch and put it on exercises, scales, put it in the context of their pieces, or even the resonant voice work or any of those different models that can and have been by some people transitioned into singing voice exercises.

And then even as I'm doing that work, it's not like, oh, they're done with their speech therapy, they're out of the SLP and laryngologist hands', they're just mine now. No. There's still that communication, maybe not constant, but there's still that communication back and forth, checking in to make sure I'm not hearing anything of concern. And if I am getting them back into the laryngologist. Or vice versa, maybe the client goes back to the laryngologist because they're feeling something that they haven't reported to me.

Paul Bryson: Yeah, I think the back and forth is key. I think it's key just for the patient and then for us to understand, for you to understand, and I think it rounds out treatment like you described.

Nick Klein: Yeah.

Paul Bryson: Well, it's very exciting. I want to congratulate you on 10 years of the conference.

Nick Klein: Thank you.

Paul Bryson: And also on starting your practice here in Northeast Ohio - as you know, there's a very rich community of vocal performers across professional, amateur, recreational spectrums and some great schools. So to have your expertise in the area is a real nice thing for not just the Cleveland Clinic Voice Center, but for Northeast Ohio.

Nick Klein: Thank you.

Paul Bryson: Congrats on that.

Nick Klein: Thank you. And I'd like to add that, yes, I'm here in Northeast Ohio. I'm here in Cleveland. But this type of work, just like any other type of medicine these days, can be done virtually via telehealth. I have a couple of new clients that I'm seeing this week that are referrals from the University of Washington out in Seattle. So it's cool and really exciting for me that this work, being one of these people who is privileged to get to do this work with the clients who really need it, that I can help people from all over the world in and along their journeys.

Paul Bryson: Yeah, it's important stuff. And having been able to practice laryngology for a long time, it's been a great, I think, sort of an innovation and a logical progression of the field to have a singing voice specialists sort of be a part of the Voice Center team. So thanks for that.

Nick Klein: Of course.

Paul Bryson: As we wrap up, my take home would be for any of the singers listening or people that are taking care of people that are singers, I would say don't underestimate voice complaints. I think it's important to have an evaluation. It allows us to visualize the vocal folds and their function and physiology and put in the context of a complaint. And I would say if you have people that are using their voice professionally or need it as part of their livelihood or just have a concern, I think it's always worthwhile to come in and be seen. It's not something that you can easily see just by looking with your mouth open. You need to have a laryngoscopy to see it. So I encourage our providers listening to make that referral so we can maybe start the journey and try to better understand what might be going on.

Nick Klein: Absolutely. I would just echo all of that. Even if you are a singer who doesn't feel like you have problems in the current moment, I think it's really important to even go and get a scope and establish a baseline. So that when you do start having problems, which hopefully doesn't happen, but it almost always happens, even if it's just reflux or extended overuse, but at least then you have something to compare it to because you know what your vocal folds look like in their normal, healthy state.

Paul Bryson: The baseline exam is nice. And then, nowadays you can record the video on your phone, and if you're traveling or leaving town or you graduate and go to something else, you have a baseline. As the laryngologist and the voice team, I'm sure, Nick, I want to see it.

Nick Klein: Yep, yep. I've been there. I've been in your chair.

Paul Bryson: Well, to learn more about The Voice Studio of Dr. Nick Klein, please visit NicholasKleintenor.com. That's NicholasKleintenor.com. And to learn more about our Voice Center at Cleveland Clinic, visit clevelandclinic.org/voice. That's clevelandclinic.org/voice. Finally, to connect directly with a specialist or to submit a referral, call 216.444.8500. That's 216.444.8500.

Dr. Klein, thanks for joining Head and Neck Innovations.

Nick Klein: Thank you for having me.

Paul Bryson: Thanks for listening to Head and Neck Innovations. You can find additional podcast episodes on our website clevelandclinic.org/podcasts. Or you can subscribe to the podcast on iTunes, Google Play, Spotify, BuzzSprout, or wherever you listen to podcasts.

Don't forget, you can access realtime updates from Cleveland Clinic experts in otolaryngology – head and neck surgery on our Consult QD website at consultqd.clevelandclinic.org/headandneck. Thank you for listening and join us again next time.