Singer Nicki Minaj with Strained Vocal Cords

Media has reported that pop star Nicki Minaj had to cancel upcoming concerts in England due to injured vocal cords.

She apparently saw a doctor who diagnosed "strained vocal cords" after an x-ray and recommended voice rest for a few days.

The singer apparently ignored this advice and sang in New York City on Aug 18 causing her voice to substantially worsen resulting in her decision to cancel her concerts this weekend.

Details of her vocal cord condition are sparse. However, based on the limited information provided, there's a few things I can guess at.

First off, an x-ray can NOT diagnose any type of vocal cord condition. The singer must have undergone a trans-nasal endoscopic procedure which is the ONLY way to visualize the vocal cord and diagnose any vocal problems.

Given the singer was instructed to rest her voice for "a few days," she most likely suffered from a mild acute laryngitis causing inflamed vocal cords. By ignoring advice to rest her voice, she potentially turned a mild laryngitis into a more severe laryngitis. She probably did not suffer from any physical problems on her vocal cords like nodules or polyps which would take weeks if not months to recover (not days) as happened to singers Adele and John Mayer.

Really, at this point, strict voice rest, hydration, acid reflux control, and steroids (ie, prednisone) would enable her to recover her normal voice ASAP.

Here's a picture of a severe laryngitis (left) compared a normal appearing vocal cords (right). Note that the vocal cords are swollen and red compared to normal pearly white and thin appearance.

 

Source:
Nicki Minaj cancels U.K. concerts due to strained vocal cords. NBC News 8/18/12

R&B Singer Maxwell with Vocal Cord Hemorrhage

At least that's what the Washington Post reported on June 22, 2012. This has resulted in cancellation of his summer tour.

Per media reports, his vocal cords are swollen with hemorrhage.

Some fans may recall that something similar happened to Adele in winter of 2011 which resulted in her also canceling a number of engagements. She ultimately had surgery to correct her problem.

Normally, the vocal cords are pearly white without any vasculature. Watch a video of how this exam is performed.

However, when a blood vessel is present in the vocal cords, they may look something like this:

The issue with a blood vessel within the vocal cord itself is that it fluctuates in size due to whether it is irritated from phono-trauma or even hormones. Such fluctuation in size causes the voice to change in pitch and quality on an hour to hour basis depending on how much swelling occurs. For a singer, it makes the voice unpredictable.

When the blood vessel becomes engorged and traumatized, it may even rupture leading to a vocal cord hemorrhage. Especially in a woman, the blood vessel may be more prone to hemorrhage during her menstrual cycle.

This is a dangerous situation for a singer because of their regular voice use and need to use it forcefully. However with too much force, the blood vessel may suddenly rupture (even in the middle of a performance) resulting in a hemorrhage into the vocal lining itself causing a sudden and complete loss of voice. If a voice is present, it is much deeper than normal due to the additional "weight" of blood and edema (just like a violin string where the thicker the string, the deeper the pitch). There may even be mild pain associated with this occurrence.

To the right is a picture of a vocal cord hemorrhage. Note the entire vocal cord on one side (which is the patient's right side for those in the know) is brilliant red indicative of the presence of blood throughout the cord.

How is this treated?

Initially during an acute vocal cord hemorrhage, STRICT VOICE REST is mandatory. With continued voice use, the patient risks abnormal healing that may result in a vocal cord polyp or vocal cord scarring. Along with strict voice rest, steroids are often prescribed to help reduce the inflammatory swelling that often occurs as well as minimize risk of scarring.

Unfortunately, though such treatment may resolve the hemorrhage, it will typically not get rid of the culprit blood vessel.

For that, surgical intervention is required.

Such surgical intervention is much like trying to get rid of varicose veins in the leg.

One option is to precisely cut it out. Watch a video on this approach (video shows a vocal cord mass removal, but just pretend the mass is a blood vessel as the approach is identical).

The other option is use of a laser which is typically what I recommend. Why? It is relatively non-invasive and I feel the risk of scarring to be less compared with excision (though not zero). Shown below is a video of a vascular polyp being obliterated using a pulsed-dye laser (courtesy of Dr. Chandra Marie-Ivey). Another type of laser that may be used is a KTP laser.

Read more about laser treatment of vocal cord pathology here.

Read the Washington Post story here.

Levon Helm, Singer/Drummer for The Band, Dies of Throat Cancer

Levon Helm, legendary singer and drummer for The Band, died of throat cancer at age 71 on April 19, 2012.

It is unclear exactly what happened over this past month, but media reports state that he was diagnosed with vocal cord cancer in 1998 and underwent 28 sessions of radiation treatment at the Memorial Sloan Kettering Cancer Center. His cancer was almost certainly due to his 3 packs per day smoking and though he quit with his initial cancer diagnosis, cancer being what it is, it can always come back.

No mention of surgery or chemotherapy since than.

Given this little bit of information and the fact that he did have an albeit raspy voice to the point that he was still able to sing 1 month prior to his death on March 19, 2012, I suspect he had an aggressive recurrence of his vocal cord cancer.

Shown below is what a normal vocal cord looks like along with one that has cancer.

Typically with vocal cord cancer, radiation therapy alone is curative and allows for voice preservation. In fact, if no cancer is seen 5 years after treatment which in Mr. Helm's case would have been in 2003, one could state "cured" from this type of cancer.

So it is strange indeed that his vocal cord cancer would come back with a vengeance to the point it killed him 14 years later, though not impossible, especially if he started smoking again as well as drinking alcohol which exacerbates smoking's cancer-causing potential.

Furthermore, it is rare that vocal cord cancer alone would kill a person as there are salvage treatments in event the cancer does comes back as apparently it did for Mr. Helm.

If the vocal cord cancer comes back, it could grow in size to the point it would cut off the ability to breath. The growth could be quite dramatic taking a breathing/talking person to being unable to breath or talk in a matter of weeks.

With an aggressive vocal cord cancer recurrence, radiation therapy really is no longer an option if previously already done. Chemotherapy can be tried but with a localized aggressive cancer recurrence, surgery is really the only option... the COMPLETE removal of the entire voice-box.

This complete voice-box removal is known as total laryngectomy. It would leave the person completely unable to talk in a natural manner. It would also leave the person with a permanent hole in the neck as the only way to breath.

It just may be that Mr. Helm was offered this option, but given his life as a professional singer, it was perhaps too draconian an option for him to conceive of. As any singer can tell you, their voice is their life. Without their voice, their life might as well be over.

Of course, he may have developed a "new" cancer somewhere else in his throat... the supraglottis located immediately above the vocal cords or the pharynx which surrounds the vocal cords.

Unfortunately, the treatment options would have been still pretty much the same.

Source:
Levon Helm's Life After Cancer. CBS 2/11/09

Levon Helm Throat Cancer: Legendary 'The Band' Musician Dies At 71. HuffingtonPost 4/18/12

Levon Helm, Drummer and Singer of the Band, Dead at 71. RollingStone 4/19/12