Singer’s Tonsillectomy: Tonsil removal for the professional voice user
Singers, voice actors, and those who rely on their voice for a living tend to have a deep-seated fear of surgery. This justifiable fear comes from horror stories of voices injured by surgical procedures.
Tonsillectomy is often framed as low-risk to the voice because it’s not an operation that directly contacts the vocal cords. However, the tonsils sit in the throat, influencing vocal tract shape. The voice can be impacted even if the vocal cords are not the target of the surgery. Tonsils affect the voice when they are present, and scar tissue from tonsillectomy can also therefore affect the voice.
What is a tonsillectomy?
A tonsillectomy is a surgical procedure that removes the tonsils.
Who needs a tonsillectomy?
While clear guidelines exist for children (1), there are many indications for adult tonsillectomy as well:
frequent infections
Strep infection
history of complications, such as an abscess
large size affecting sleep
tonsil stones
What are the risks of tonsillectomy in vocal athletes?
Tonsillectomy is generally a safe procedure. The most significant risk to a typical patient is bleeding of the tonsil bed.
However, for the singer and voice actor, other risks exist. The tonsils sit in the throat, on top of muscles that are used for voicing and articulation. The vocal tract is shaped, in part, by palatal elevation. Injury to vocal tract muscles can impact placement and resonance, impacting the sound of the artist’s voice. Tonsillectomy is performed by separating the tonsil from these muscles. Surgery risks scarring these muscles, resulting in irreversible changes to the vocal tract.
Other complications, such as severe palate scarring, may result in leakage of air into the nose, but this is exceedingly rare.
What is the Singer’s Tonsillectomy?
Dr. Gupta developed the Singer’s Tonsillectomy to address these risks. The goals of the Singer’s Tonsillectomy are:
Patient selection: ensure surgery is only performed in those who need it. There is no such thing as a risk-free surgery
Pre-operative voice evaluation: partner with the patient and their coach to understand the individual voice. Perform stroboscopy to get a complete picture of the vocal health of the patient prior to surgery. Optimize vocal health prior to surgery to decrease inflammation and improve healing.
Anesthesia care: ensure intubation and extubation are performed with direction visualization of the vocal folds. A smooth wake-up further mitigates risk to the vocal folds
Intraoperative technique: minimize thermal injury to the vital phonatory muscles in the throat
Rehabilitation: exercise the muscles to ensure maximal length and health of the tissue, return to voice use early, perform complete post-op voice evaluation including stroboscopy prior to return to voice use to ensure readiness for voicing
This is a several week program and was developed to ensure the lowest possible risk to the singer and actor’s voice.
What about recovery?
The most important aspect of the Singer’s Tonsillectomy is ensuring the entire team is collaborating to care for the singer. These protocols have helped vocal athletes resume normal voicing within 2 weeks of surgery, with less need for narcotic pain medication, and a quicker return to health than a standard tonsillectomy.
References
https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/tonsillectomy-in-children-update/#clinical-practice-guideline-tonsillectomy-in-children-update