vocal cyst

What am I going to do about my voice? by Kevin Embleton

I don’t know what I’m going to do if I can’t figure out what’s wrong with my voice... singing hasn't been fun in a long time.

What I’m about to share is very personal, health related, and kind of long winded, so prepare yourself ;). There are reasons why I’ve been so slow to release any new music or play many shows in the past two and a half years. But it’s not out of lack of desire, passion, personnel, or even new material. As many of you know, my wife and I left Ohio in summer of 2015 to move to San Francisco. I had taken a job as a Music Minister at a new church, and Jocelyn and I were excited to experience a part of America we’d been dreaming about for ages.

My job fell through within a few months of being here, and we needed to decide whether to stay or move back to Ohio. We decided to stay, and we both hustled to find work; I taught guitar lessons and worked at a coffee shop in the Tenderloin to keep us afloat during the transition. Jocelyn found a job doing customer service and eventually marketing for a local, online retailer of neckties and bowties. After being underemployed for months in the most expensive city we’d ever seen, I found a new job, and we started catching up with life.

In all the transition, I started experiencing some major vocal and throat discomfort. I had tons of post-nasal-drip and irritation in my throat. My voice would often cut out during conversations and during performances. During one performance, I completely lost my voice. During another, everything felt so constricted I could barely sing. My voice became fatigued rapidly, and I didn’t know what to do. When I finally shined a flashlight light back there, I noticed (with horror) several huge bumps on the back of my throat. I thought it was cancer at first, but later found out it is called cobble-stoning, a condition where parts of the throat swell up due to drainage (they haven't disappeared since).

I scheduled an appointment with Kaiser San Francisco's Head and Neck department. My first ENT agreed with my primary physician’s prognosis: allergies. I found this strange, because I’d only ever had allergies a few times in my life, and when I did it was a runny nose, not Post Nasal Drip. They prescribed allergy pills and a whole nasal rinse routine, and I did that for a couple months. The voice issues continued and even worsened. The next year and a half resulted in 6-7 visits to the ENT for multiple laryngoscopies (where they stick a camera through your nose, down your throat), a visit to the allergist, speech therapy, finding out it was not allergies but rather acid reflux, then overcoming acid reflux, stress, and muscle tension. To no avail. You can read the longer version with more medical detail here, but no pressure***

For much of this time, I was also seeing a holistic voice coach, who was helping me correct some of the bad habits I picked up along the way. As my muscles in the larynx tightened to protect from the acid reflux, I developed some bad habits of pushing the sound out, using muscles rather than air to phonate (make sound). She essentially helped me learn how to breathe again – truly life-changing stuff. Relearning vocal techniques and ensuring proper vocal hygiene have definitely made the pain more bearable, especially since my jobs as a music minister, guitar teacher, and performer have required me to sing or talk several times a week for the past two years.

Sometimes things got easier, but I was still having trouble not just with singing but also with talking. When my voice cuts out, it irritates and wears out my vocal cords. This fatigue is different than the fatigue caused by post-nasal-drip. It’s like you’re winding up to pitch a softball and someone hits your arm while it’s in motion and throws everything off. You then have to try again, adjusting things so as not to be hit again. It’s probably a bad analogy, but that’s been my life for ages now -- this odd cutting out of the vocal cords, mostly while talking. A feeling that something is stuck in my throat. Tension in my larynx.

When I went back to the ENT for a checkup this past August (2017), he noticed some kind of lesion or cyst behind/underneath my left vocal cord. I thought, “Yes! Finally some answers.” But the ENT said he didn’t think it was affecting my cords, and he was hesitant to operate. He encouraged speech therapy and also set up an appointment for me to see another ENT in Walnut Creek. The second opinion was the same: “I don’t think it’s affecting your cords. Just do speech therapy and come back for a checkup in a few months…”. As an aside, I went back and looked at the videos from my original laryngoscopy, and the cyst has been there this whole time, he just didn’t see it the first time. To me, this explains why the problem has been there for so long.

My speech therapist simply thinks I should move out of the city – that I’m too stressed. I try to explain that my stress mostly comes from the discomfort in my voice, not the city itself, but she just thinks I need to get out of here. How can moving guarantee that my voice problems will go away? That doesn't add up.

I’ve been doing the hard work of trying to get better, and even at my “healthiest”, things are still so difficult. And that’s the thing: I’m healthy. My body feels good. My breathing is good. I eat well. I exercise. I run. I bike. I skate. All of the pain and discomfort is located in my larynx. It’s like I can feel my cords hit the cyst when I’m in my low range. When it cuts out, I have to try again, pushing more air through. When I push more air through, I think the cords maybe vibrate more efficiently and faster, causing less movement around the cyst. When the cords are relaxed, vibrating slower, they brush up against it and experience brief paralysis. My theory is that I need surgery to get this cyst removed so that I can recover.

Singing doesn’t bring me life like it used to, and it hasn't in quite some time… it hurts, and it’s unpredictable, even when I think I do things right. Talking is even more painful. It cuts out in conversation with strangers, during meetings, or at home with my wife when we are trying to catch up on our day. I just want to be silent. But that’s what’s difficult. I talk and sing for my living. Honestly, I’ve been hoping I can have the surgery to remove the cyst so that I’ll be put on vocal rest for a few weeks, maybe longer. My heart is longing for a break.

I’m going to see another ENT next week in Oakland. I’m not leaving that room until I have answers. I’m not leaving until he sees, definitively, whether or not my cords are hitting that cyst. And whether they're hitting or not, I want him to give me every reason why he wouldn’t operate to remove it. Either way, I’ve done my research, and cysts can cause vocal dysphonia and paralysis even in cases where the cyst is not directly on the patients’ vocal cord/s.

If he just says, “Kevin, you have a vocal disorder and you’re just going to have to deal with it….”, I don't know what I'll do? I’m losing hope. Am I going to have to quit music? I’m not sure I can continue singing and making music if I can’t figure this out. I don’t know if I have the strength to push through this anymore. At this point I might consider starting another career. But that’s the thing; I don’t really have skills outside of music and communication.

I recently stepped out into another job change. I’m starting a recording studio that will hopefully serve as a really cool hub for building community and providing resources and encouragement to artists in San Francisco. I’m also serving as one of the music ministers at a smaller church in town and teaching some guitar lessons again. Other than the fact that I have to talk and sing a lot, I feel I'm taking a step towards long term goals.

But my insurance runs out at the end of the year unless I can come up with the extra cash to cover our premiums through COBRA. Our current insurance is great and allows me to see a specialist for next to nothing. I’m not sure what I’ll do if I lose that coverage. This isn’t a plea for money. I’m just trying to tell you what I’m up against, and why there is seemingly no movement in the creative part of my life.

It hurts too much to create.

It sucks when I think about how I’m falling behind, unable to release my best work right now. I have an entire record written and partially recorded. I even have the studio time covered through the investment of a dear friend. But how can I put out a record if it hurts so badly to communicate?

So that’s it. Hopefully I can get some definitive answers next week. I appreciate your prayers, thoughts, comments, and everything. It’s difficult for me not to feel like I’m wearing out my welcome with the people who are closest to me. I sometimes fear that they’ll just write me off for being too high maintenance. They’ve been there through thick and thin, and I’m forever grateful for that. Jocelyn, you are my rock. I love you. If you had no idea about any of this, it’s time I shared it with you. I’ll update you soon.