Anthony F. Jahn, M.D.

Articles and Tips

Questions on Extreme Weight Loss, Belting, and Allergy Control:

Dear Dr. Jahn, I am a 29-year -old singer in my third year of voice studies. I will be taking part in a physician-supervised diet at a hospital. I currently weigh 260 pounds and will be fasting with liquids for 3 weeks and then moving on to an all protein diet/fast. The fast will also include a regular exercise routine of walking, cycling and some swimming. Will this rapid weight loss adversely affect my singing?

Dr. Jahn: I congratulate you on this difficult undertaking. From the point of view of your general health, longevity, and even vocal longevity, you are doing the right thing. I hope you succeed in taking it off and keeping it off. In terms of the voice, a rapid loss of weight will likely have some effect. You may be low on energy, and find that your support has changed. Also, the color of the voice may be somewhat different, since the shape of the resonators and the tissue turgor have changed. I can not predict exactly what these changes would be in your individual case, but it may be that you will have some adjustments to make, since you are used to working with your old instrument. Nonetheless, you should do this, and with some effort at listening and adjusting, you should be able to sing fine. You know that a number of top singers, including Pavarotti, have lost a lot of weight and are doing fine.

Dear Dr. Jahn, Thanks very much for your very informative two-part article on nodules. I was particularly interested on your comments on belting. I often use chest voice in my lower register, and didn’t know if that qualifies as “belting.” In general, I change to “legit” voice as soon as it begins to feel uncomfortable. I would appreciate your opinion on this.

Dr. Jahn: Chest voice in the lower register is appropriate, and in fact that range is the proper domain for chest voice. Belting refers to carrying up the chest voice (meaning the muscle mechanics used to produce chest voice) into the head voice range. This means that you have, often with a great deal of effort, shifted your passaggio upward. Many belters, particularly untrained singers, do not use head voice at all, and put great strain on their laryngeal muscles and vocal folds. I would suggest that you make sure first that you have mastery of your full range, chest and head, with a clean and seamless passaggio. Know where this lies for you comfortably. Then you have the option of pushing chest up a bit when the music calls for it. In most cases this should not cause damage. You can also blend the voice, using some of the head voice muscles along with chest voice muscles, to further reduce strain on the vocal folds. Of course, I cannot comment in your individual case, since every instrument is different. You should check with your teacher, and, if you feel strain or hoarseness, with a laryngologist.

Dear Dr. Jahn, I’m studying classical voice and I read your article on medications and how they affect your voice. I have severe allergies and I have to take Claritin-D and Nasonex. I would appreciate if you could tell me how these medicines will affect my voice and what I could do to help my voice from being dehydrated. I would also like to know if immunotherapy (allergy shots) would be better for my voice.

Dr. Jahn: If you have allergies, the best treatment is to identify what they are and avoid, or minimize, exposure. This includes measures such as not jogging outside on high pollen-count days, or covering your feather comforter or pillows if necessary. An allergist can test you and tell you what you may be allergic to. Immunotherapy, which involves weekly injections, is time- consuming and costly, but may be your best option if your allergies are present all year round (perennial). If they occur only for a few weeks in the spring or fall (seasonal), then what you’re doing is fine. Some people find antihistamines drying, although Claritin is not normally bad in this way. The main complaint I hear about Claritin is that it is too mild for some allergies. The cortisone-containing nasal sprays are again useful, although some of them dry the lining of the nose and can even cause nosebleeds. Nasonex is not normally one of the culprits. To minimize drying, drink lots of water, and you may even consider taking a medication such as guaifenesin, to increase your watery mucus. If you use saline spray in your nose before the cortisone spray (then blow it out before the medication spray), it will decrease nasal dryness. Apart from the drying effect, I’m not aware that either of these medications would harm your voice.

DISCLAIMER: Reprinted by Permission, Classical Singer Magazine. The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice, or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.