Episode 9-The Human Instrument with Dr. Adam Klein

This week, Heather sits down with Dr. Adam Klein of the Emory Voice Center — the physician who has taken care of celebrity singers and the one she trusts with her own students when something doesn’t sound right.

They dive into the truth behind common vocal myths (whispering, dairy, hydration, screaming at football games… yes, all of it), what’s actually happening inside the voice when things go wrong, and why diagnoses like nodules are not the end of the story.

Whether you’re a singer, teacher, speaker, or just someone who uses your voice every day, this conversation brings clarity, confidence, and a little peace of mind.

Transcript

SPEAKER_00 0:07

This is the Heather Patero Show where Conversation meets colleagues. Well, welcome back to the Heather Patero Show where Conversation meets colleagues. Today's guest is Dr. Adam Klein, co-director of the Emory Voice Center, Chief of the Division of Laryngology, Vice Chair in Emory's Department of Otolyngology, Head and Neck Surgery and Holder of the Willard and Lillian Hackerman Professorship and Voice. That's a lot of words right there. He trained at Massachusetts General Hospital under Dr. Steven Zeithills, who has treated famous singers like Adele and Steven Tyler, specializing in laryngeal surgery and voice restoration. He is not only a doctor, but is also a vocalist. He has sung in an a cappella group in college, which means he has sweated through rehearsal and cared deeply about all the notes. Those are basically a lot of words to say that he knows what he's doing. And that's why I trust him with my singers. Adam, welcome.

SPEAKER_01 1:17

Oh, thank you so much, Heather. It's great to be here and congratulations on your new podcast.

SPEAKER_00 1:22

Oh, thank you. And thank you for taking care of my people and so many other singers.

SPEAKER_01 1:27

My pleasure. I love doing it.

SPEAKER_00 1:29

Well, aren't you impressed that I was able to say all those big words?

SPEAKER_01 1:33

I was very impressed. It's it's some of those are tongue twisters. You did a great job.

SPEAKER_00 1:38

Thank you. Well, before we get into myths and mechanics, what's the phone call that makes your heart skip? Is it the tour on the line call, the Broadway opening, the public figure who has to speak tomorrow? Tell us about a high stakes moment where someone's voice really mattered and no names are necessary.

SPEAKER_01 1:58

Oh, well, I think you all of the ones that you mentioned are high stakes and where the voice really matters. But I think the one that can be most challenging is when someone calls and has an opening or a big, big commitment that that following day or even that night, and they just don't really feel like they're um that they're at their finest. Uh, those moments are are very uh critical uh from a medical point of view, and they're also very impactful uh for the ultimate performance or obligation that they have to fulfill because it's a lot of moving parts, and as you can imagine, uh having to pivot or stop or cancel uh is is very uh uh it can impact a lot of people.

SPEAKER_00 2:43

Sure. So when singers push too far, what's usually behind it? Is it ego, fear, maybe bad advice, just not knowing?

SPEAKER_01 2:52

Uh well, I think it can be a combination of things. Sometimes it's just again that feeling of obligation that if they're pushing through something, maybe they're not feeling like at 100%. Uh, maybe they're getting over a cold, maybe they're just pushing through performance after performance and their voice needs a rest. Sometimes they just feel like they have to keep going. And we see that especially, we see that in all levels of performers, but I would say it probably happens more in the early career performers where they just are always trying to please and impress and um and the last thing they want to do is is is show their weakness, um, which it really is not a weakness, it's a reality of trying to use the voice uh at that level.

SPEAKER_00 3:39

What do singers underestimate most about their instruments?

SPEAKER_01 3:43

Well, I think endurance is probably one of them, kind of you know, following in your line of questioning. Um, it's as people become more successful in their career, their vocal demands continue to go up. And although they are well trained and are building those muscles and in building that endurance, uh all of all of us hit that um that point where we can't uh keep going and we have to give ourselves the rest that we require.

SPEAKER_00 4:15

So let's clear out some of this nonsense. There's so much folklore around the voice, right? And singers, you know how we are. We're a little dramatic, so help us. When I tell students to drink water, what am I actually protecting?

SPEAKER_01 4:30

Well, in general, water is important just for our hydration, of course. And that's gonna do a few things for them as vocalists. One is that it's going to coat the throat, right? It's gonna prevent throat dryness, which, as we know, can be pretty detrimental if you're trying to sing or or speak publicly. Um, and sometimes that's as much for articulation as it is for phonation. What it's also gonna do is allow for better lubrication of the vocal folds. Um, and we can talk about that in a bit more in a second, as far as why that's important. But it's not um it's not that it's directly lubricating the vocal folds because water is not gonna hit the vocal folds. If it were, you'd be having a new problem called aspiration. Um, but what it's doing is making sure that your well is full so that as you're um making your own saliva and making your own um uh uh lubrication, which our voice boxes do, that you're amply supplied to do so. So it's really helping with the lubrication of the vocal folds, the um keeping the oropharynx and the mouth from drying out so that you can create the sound and then form it into words.

SPEAKER_00 5:48

Right, because we don't want to chug an Evy in five minutes before we go on stage, because that's just an expensive way to make sure that we have to pee during the bridge, right?

SPEAKER_01 5:57

That's right. That's right.

SPEAKER_00 5:58

Let's talk about whispering. Why is whispering not the spa day singers think it is?

SPEAKER_01 6:04

Whispering is um so whispering, you're you're kind of posturing your vocal folds uh in two ways. You're holding them apart a little bit so that air just glides right through without actually making the vocal folds um do their full job, uh, but you're also kind of holding them a bit taut. And the in a way that's adding a little bit of stress and trauma to them. So we tell people that it's actually, even though you're not making sound in the way we think of it, that it's actually not completely benign. It's not completely atraumatic for the vocal folds.

SPEAKER_00 6:43

So that resting whisper marathon is actually not helping, is what you're saying.

SPEAKER_01 6:48

It's better just to literally rest the voice than to try to make a fake fake phonation, if you will, through whispering.

SPEAKER_00 6:55

Gotcha. Let's talk about pain. This one matters. Most people think if it doesn't hurt that we're safe, right? So do vocal folds have pain receptors the way that we expect?

SPEAKER_01 7:06

Well, you can feel sensation there. I think we all have. Um, you know, certainly if we overdo it, it can uh it can be uncomfortable. We know that it can hurt because, well, honestly, when when we work on the vocal folds, people can feel things. But also if certain types of uh of pathology or certain types of injury occur to the vocal folds, people will feel that. Uh if they have a vocal fold hemorrhage, for example, those can often be quite uncomfortable from the pressure of the uh blood within the vocal fold. Uh so if um so we know people can feel it, but just because you're not feeling pain does not mean does not imply that no trauma is occurring. Uh so phonotrauma, as we call it, which is the trauma of phonation, uh, it uh it can be causing little um little areas of microtrauma, which may not hurt at all uh in it in the moment, but it uh doesn't imply that things aren't um going awry.

SPEAKER_00 8:07

All right. Dairy is mozzarella innocent. Why does dairy feel like it's ruining everything, even if it's not injuring tissue?

SPEAKER_01 8:17

You know, it depends. That's person-to-person specific, I would say. Um I'm certainly no dairy expert, uh, but in general, you know, we find that dairy just tends to make people um more phlegmy, for lack of a better word. And so it's certainly not an ideal thing to ingest right before you're gonna perform because your body is going to typically react to it uh and form thicker saliva, and that is never going to make phonation or singing very easy.

SPEAKER_00 8:49

Last one, screaming. What is actually happening when someone screams?

SPEAKER_01 8:55

Ooh, well, it depends how you're screaming, I suppose. But in general, right? There's a lot to a scream. And we all we hear lots of different types of screams. But okay, so the big thing about a scream is the biggest one is probably volume. And so when we're increasing the volume of the way of sound creation or phonation, uh, that is a significant amount of air pressure, or specifically what we call subglottic air pressure, because it's coming in from below the glottis or vocal fold level. And when that's happening, um you're holding your vocal folds closed, which is what we do as air comes up in order to make sound. And that increased air pressure means that when the vocal folds are now going to vibrate, which is what they do as the air is going through, those collision forces of the repetitive vibration are going to be that much more amplified because of that increase in subglottic air pressure. The other thing we do to make matters worse is that when we scream, we tend to raise our pitch. And raising our pitch means we're elongating our vocal folds, making them more taut, and they're gonna vibrate at a faster frequency. That's how we make higher pitch sounds is by elongating our vocal folds. So now you are in a situation where they're vibrating more quickly, they're more taut, and the amplitude of that uh of the of that um uh vibration uh is more traumatic each and every time because the increase in pressure. So the combination of the loudness plus the pitch tends to um tends to overdo it a bit in a lot of us.

SPEAKER_00 10:39

So basically we're slamming tissue together hundreds of times per second. No wonder the next morning is rough after coming from a Braves game, right?

SPEAKER_01 10:48

You got it, absolutely. Yeah. And and then we're doing other weird things, of course, to make our scream sound guttural or or what have you. It's gonna just add to the um add to the the loveliness of the of the uh uh you know uh the next morning. But um, yeah, it is it can be uh quite traumatic and everyone's different. Some people can handle a scream very well, and and by the way, there are right and wrong ways of screaming, which I'm sure you you're aware of. Um, but uh, you know, I would say a lot of us don't do it very the right way. We we tend to just scream and and we you know deal with the aftermath.

SPEAKER_00 11:24

I actually know a teacher that teaches people how to scream, sing, and do heavy metals and how to do it correctly. So yes, there is definitely a right way to do it. So now explain the voice like we're smart. Let's get to the meat of everything here. But we're smart, but we're not in med school, so break it down for us, kind of like we're a baby. When someone sings, what has to happen physically in the body for sound to become voice?

SPEAKER_01 11:52

Great question. And I would I would actually say that sound and voice are becoming one and the same in this situation. So in order to create sound, there's multiple parts of the system. First of all, you need a power source, okay? And the power source is our lungs, right? That's where the air is coming from. As I mentioned, the air is what's powering the sound. Um then that air has to go up our airway, our trachea, and then hit what is the larynx, or in this case, the sound source. And this is where the air column is being divided up and creating vibrations that are going to be eventually perceived as sound. And the way we do that is we have a vibrating valve, which is our voice box, our larynx. And in particular, it's the vocal folds that are, as I mentioned, closing against this column of air. And as the air is pushed through it, they are opening and closing, not uh completely, but it uh it's actually a vibration pattern, also called an oscillation pattern, where the folds themselves, which are just flaps of tissue, can open and close just a little bit to allow little bits of air through. And as you mentioned, that's happening anywhere from less than 100 to 800 or 900 times a second, depending on the pitch that you're trying to sing. So that's where air is effectively becoming sound. And as that's as that raw sound, it actually sounds a bit like a duck call, as that raw sound is coming out of the voice box and into all of the area above it, now it's entering into what we call the the resonance chamber, right? This is where the sound is being converted into speech. And so it everything above the vocal fold, so that's our throat, our mouth, our the back of our nose, the the nose itself, the sinuses, all of this is gonna start to resonate this sound, it's gonna pull out harmonics, and then what we're gonna do with it is use our teeth, lips, tongue, gums, and so on to actually form words out of it. And that's why if we hum and we're not doing much with our teeth, lips, tongue, gums, it's just gonna be that same raw sound, but have some resonance to it and some harmonics to it, but we can actually modify that sound into words by um by articulation.

SPEAKER_00 14:32

Good explanation. That was great. So, how small are the vocal folds really?

SPEAKER_01 14:37

Male and female are a little bit different, but really they're on the centimeter scale, you know. I mean, it's um centimeter inches, whichever you prefer, but um in a male, it's probably about an inch to an inch and a half in length. They're really not that big. Uh females are a bit smaller. Uh so they're they're doing a lot, you know, for these small little areas are um asked a lot uh uh to uh of us uh to to not only and by the way, it's it's not just the um it's not just the formation of sound, they're also participating in pr airway protection when we swallow, and they're participating in cough or throat clearing, right? So they're doing a lot of things. They also help control airflow. So when we're exercising, for example, uh the the the amount of airflow going through uh can help uh improve our performance when we're exercising. If you think about bearing down, if you're lifting something heavy, they're also participating in that. So we're asking a lot of these little structures. And uh in order to do all of that, the especially the phonation part, they actually have little layers within them. And you know, the the very the most important layer being the layer that vibrates, uh, going back to that um uh description that I mentioned earlier about how they work. So they have they have a what we call a microstructural architecture that allows them to do these multiple uh uh jobs.

SPEAKER_00 16:11

That's amazing, isn't it? The the human body is just pretty amazing. And and the voice, you know, I I tell my students to take care of their voice because science really hasn't been able to come up with uh another voice. You know, you can have a heart transplant, you can have a liver transplant, you can have a kidney transplant, you know, they can put something on your arm if you if somebody lost their arm or a leg to help you continue to walk. But the voice is very unique, isn't it?

SPEAKER_01 16:41

It is in that way, and and yeah, you you hit it on the head because not only is it difficult to um give someone an entirely new voice box and have it number one, take, if you will, but also function, because it's a very dynamic structure. And so to re-innervate something like that is really truly uh a significant challenge. Um, but as I mentioned, that that microstructural architecture, uh, really that's what a lot of people are struggling with. As they slowly lose that over time or overdo it and hurt it, um, it's challenging for us to try to replace what they've lost because once you lose that vibratory layer, uh, there is no good replacement for it. And so what we do as professionals, uh, you know, we work with uh voice therapists uh as part of our multidisciplinary team is through therapy, through um sometimes medication, through sometimes surgical intervention, to try to optimize someone's ability to use their voice when they might have lost some of that um some of that uh uh initial um uh anatomy or ability that they once had.

SPEAKER_00 17:59

Well, my uncle uh he's gotten older and he had to have throat radiation. And with that, it caused a lot of problems with his saliva and uh his hearing. But one of the uh consequences was also it paralyzed one of his vocal folds. And so now he's uh getting food down in his lungs, and so now he had to be put on a feeding tube. We don't think about all the roles that our uh vocal tract plays in just helping us function day to day. Absolutely, which is the reason why we need to take care of it. And so let's say a singer or a public speaker has a cold and of course they're swelling, usually they have a you know a drainage or a sore throat. What physically changes when there is swelling in someone's vocal tract?

SPEAKER_01 18:56

That's a great question, yeah. So, and really what you're describing is laryngitis, right? And so it's actually that vibratory layer that I was talking about. That's the main thing that people are perceiving as causing the difference or perceiving in their voice as as being different, is the clarity of the voice changes because that vibratory layer, which in general is only a couple of millimeters thick, if if at all, um, it thickens. And if you think about it like an instrument, which of course it is, um what happens when you go from a thin string, for example, to a thicker string? One of the things is your pitch is gonna drop, right? So the pitch is gonna drop. It's more difficult, more massive, and more difficult to vibrate, to get to vibrate. And so as the layer thickens, our voices get usually deeper and raspier and just more effortful because now you're trying to vibrate something uh that is more massive.

SPEAKER_00 20:00

Right. So let's talk about the N-word. What are nodules? We hear we hear about those often. Adele, I believe she had some nodules, and we've heard people like Julie Andrews, you know, we've heard some horror stories about how there was a mistake uh when she went in, and and we hear about those kind of stories. But what exactly are they and how do they form?

SPEAKER_01 20:26

Nodules, when I s when I speak to patients about nodules, I like to say that they're basically similar to calluses, calluses on the vocal cords. And and vocal, by the way, we use the term vocal cords or vocal folds, they're interchangeable. But if I say vocal folds, I'm I'm talking about the same thing. Um, so nodules, think of them like calluses on the vocal folds, they form from repetitive trauma, and they come in pairs. It you can't usually have one nodule. If you're gonna get nodules or singers' nodes, right, that's the other term people will use sometimes, uh, they're gonna be symmetric raised areas in the middle of the vocal folds, because that's the primary site of uh primary point of contact or maximum amplitude of that vibration that I was talking about before. And therefore the most heavy uh point of contact is right there in the middle of the folds. So with repetitive trauma, as we talked about earlier, hundreds of times a second, maybe at higher amplitudes or volumes, eventually you're gonna start getting thickening of a specific layer in the skin overlying the vocal folds called the basement membrane zone. And as that zone starts to get traumatized, it starts to thicken. And as it thickens, eventually you can have this fibrous area form, which is effectively like a callus, and they just occur on. Both sides. And what happens is as you start to develop these areas, it becomes more effortful to use the voice. And with more effort, often comes more trauma. And so it becomes a bit of a vicious cycle that once you get these lesions, they're hard to get rid of and sometimes they get worse because you're trying to push through, you know, and accomplish things that are now going to be more difficult to accomplish.

SPEAKER_00 22:30

So do you think this happens more to trained singers or untrained singers? I mean, are nodules specific to a singer?

SPEAKER_01 22:39

I wouldn't say specific, but I would say that trained singers tend to know how to avoid them. Um, you know, usually part of the training is proper technique and what we call vocal hygiene. And so they um they tend to fare better under significant vocal demand than the untrained singer.

SPEAKER_00 23:03

But trained singers still can get them right.

SPEAKER_01 23:08

Without causing widespread panic, I'll say yes. Yes, they can. I mean, anyone can. Anyone can, right? It's just like any athlete, no matter how well they're trained, can get injured, right? I mean, it's a form of injury. Yeah. Yeah. Exactly.

SPEAKER_00 23:22

So when is therapy enough to treat nodules?

SPEAKER_01 23:26

Therapy is our first-line treatment for nodules, and often it is enough. Um you know, a lot of it, as I was alluding to, is uh is the way the voice is being used and the tech, you know, the technique of how it's being used, and the amount of trauma uh b that they're that they're suffering. And so through therapy, a lot of those um there can be behavioral modifications so that there's less trauma and better technique. And so over time, just like a callus, they can start to they can start to uh uh resolve. But there are times where for whatever reason, whether it's just that they've settled in and don't want to go away, or that a person really has so much so many vocal demands that they can't make a meaningful enough change to uh to allow these nodules to resolve, that we do start to talk about surgery. Um and so it I wouldn't it's certainly not every patient, um, but you know, there's a percentage of patients where we say, well, if the voice therapy is not enough, then we can always um help you out with surgery.

SPEAKER_00 24:31

So how has recovery changed over the last 20 years? You know, 20 years ago, even 30 years ago, I I've been singing a very long time. Nodules were the death sentence uh of a singer. How has that changed? And are they a career ender?

SPEAKER_01 24:48

No, they do not have to be a career ender. Um, and and that's one of the first things I tell patients is that this is a sign that you're using your voice a lot, just like a dancer's feet are going to be beat up a little bit, right? You're using your voice a lot. And so in this case, uh this is um a testament to how much you've been using them, uh, but it's not going to be a career ender necessarily. Uh, and there are ways that we have to help you, whether it's through voice therapy or through surgery. As far as how we've changed the management, the post-surgical management, I'd say in general, we have become um a little bit actually, much like other types of surgery, uh, whether it's knee surgery, hip surgery, and the quick return to use and rehabilitation, I'd say we're following in the in the same footsteps as that. So it used to be that patients would maybe have surgery or maybe just be told to go on voice rest for many months to see if the vocal fold nodules will go away. Um for uh in our practice here, uh we don't put people on complete voice rest initially instead of therapy. And if we're doing surgery, we'll actually just say one week of voice rest, complete voice rest. Sometimes we'll extend it to two, depending on how they look at a week, but usually it's about one week of voice rest and then a gradual return to full voicing over the subsequent three, maybe four weeks or so. So when I am treating my singers, I'll say you should be able to get back on stage or do what you want to do with your voice in about four, maybe five or six weeks, but on average, four to six weeks.

SPEAKER_00 26:34

That's great. Thank you for sharing that. I'm sure that will bring some people some hope, you know, if they've ever had that diagnosis. So let's switch gears. You sang a cappella.

SPEAKER_01 26:46

Uh-oh. It was a path life, Heather. It was a past life.

SPEAKER_00 26:51

Who is your uh favorite uh a cappella group of all time?

SPEAKER_01 26:55

Ooh gosh. I'm gonna have to say pentatonics.

SPEAKER_00 26:59

Okay.

SPEAKER_01 27:01

They are they are yeah, yeah, I'll have to say pentatonics.

SPEAKER_00 27:04

Hey, that's great. Now, you know, there's wonderful a cappella group here in Atlanta called the Atlanta Vocal Project.

SPEAKER_01 27:10

Oh, I've yes, I'm well aware of the Atlanta Vocal Project. Yeah.

SPEAKER_00 27:13

Oh, they are amazing. I actually had them come a Valentine's last year, and they do this Valentine singing gram, and they go to people's houses and workplaces and they sing. So I had one for my husband, and they came and sang right in my living room. It was amazing.

SPEAKER_01 27:29

Oh, that's great. That's great. They're a great group.

SPEAKER_00 27:31

They are. What is your who is your favorite singer of all time, male or female?

SPEAKER_01 27:36

Ooh, that's a good question. Uh, you know, I've I've got a lot of I've got a lot of singers that I really enjoy. Um, but maybe it's just because I also used to play piano quite a lot that I'm gonna just have to stick with Billy Joel. Sorry. I know it's a little bit cliche, but uh it it's uh it was a big part of my younger years, and so that that one always makes me nostalgic, uh, listening to him.

SPEAKER_00 28:05

That's awesome. No, he's great. So is there a voice you think is technically underrated?

SPEAKER_01 28:10

I think that there are, I'm not, I'm not sure uh a specific person is is not popping into mind at this moment, but I would say that absolutely there are uh I I guess you're asking technique-wise, or yeah, yeah. Um, I I mean there are definitely people who maybe don't have the training, right, that a lot of professional singers have, but they are uh just naturally fantastic, right? And so they just know how to do it, just like uh again, with any sort of uh sport or activity that some people are just have the aptitude and it's just very intuitive to them. And so there are many fortunate people that they just open their mouth and it's a natural, beautiful voice with minimal training. So I think that happens probably more than we uh than we give credit for. But um uh yeah, I I'm sorry I don't have a specific name for it.

SPEAKER_00 29:10

No, that's okay.

SPEAKER_01 29:11

Uh I'm gonna think about it about 7 p.m. tonight.

SPEAKER_00 29:13

I know you'll sit straight up in bed and go, oh, yeah, Eureka. So what voice do you personally admire from a technical standpoint? Who's someone that you admire and and and you just say, Oh, they are the cream of the crop?

SPEAKER_01 29:26

I um I mean, you know, I think uh a voice I really enjoy listening to, uh George Michaels voice, I think is just has a really just amazing sound and um uh you know, and his training there's just something very uh very genuine about his voice. I obviously there's uh I mean there's just so many well-trained people, there's so many well-trained opera people and pop music people. I think that um there's just so many, there's just so many people that have such special voices, it's hard for me to to uh to pick a few here. But yeah, I mean George Michaels pops to mind. I think that there are voices that have this kind of natural sound that even though it's not a well-trained sound, are just so iconic, right? And so the and there's something about that that draws people that you would you would never train them to do, but it just happens naturally, right? And I think that's what makes people special as singers sometimes is that we're not trying to make them all cookie cutter, right? We're trying to take what's special about their voice and um and and double down on that. And um, and so I think that's what makes singers so interesting is that there are just so many different types of voices out there.

SPEAKER_00 30:54

Yeah. Well, and it's so much more than just about the voice, it's the heart behind the song, right?

SPEAKER_01 30:59

Yeah, oh yeah, yeah, the passion and the heart behind it, yeah.

SPEAKER_00 31:02

For sure. Well, you mentioned George Michael, and when I asked you what your never skip song is, you said Rio by Duran Duran. Why that one?

SPEAKER_01 31:14

Uh that was, you know, I don't know. It was the first thing that just popped into mind. And it's I which I guess is telling me something in my subconscious that that's a song. And it's true. I I don't think I could let that song pass on the on the radio or you know, if if we're just listening to a station on Spotify or something like that, if that song came on, I'm gonna listen to the whole thing. Uh we played in my band too. So yeah, it's uh and and actually in in the a cappella world, it it's it can it pops up from time to time. It's a great song. It's just a great song.

SPEAKER_00 31:46

Well, I feel like you're telling me there's a parallel universe where you chose synthesizers and hairspray instead of the scalpel.

SPEAKER_01 31:54

That's right. I was a part of a band in the in the 80s, and so um no hairspray, admittedly, but uh definitely synthesizers. That was my instrument, yeah. Yeah.

SPEAKER_00 32:06

Well, tell us about this. You build tools, and what kind of tools are they?

SPEAKER_01 32:14

Oh, as far as medtech innovation, uh so uh it varies, you know. Uh it's a it's a become a real big passion of mine. Um, I think that there's a lot that physicians and surgeons uh can offer uh to care for patients in a different way, right? Other than just seeing them and taking care of them in the day-to-day in the office. Um, I think in some ways it's almost an obligation uh to kind of keep bettering the tools that are out there and the devices that are out there to help people. Uh so in personally, I've uh I started uh with MedTech Innovation with um actually creating a trainer for the phonomicrosurgery that I alluded to with the nodules patients. Um it's you know, phonomicrosurgery is a delicate type of surgery. We're doing it under the microscope, we're doing it under high magnification, we're doing it with little micro instruments that are about a foot to a foot and a half long. And so it is uh it takes a lot of time to hone those skills. And in training, we get that exposure, but we're trying to get exposed to a lot of things in our five years of training as otolaryngologists. And so um uh earlier in my career, you know, I would put together a lot of training courses for residents and just found that some of the materials that we'd have available to us were um suboptimal and and also hard to come by uh as it pertained to training uh uh residents and other trainees. And so I developed a phonomicrosurgical trainer uh that has uh all of the ergonomics that you need to practice surgery and also uh really just made it turnkey for people to sit down and just practice honing these skills uh uh if they had a spare moment. Uh traditional courses are time consuming, they're difficult to set up, they're expensive, and so this is a way to uh to try to give people more time to train. So that was my entree into that kind of uh world. But um since then, I've been involved with uh Parkinson's uh uh voice device, uh a steroidiluting hydrogel for um neck surgery to help uh with the swelling after certain types of neck surgery, uh been involved in uh several other projects as well. And I also helped mentor groups at um at our uh our sister school over here, Georgia Tech, which uh uh has wonderful um uh uh programs that sp that uh that focus on uh innovation in in the med tech world. Uh so I I have worked there as a uh as a uh mentor and advisor. Uh so just become a much larger part of my career.

SPEAKER_00 35:12

Well, you're a sci-fi fanatic, and is there a sci-fi version of voice care that might actually become real?

SPEAKER_01 35:21

Ooh, ooh, that's a good question. Good question, Heather. Um I would have to say, I mean, you know, okay, like if we're thinking about sci-fi medicine, of course, I think one of the anyone who's seen this stuff uh of course goes right to, you know, the physicians in Star Trek kind of waving their little wands around on people. And so I would say that those types of devices, whether it's for diagnostics or even for therapeutics, are going to be uh I think we're just gonna get better at um the diagnostics of voice and throat disorders and swallowing disorders and managing them without having to put people to sleep and put them under the knife, so to speak. Uh so I do think that that's, you know, I think we're gonna we're gonna improve our ways there. One of the unique features of the voice box is that it is pretty easily accessible, right? Even though it's on the inside, there's a natural opening that we can use to get there. And that's of course how how we diagnose and or evaluate and diagnose in the office, and that's how we treat uh either in the office or in the operating room, is all through the mouth typically. Um, and so we have a lot of opportunity to innovate and iterate on our approaches and our devices uh to try to make our uh treatments more effective, less invasive uh uh uh than than they have been in the past.

SPEAKER_00 36:56

That sounds amazing. And it'll be interesting to see how AI plays into some of that as it develops.

SPEAKER_01 37:04

Yeah, AI is is definitely getting more, I mean, as with any aspect of medicine and the world in general, AI is is definitely starting to take a bigger role in the voice. Uh from the diagnostic side of things, there's a lot of talk about voice as a biomarker for uh not only vocal conditions, but other types of medical conditions. Uh, it is a bit of a window to the soul, so to speak. And so you can actually diagnose a lot just by the acoustics of the voice. Um, and so that is a big uh that's a big thing. There's research going on in various places, uh looking at at the the biomarker uh um features of of voice. Uh and then there's also a lot happening with AI as far as um how to uh address these different vocal issues that are being discovered.

SPEAKER_00 38:04

All right, let's uh change tempos, if you will. This is our quick fire section of the show, and you gotta answer fast, okay?

SPEAKER_01 38:11

Okay, I'll do my best.

SPEAKER_00 38:13

Okay. If singers were cars, what are they?

SPEAKER_01 38:18

Uh Porsche's.

SPEAKER_00 38:20

All right. One vocal habit that secretly makes you nervous.

SPEAKER_01 38:26

Throat clearing.

SPEAKER_00 38:28

Broadway or rock arena?

SPEAKER_01 38:30

Rock arena. Sorry, I'm gonna apologize to my wife, but yeah.

SPEAKER_00 38:36

A sound that makes you irrationally happy.

SPEAKER_01 38:39

Uh babies giggle.

SPEAKER_00 38:41

Aww. A sound that makes you tense.

SPEAKER_01 38:44

A baby crying.

SPEAKER_00 38:47

I know, right? A singer you'd love to examine, living or dead, just out of curiosity.

SPEAKER_01 38:55

Ooh. Um meatloaf.

SPEAKER_00 38:58

Ooh. Interesting. Why?

SPEAKER_01 39:01

Oh, he's got such an iconic, gritty sound. I mean, I would just love to see what he how he makes that sound. That's awesome.

SPEAKER_00 39:08

All right. You you open that B tomorrow, because you said that you would love to open a B. What's your signature breakfast?

SPEAKER_01 39:18

Whatever one for my wife. You don't want me cooking you breakfast. Uh, she's such a better uh cook than I. Um, no, but I I think it would have to be, it would probably be um, you know, uh pancakes with fruit and um just kind of a well-rounded uh uh comfort food type of breakfast.

SPEAKER_00 39:41

There you go. And finally, no catch up on hot dogs. Explain yourself. Go.

SPEAKER_01 39:48

Oh gosh. Well, I think the the um the question was something that I had a very strong opinion about, right? Or something like this. I don't know why that was the first thing that popped into mind, but it it is really uh shocking to me that anyone would put anything but mustard and sauerkraut on a hot dog. And maybe that's because I grew up near New York and just, you know, had a lot of hot dogs in New York. But um, yeah, it it it shocks me uh that that it that it would be eaten any other way. I think it's a crime. A misdemeanor. It's a misdemeanor. I mean, yeah, it's not it's not a phone card. Yeah.

SPEAKER_00 40:30

Okay. Well, my husband will forgive you because he's to he's from New York and he is totally a catch-up on a hot dog. You're a kid.

SPEAKER_01 40:36

Oh my god. I don't know where in New York he was, but uh he's he's from Long Island. So Ah, there it is. Okay, yeah, that explains it.

SPEAKER_00 40:44

He's a Buffalo Bills fan, so there you go. So you said something I love. You said be your own best advocate when it comes to your voice. What does that mean to you?

SPEAKER_01 40:56

Um well it is very common that people, as we talked about a bit before, people feel obliged to others when it comes to their voice, whether it's for performance or other professional endeavors. You know, when we talk about the amount of voice use, we talk about the internal push and the external pull, right? And the external pull for performers can be very strong. And very rarely are is anyone on the external pull side going to check in and make sure you're doing okay and give you a moment if you need a moment. And so if someone is struggling with their vocal demands or what they're being asked to do, it's so important to be your own best advocate because no one's gonna care as much as you do. And you know yourself best. And so these are it's really important to check in with yourself and make sure that you're up for the challenge, that you're up for fulfilling those demands, and if you need to take them a minute, whether it might just be for a rehearsal, a practice, or even a performance, uh, if you feel like it's in the best interest of your long-term health, vocal health, then it's important that you're your own best advocate in those moments.

SPEAKER_00 42:24

Is there anything else that you would like to leave our listeners with today, Adam?

SPEAKER_01 42:28

Enjoy using your voice. It's a it's a gift we're given, it's an instrument, and um we can do so much with it. And I just think it is uh just one of such an enjoyable part of life to be able to uh use our voice for whatever it is you're passionate about, whether it's singing or talking or laughing, uh, but just enjoy using the instrument.

SPEAKER_00 42:55

Yeah, and we and we have to remember that the voice is not fragile, but it it we should respect it, right?

SPEAKER_01 43:01

We should absolutely respect it and uh not take it for granted. And I hear that so many times from patients is as they come in and they say, you know, I just took it for granted until something happened. And not always not always just the singers, you know, even just people who are using their voice for speaking, whether it's personal or professional interactions, uh, taking it for granted until something happens and you don't have it uh at your beck and call. All of a sudden everything changes.

SPEAKER_00 43:31

Well, and I would be remiss as a vocal coach, not to say it's important to also train it wisely and to rest it when it needs rest, too, right?

SPEAKER_01 43:40

Absolutely. You know, we no one, unless you are a trained professional, no one really trains us how to use our voice uh or how to care for it for that matter. Uh so we just kind of do what we do. And it is uh it is very important to realize that there are proper ways to use the voice. Voice and proper ways to care for it. And so that's certainly something that we talk about with our patients, whether they are going through voice therapy or rehabilitation after surgery. We really try to improve their literacy about vocal health and vocal care, and hopefully it is uh is able to impact them moving forward.

SPEAKER_00 44:23

So, friends, use your voice boldly and wisely. Dr. Adam Klein, thank you for protecting the human instrument and for your heart for vocalist and helping us use that that voice to our best ability.

SPEAKER_01 44:36

Oh, well, thank you so much, Heather. It's my pleasure to be here and participate and uh and always my pleasure to care for people's voices. Thank you so much.

SPEAKER_00 44:46

Thank you. I'll see you next time on the Heather Potero Show. You've been listening to the Heather Patero Show, produced by Heather Patero Studios. Connect with us on Facebook or Instagram or visit Heatherpatero.com. Until next time, stay creative and live on purpose.