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Air for an Audience

An article by Nathan Curnow.

June 2018. We’re about to perform in the German city of Heidelberg. It’s a beautiful evening, and we’re trying to keep calm as the sun dips below the rooftops of the baroque streetscape. It’s the opening night of their annual literary festival. The Spiegeltent has been erected in one of the cobblestone squares of the old town district and now sound check is over, the stage is set, the venue is filling up. I have to be cool, but it’s easy to be undone by the significance of all this. The city of Heidelberg has flown us halfway around the world to be the headline act in the birthplace of Romantic poetry.

For me, it’s the culmination of twenty years as a poet and spoken word performer. I’ve worked countless rowdy bars, quiet libraries, country halls and tin sheds, using nothing but my voice. Spoken worders aren’t singers, comedians or musicians. We don’t have tunes, punchlines or a guitar to hang around our necks. We don’t even have a piece of paper to read from. All we have is a bare stage, a microphone and our memory, which we hope works, plus some experience in rhythm, rhyme and intonation. We manage air for an audience, the air across our vocal cords, the air that we form into words.

Now jump back twenty years to when I first got up at an open mic. Imagine a dark, upstairs room, with bodies jammed onto couches so rundown that no undergrad would want them in their share house. It’s a hot and stuffy Wednesday night on Brunswick St in Melbourne, windows jammed open for fresh air, tram’s dinging their bells as they pass. You’re in a room full of weirdos and wannabees, each one waiting for their name to be pulled from a baby doll’s head. You’re at Babble. And suddenly you’ve been chosen to have your three minutes on stage.

It was do or die back then. And most of us died. Some were a three-minute train wreck. Each night was an electric circus of danger and possibility, the room supercharged by failure, success and expectation. It was there that I began exploring voice. I’d listen for hours, asking why some people hit and some completely missed. Mostly it was a total drag of a night, except for one magical moment when someone got up and did something amazing, something that gave us enough reason to return the following week and endure it all again.

So what makes a voice hit its target? It’s obviously a combination of what’s said, how it’s said, plus when, where and why. There’s the anger and urgency in the orations of Malcom X or the fierceness of Nina Simone. There’s the dramatic delivery of Alan Rickman, the charm of Jeff Goldblum, the sultry heat of Eartha Kitt or the creepiness of John Malkovich. I don’t have the clinical knowledge of a specialist. All I know comes from my years on stage and from being part of a listening audience.

Earlier I said that I had to keep cool before taking to the stage. Everyone has doubts, especially performers, but staying cool and present gives your voice the best possible chance of sounding believable in the moment. People respond to what they perceive as real, so like a magician, you’re hiding the tricks. You’re managing your nerves so that the audience won’t see the techniques of your delivery. People want to think it’s natural, effortless, even though deep down they know it’s not.

I contend that there are three elements to manage an effective voice. Now, these aren’t Toastmasters or TED Talk techniques. They’re not ways to sound as captivating as Maya Angelou or James Earl Jones. They may not give your voice the X factor, but they’re fundamental to working a microphone or to just having a conversation down at your local supermarket.

The Internal

When I was six years old I had a debilitating stutter. I was unable to say the smallest words like ‘hi’ or ‘and’, the sounds refusing to complete their release of me. My mother suspected it was due to the tantrums of my Grade One teacher, a lady whose face lit up redder than the planet Mars before she exploded at the little children before her. My mother was right, I was petrified of the woman, and this fear manifested as a stutter.

It’s almost impossible to find your voice when your inner world is in chaos. Performers might commonly suffer stage fright, but we can all feel that same intense pressure in our daily lives—the threat of judgement, the fear of failure, the weight of expectation. When we’re constantly overwhelmed we’re not safe to feel ourselves, and being ourselves is the key to voice. If eyes are windows to the soul then perhaps voice is the orchestra of it. The sounds we make reveal us—who we are, what we fear, what we want or what we’re hiding.

For a performer, nerves and adversity can be a wonderful motivator in the short term, bringing a necessary edge to the voice, but if left unmanaged the performance will eventually suffer. This goes for anyone, no matter where or what the occasion. It’s hard to speak if you’re in distress, and sometimes the smallest audiences are the most terrifying.

The Meaning

Have you ever seen a music video that bears no relationship to what the song is about? If not, check out the Look of Love by ABC. It’s bizarre! Or have you ever listened to a good audiobook that’s read badly? There’s a disconnect between the message and the delivery. The voice seems to ring untrue. To deliver a believable voice we must understand our message and what it means.

Sometimes a well-intentioned producer will employ trained actors to read the work of poets, instead of the actual poets themselves. I understand the idea, but I’ve never really known it to work out. Why? Because actors tend to overshoot it, emoting it to death, putting themselves and what they do before the message. Rather than being stewards of the poem, they think it’s about themselves doing it.

In A Hard Rain’s Gonna Fall, Bob Dylan sings: ‘I’ll know my song well before I start singing’. It’s a simple line, one that’s always meant a lot to me. The clarity of the idea combined with his sing-speak sound has made it unforgettable. If you truly know your ‘song’, you’ll know its meaning. This guides your delivery so that you can get out of the way of your own performance. Now that’s a kind of irony, isn’t it? How can a performer get out of the way of their performance? Simply, by managing the ego. Realising that it’s not all about you gives your voice room for the message, providing the best chance of bringing people together.

The Audience

There are those magical moments when a performer feels perfectly in tune with the audience. It feels like you’ve become involved in something bigger, a shared experience you can’t explain. For the performer, it’s like they’re delivering the show but receiving it as well. Spoken worder Sean M Whelan says:

‘It’s about being inside that moment for the duration of the performance, but it’s about being outside of it at the same time.’ (2012, Verity La)

Our voice reveals our relationship with our audience. It reveals how we consider them, whether their loved, feared or loathed.

Some ‘page poets’ resent having to read their work in public. They’d rather be one step removed, speaking only to the reader through the printed words in their new book. And yet live readings are where most poetry books sales occur, so they’re thrust onto the reading circuit. What results is something that’s excruciating to sit through. You can hear their disdain and discomfort in every word.

As I said earlier, people respond to what they perceive as real, and in my experience the only thing an audience won’t forgive is contempt. You have a role to fulfil beyond your own doubts or misgivings, and they want you to fulfil it. If we’re uncomfortable with this role then our voice suffers. In this sense, our attitude toward our audience completely relates to the who, what, where, when, why and how of speaking.

Now as you already know, these three elements connect and overlap. They relate to us being in the present, whatever the context, wherever the stage. These moments are full of pressure, irony and expectation but we have to find peace with that in order to speak. Ultimately, I think it’s about acceptance. To deliver our best voice we must accept that things may fail, and that failure is a success if it’s genuine. We must fool ourselves into thinking that our own magic trick is trick-less. Because it is, and it isn’t, and that’s exactly how real magic happens.

June 2018. I step up to the microphone in Heidelberg, breathing in the air that’s mine and all of ours. By recognising this I can find my voice, managing it out of respect for myself, my message and my audience. I breathe out and the air is formed into words that hopefully hit their target. Then through my voice, I begin the show, which is all of us creating something.

Bio

Nathan Curnow is an award-winning poet, spoken word performer and past editor of Going Down Swinging. His books include The Ghost Poetry Project, RADAR, The Right Wrong Notes and The Apocalypse Awards. He has taught Creative Writing at Federation University; been a peer assessor for the Literature Board of the Australia Council, Creative Victoria and Arts Queensland; and recently co-judged the Newcastle Poetry Prize. In 2018 toured Europe with loop artist, Geoffrey Williams, performing at the OFFMilosz festival in Poland and opening the Heidelberg Literature Festival in Germany.

 

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”

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Look how far we have come!

An article by Dr Malcolm Baxter.

When I trained in ENT in the mid-1970s, laryngology was somewhat in the doldrums and not regarded as a subspecialty, which is surprising given its great importance in Victorian times with contributions from outstanding laryngologists in Europe, the UK and the USA.

Certainly, laryngeal malignancy was to the forefront, and in general, in Melbourne, laryngeal carcinoma was treated by radiotherapy and salvage laryngectomy although primary partial laryngectomy was increasingly used in some centres.

The options for benign laryngeal disorders were somewhat more limited.  We were almost unaware of the seminal work of Hirano.  Microlaryngoscopy was done for biopsy and removal of laryngeal lesions, although the instruments were fairly gross, which made it sometimes difficult to produce good results.  There was one C02 laser in Melbourne for laryngeal work during my training, and this was at the Royal Children’s Hospital, used for laryngeal papillomatosis which was then considered to be a paediatric disease largely.  The occasional adult patient with the disease could be treated there by special dispensation.

Concerning other benign lesions, a popular operation at the time was so-called “vocal cord stripping”, a procedure which sounds as bad as its name and produced expected results.  Although various procedures on the external larynx such as the Woodman procedure were described, these were seldom done. We used Teflon injections  for the paralysed vocal cord, an excellent solution for those people with a malignant cause who was not expected to live more than six months but unfortunately this was sometimes carried over in some cases to people who did not have a malignant cause for their paralysis, often with unfortunate  late results such as local laryngeal granulomata and even Teflon spreading to distant organs.

My interest in laryngology was stimulated by one patient I remember who had a so-called vocal cord stripping and on review in the outpatients on indirect laryngoscopy had beautiful looking vocal cords which moved and apposed beautifully without a sign of any lesion but unfortunately with an absolutely dreadful voice.  Of course, the vocal cord stripping ignored the principles of preserving the lamina propria, but without videostroboscopy, I was unable to appreciate the vibration of the vocal cords (or rather the probable total lack of vibration!).

Examination in ENT, including the larynx, throughout most of my training, was still using the frontal mirror, beloved of American cartoonists, using a reflecting lamp which shone from behind the patient on to the surgeon’s head-worn mirror back to the patient. The larynx was examined by indirect laryngoscopy; a technique described first by the singing teacher Garcia in 1862 and which still gave a good visualisation of the larynx in those people whose gag reflex did not completely preclude it but not allowing assessment of connected speech or vibration.

Our speech pathology colleagues usually attended Outpatients but were somewhat frustrated by not being able to visualise the cords and having to rely on our description.  Ros Frank, a leading speech pathologist at the Royal Melbourne Hospital, had acquired an attachment which fitted on the surgeon’s frontal mirror and by standing behind the patient looking at the examining surgeon, you could see a reflected image of what the surgeon saw with his mirror – a sort of doubly indirect laryngoscopy!  Slightly later the frontal mirror was superseded by the Vorroscope now widely used in Australia by ENT specialists.  One further refinement was the use of a half-silvered mirror which was attached to the Vorroscope, which allowed some vision to an external observer.

Even after I did my post-fellowship work overseas, flexible endoscopes were only just making an appearance, although by the end of the ’80s most ENT specialists had converted to using this instrument which obviated the need for indirect mirror laryngoscopy and also thankfully the more difficult technique of mirror nasopharyngoscopy to visualise the nasopharynx.

The general management pattern in the pre-flexible laryngoscope era was that the patient who presented with dysphonia would have an indirect laryngoscopy and if they could not tolerate this or cords not visualised adequately, they would have to be booked for a microlaryngoscopy under a general anaesthetic.  The flexible laryngoscope, besides giving better vision, also greatly reduced the number of GA’s which needed to be given.

Once the patient’s vocal cords were seen, they were usually divided into those which had an observable lesion which were usually booked for biopsy or other surgery or those which did not, in which case they disappeared behind the door marked Speech Pathologist (or possibly in those days, Speech Therapist) never to be seen again.  There was a generally unspoken assumption that if a person had dysphonia with nothing observable on the larynx, then it was obviously something “in the mind” and who better to deal with this than the speech therapist/pathologist!

Stroboscopy of the larynx had been experimented with previously in several centres overseas but nowhere in Australia at that stage to my knowledge.  I do remember reading about this technique before I qualified and thinking it would be something that I would be interested in, but I forgot about it with the pressure of going overseas for post-fellowship work.

On return to Australia, I entered general ENT practice with a special interested in Otology and in the mid-1980’s I asked Laurie Ryan if I could join him at the Royal Victorian Eye & Ear Hospital as a visiting consultant which I duly did.  I was a little lost for a role at that stage and decided that acoustic neuroma surgery was probably not for me, but Laurie suggested,  knowing that I was interested in singers and music, that I consider setting up a voice clinic at the hospital, a suggestion for which I am always grateful.

A short time before, the hospital had bought an early model laryngeal video stroboscope, the Danish Bruel and Kjaer system, a behemoth of a machine on which one could occasionally see pictures of the vocal cords.

Together, I started the Royal Victorian Eye & Ear Hospital Voice Clinic with  Jenni Oates, speech pathologist and we developed a technique of seeing voice patients that presented to us in a joint consultation model which allowed each of us to contribute our own particular special skill sets towards the diagnosis and management.  Mercifully the Bruel and Kjaer system was replaced with a new Kay video stroboscope which was updated once or twice and remained the instrument of choice.  The Kay system, later Kay Pentax, was the standard workhorse for video stroboscopy for many years both in the public system and our private clinic, although in later years in our private rooms we converted to the Xion.

We started the Eye and Ear Voice Clinic around 1989 and in 1991 we recruited Andrew Hughes, Neurologist, and started a laryngeal Botox service which ran very successfully for several years until Andrew left around 2008 closely followed by me.  Unfortunately, this meant that the hospital lost the Botox service although the Voice Clinic was taken up by others, and Jenni continued.  Despite this, Andrew, I and Jenni continued to work closely together as Andrew now had a wide experience with Botox injections and although we now no longer worked in the same location, we still maintained close contact and referred patients between ourselves.

Approximately 25 years ago, Jenni and I joined with Neil Vallance (ENT) and Debbie Phyland (Speech Pathologist), to form the Melbourne Voice Analysis Centre, a private Voice Clinic which had so many locations over the years we probably should have used a caravan.

Again, we had the same model of using a joint ENT and speech pathology assessment, and we insisted on this pattern if a person wished to see us for an assessment.  Some patients wondered why they should see a speech pathologist when they wanted a diagnosis or vice versa why they should see an ENT surgeon when they were told they needed therapy, but we have always insisted that the model was the best for optimal diagnosis and therapy.

The Melbourne Voice Analysis Centre has continued over the years.  We have recruited several other speech pathologists working for Debbie over the years, and Paul Paddle and Charlie Giddings (ENT) have recently joined as laryngologists.  We have seen and treated a wide variety of pathologies, benign and malignant.  Patients who require an operation have been treated either at a private hospital or by Monash Medical Centre ENT Unit, which both Neil and I were involved with.  Over the years, we have taken part in research, therapy and attended international workshops and conferences and made contact with international laryngologists and speech pathologists.

About six years ago we were instrumental in the formation of the Laryngology Society of Australasia, which provides a forum for research and clinical focus for all professionals that are interested in the larynx and voice, particularly laryngologists, other ENT specialists, speech pathologists and voice scientists.  Laryngology has now happily reached the stage where some registrars, here and interstate have gone away and done laryngology Fellowships in the US and brought their skills back. Laryngology is firmly established here, as overseas, as a subspecialty and one which engages the interest of many trainees

Over the years I consider there have been many important advances such as better imaging and documentation due to progress in video stroboscopy, better operative results due to respect for the physical principles of the structure and function of the vocal cord and the advent of finer delicate laryngeal instruments. I had a special interest in the paralysed vocal cord, and we have used a variety of techniques both by injection laryngoplasty and external thyroplasty to correct this problem.  I myself mainly used autologous fat for injections as I was comfortable with it and felt I achieved better results but there are now excellent newer synthetics on the market.  Similarly, the laser is becoming increasingly important in its various manifestations and another particular interest has been the treatment of adult laryngeal papillomatosis for which we have used various techniques including laser, micro debridement and Cidofovir injection in an attempt to control this dreadful disease.

A focus of course both in public and private has been the so-called “professional voice user”, a concept I have never been entirely comfortable with as I believe that a person’s voice is important to them irrespective of occupation. Whilst recognising that singers and actors are totally dependent on their voice people such as teachers and call centre workers are economically dependent on it as well.  We have seen a wide variety of people from all walks of life including singers at all stages of their profession.  Apart from those reliant on it for their living, there are of course the students and aspiring singers but also a large variety of people who sing for the love of it and for whom dysphonia is a significant handicap in that it is often such as major interest in their life.

Of course, laryngeal disease may manifest as airway problems also which I became increasingly interested in. One unexpected consequence of this was suddenly becoming an apparent magnet for Chronic Cough referrals, often from Respiratory Physicians. Thankfully I fell back on the earlier principle of sending them to the Speech Pathologist but many came back leaving us trialling things like Gabapentin with variable results.

A few years ago, Professor Phil Bardin at Monash Lung and Sleep Department, Monash Medical Centre formed a Laryngeal Clinic because of their interest in vocal cord dysfunction as it impacted on respiratory conditions and its relationship with difficult to control asthma.  Although this was a source of some turf war mutterings, it is, in fact, logical that the Respiratory Physician should be equally interested in this condition of vocal cord dysfunction or VCD, now increasingly becoming known as ILO (Inducible Laryngeal Obstruction).

Phil and I ultimately joined together to form a Multidisciplinary Team and clinic to tackle this problem at Monash.  Debbie Phyland joined us as a speech pathologist plus Ken Lau as a radiologist with Laurie Ruane, respiratory scientist and we conduct outpatient clinics and injecting session for laryngeal Botox as well. Our treatment protocol involves “Laryngeal Retraining” (Speech Pathologist again!) in the first instance and those not responding may be offered laryngeal botox or other modalities. We have now seen over 80 patients with some encouraging results and have published our results.

I no longer operate apart from squirting the odd amount of Botox into the vocal cords and do not see many voice patients these days.  I have, however, become increasingly interested in patients with VCD /ILO.  These are generally fairly sick patients, and I believe our clinic is helping them greatly although whether it is the therapies we offer or the psychological support we give, I am not entirely sure.  Watch this space as this is a work in progress!

If you had told me at the beginning of my career that I would at the end be managing chronic cough and asthmatics and working with Respiratory Physicians, I would have thought you were mad, or possibly changed specialities.

In summary, it is gratifying looking back over the last 40 odd years to see what has happened to laryngology in this country. It is now definitely at the point where it is recognised as being a separate sub-speciality of Otolaryngology, and this must be for the good of our practice and our patients.

“Unless stated otherwise, this article represents only the views of the author and not the views of the AVA”