Professional voice, the science and art of clinical care, 2nd edition

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    Scott P. Stringer, MD, Section Editor

    ACOUSTIC TUMORS: DIAGNOSIS ANDMANAGEMENT, 2ND EDITIONEdited by William F. House, Charles M. Luetje, andKaren Jo Doyle, Singular Publishing Group, Inc., SanDiego, 1997, 330 pp, $99.95

    Although this is listed as a second edition, it could wellbe considered the third, as the first edition was a fol-low-up on Dr. Houses monograph that covered his pio-neering experience with the management of acousticneuromas. This edition differs from it predecessor(s) inthat it does not strictly detail Dr. Houses experiences.Rather, the editors have called upon a strong contin-gent of collaborators from around the United States,including a number from other disciplines (eg, neuro-surgery, radiology, and pathology). This shift of pri-mary authorship has not dramatically changed thetexts overall perspective. The philosophies espoused bythe House Ear Clinic are still quite evident. Althoughthis bestows a certain thread of consistency, it leaves asignificant body of opinion underrepresented. For ex-ample, many neurosurgeons would take strong issuewith the translabyrinthine approach as the primaryapproach for most acoustic neuromas.

    The bulk of the text is assigned to surgical manage-ment. These chapters were well written, and most sur-geons will find them quality references to have close athand. In addition to the section on surgical manage-ment, there are sections on the history, pathology,evaluation, and miscellaneous issues (such as stereo-tactic radiosurgery and neurofibromatosis). The text isvery comprehensive and well organized. There are nogross omissions. I found the chapters covering the his-tory of acoustic neuroma surgery to be the most enjoy-able, because they add another, more colorful dimen-sion to this most gratifying area of neurotology.

    The illustrations were the only cause of disappoint-ment with this text. All 169 illustrations are in blackand white and printed on low-quality paper. This doesnot compromise the quality of the line drawings. How-ever, the radiographs and photomicrographs wouldhave been much better displayed had they been glossyreprints. This is undoubtedly a compromise that hasbeen made to market such a comprehensive text at aprice less than $100. Indeed, at this price, most sur-geons involved in the management of acoustic tumorswill find this a valuable addition to their library.


    Gainesville, Florida

    PROFESSIONAL VOICE, THE SCIENCE ANDART OF CLINICAL CARE, 2ND EDITIONBy Robert T. Sataloff, Singular Publishing, San Diego,1997, 1094 pp, $325.00

    As most of us are otolaryngologists with little or noperforming arts background, management of artists(especially singers) with voice complaints are especiallyanxiety provoking. They seem a special breed whichboth fascinates and puzzles. With their myriad of sen-sory and motor systems tuned to such a high degree byperformance-related prowess, their symptoms andcomplaints are often related to sensation, to acoustics,to perception. Their world is a far cry from the scientificworld of medicine based on systematic empirical obser-vation, study of organ systems, and deductive treat-ment based on Newtonian mechanics. Because of theirspecial needs, singers in the office may seem histrionic,demanding, and difficult. This lack of adequate under-standing goes both ways. In the artists community, onehears of the unsympathetic view taken by physicianswho advise patients to go on voice rest, a dismissiveattitude to patients when no objective findings arepresent, and a lack of adequate explanation and empa-thy. A book on the care of the professional voice whichcan help to bridge such a chasm between the perform-ing arts world and the medical world would certainly be

    Head Neck 20: 279281, 1998

    CCC 1043-3074/98/030279-03 1998 John Wiley & Sons, Inc.

    Book Reviews HEAD & NECK May 1998 279

  • welcomed. Professional Voice, the Science and Art ofClinical Care, 2nd Edition is one such text.

    There already exists several excellent textbooks ofvoice science and phonosurgery in the English, Span-ish, German, and Portuguese literature. These includethe first edition of the book by Dr. Sataloff; books au-thored by Blitzer, Tucker, Tietze, Ford, Fried, Rubin,Gould, Benninger, Aronson, Isshiki, Garcia, and Belauare just a partial list. Strangely, after reading thosetexts, none could be called both a text on laryngologyvoice disorders and a textbook on a performing-voicemedicine. One such problem may be that texts devotedto anatomy, physiology of larynx, and voice disordersare a far cry from the world of body alignment andvisual and acoustic imagery necessary to vocal expres-sion. Dr. Sataloff in this magnum opus (1094 pages,$325.00) bridges this gap by being an expert and incor-porating experts from both the scientific and artisticworlds. This is no easy task.

    This eagerly awaited second edition is a completelyrevised book which is handsome, draws on more ex-perts and contains many new chapters that are richlyillustrated. At once a comprehensive reference text,many of the chapters read as if listening to a lecture.The book is organized around the following categories:basic science, clinical assessment of voice, voice man-agement without surgery, structural disorders and sur-gery, and voice therapy. Each of these should be broadenough in breadth to command a textbook (many do).The introduction has an amply illustrated section oncultural history of the larynx and voice, by Dr. VonLeden. This adds to the beauty of the book and puts thevoice in a Western cultural perspective.

    The basic science section include several chapters ofspecial interest. The chapter by Letson on arytenoidmovement sheds new light on biomechanics of thecrico-arytenoid joint and illustrates well new thinkingthat is necessary on crico-arytenoid articulation. Itstrangely includes illustrations from Issihikis textbookon medialization laryngoplasty. The chapters by Bakenand Sundberg are beautifully written chapters on la-ryngeal function for production of sound and vocal-tractresonance. These are must read chapters for residentsand graduates of otolaryngology residencies in theUnited States whose basis in basic science of voice andvoice production is less developed than in Europe orJapan. To be a complete laryngology text, more infor-mation on intrinsic and extrinsic laryngeal motor con-trol, muscle kinesiology of speech, voice and swallow,central control of laryngeal function; laryngeal musclehistology and newer studies on the microanatomy ofthe vocal folds should be included.

    The clinical assessment section is the strength ofthe book. The first edition was one of the first books tocontain chapters which address issues of specific inter-est to the performing artist. This book continues to in-clude these chapters and more. In this book, there are

    chapters on diet, cosmetic surgery, chronic fatigue syn-drome, pyrotechnics, eye care, and breast cancer. I readwith special interest the sections on psychological as-pects of voice disorders, by Deborah Rosen, and pyro-technic health effects and fogs, by Monona Rossol.Many of the chapters have contents which would not bein the usual practice of otolaryngologists/head and necksurgeons but affect the lives of professional voice users.Presumably, this textbook may be used by singingteachers, speech pathologists, and internists to refer tocurrent thinking on the specific topic.

    The section on medical management of acute andchronic laryngitis, laryngeal edema, and performance-related issues is one on the forefront of questions askedby singers in the otolaryngologists office. What are themedications which can be used acutely to salvage aperformance? What are the tricks and pitfalls of thesemedications when they are used before a performance?(ie, euphoria and psychosis with high-dose steroid use).Although there are two excellent chapters on medica-tion effects and medications for traveling performers, achapter devoted to workup and management of laryn-geal inflammatory disorders as it relates to singing andperformance would be useful. This is especially true forthe otolaryngologist practicing in settings without thesupport of singing therapist, speech therapists, andvoice coaches.

    The use of non-Western and nontraditional medi-cations and therapies in the management of voice dis-orders is rampant by many singers. As traditionallytrained doctors involved in voice care, we are oftenasked to give advice on herbal medicine, home and folkmedicine, acupuncture, accupressure, biofeedback, andhomeopathic and manipulative therapy. Any informa-tion on this diverse topic as it relates to voice carewould be helpful.

    Phonosurgery is a small but new topic for most oto-laryngologists. It is an expanding area propelled bylaryngeal framework surgery, new microlaryngeal pho-nosurgery techniques, and newer methods of evalua-tion. The chapters on phonosurgery are amply illus-trated with video prints and photographs and addimmensely to the diagnosis and understanding of pho-nosurgical procedures. Unfortunately, some of thevideo prints appear to not have reproduced well. Thesection on laser surgery failed to discuss laser tissueinteraction, power density and, in general, reflects abias against the use of CO2 laser for use in benign la-ryngeal lesions. This may need balance by other otolar-yngologists who have experienced distinct advantagesin CO2 laser use.

    Surgical management of individual disorders suchas sulcus vocalis, laryngeal webs, and contact ulcersare complex. More detail on surgical techniques, tissuemanipulation, and timing and indication for surgerywould be helpful. Many voice disorders treated by sur-gery are challenging and perplexing disorders to treatand frequently require multidisciplinary management.

    280 Book Reviews HEAD & NECK May 1998

  • The details and options on management of these com-plex phonological disorders is one which would be ap-preciated by the more advanced reader. For example,which patients with benign voice disorders should betreated by voice therapy? Who should receive medicaltherapy followed by surgery? Who should receive sur-gery sandwiched between therapy sessions? These aredetails of interest to the advanced reader.

    The voice therapy section is a must read section forphysicians treating voice disorders. Especially wellwritten is the excellent overview chapter by CarolWilder. The interaction between form and function invoice production is one which most otolaryngologists inthe United States grasp much later in practice than ifhe/she were to receive a phoniatric education in theEuropean tradition. Systematic observation of respira-tory and breath support, laryngeal carriage, resonance,tone focus, prosody, and body tension is not usuallyimparted during a residency training. To be an excel-lent voice clinician, cross training by the physician todevelop a fine ear for voice is necessary. Some more-specific details of types of therapy techniques for spe-cific functional and organic pathologies would be help-ful to the otolaryngologist and speech pathologist lesswell versed in the art of voice therapy.

    The appendix includes an extensive glossary andappendix. These include the international phonetic al-phabet, patient history for singers in multiple lan-guages, sample report generations for objective voiceanalysis, videostroboscopy, and voice therapy practicelist. This will undoubtedly be valuable to internationalvoice professionals and those interested in setting upvoice laboratories.

    In summary, Dr. Sataloff has produced a majortextbook on the care of the professional voice. With thistextbook, he is to be lauded on advancing the care of the

    professional voice to the forefront of awareness by oto-laryngologists and health-care professionals. Withinthis textbook, much reading and rereading will be doneto mine the jewels relevant to clinical care of the pro-fessional voice. In the past, the literature on care of theprofessional voice has been often shrouded in secrecy.There are miracle doctors of voice, doctors to thestars, with special talents who can get their singersthrough a performance, who, by their sheer psychologi-cal insight, personality, knowledge of singing, andsprays and potions have come to command the specialreverence of singers and artists. Professional Voice, theScience and Art of Clinical Care, 2nd Edition helps todispel some of the mysteries and brings voice care ofprofessional voice users into the limelight of scientificscrutiny and investigation. In many ways, ProfessionalVoice, the Science and Art of Clinical Care, 2nd Editionwill be a work in transition. It is doubtful that a singletextbook will satisfy all the needs of the voice healthprofession. Much of the needs perceived from my read-ing of the book will be seen as superfluous and mun-dane to other readers. Such is the delight and exaspera-tion of the topic. In caring for the professional voiceuser, the title science and art of clinical care willmanifest its truest meaning to the practitioner aftermany years of applying his or her craft. As students ofknowledge seeking universal truths, we are permittedonly a glimpse of the whole. Thus, only upon complet-ing the journey may one be afforded a clearer, morewholesome view. For all the disparate truth seekersinterested in excellence in care of the professionalvoice, this textbook affords an excellent beginning.


    New York, New York

    Book Reviews HEAD & NECK May 1998 281


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