Case Study #2

Singer With No Falsetto

A 32-year-old recording artist states he has not had access to his head voice for years.

As his career took off, he gradually lost his falsetto, which he attributed to aging. Singing was also more effortful and he now needs 2 days to recover his voice after a show. 


  • Loss of falsetto is not a sign of aging
  • Voice loss from aging does not happen in your 30s
  • Prolonged recovery after performance indicates a problem
  • Success brings higher demand and an increased risk of injury due to lack of care and rest


This singer is a busy, touring recording artist and has not had time to invest in his vocal health. He has never seen a laryngologist, and always went to voice doctors/ENTs for crisis care. He began working with a vocal coach who referred him for care. We accommodated an appointment that corresponded to his tour stop in Los Angeles. He needed an accurate diagnosis with a treatment plan that worked with his performance, tour, songwriting, and recording schedule. He requires privacy and discretion as a high-profile patient.

Your Voice is More than Your Livelihood…It’s Your Life

The Best in Voice Medicine for the Performing Artist


Vocal injury can occur at any time, but the risk is greater with high-impact voice use. This includes complex tasks like singing, voiceover, and projected/professional speaking. These are forms of athletic demand, and professional voice users are at risk for injury, just like other athletes.

When there is underlying inflammation, such as from illness, back-to-back performance, smoking, etc, the risk of injury is even higher.

Voice injury is most common in vocal athletes, where it sidelines them, making it difficult to earn a livelihood and create. Treatment may require time-consuming rehabilitation, medication, therapeutic interventions, or surgery. However, the busy performer may struggle to integrate vocal health care into their work schedule. This may cause the progression of injury and, when care is eventually sought, the treatment course is often prolonged or suboptimal. This is because injury worsens over time and compensatory muscular patterns develop quickly.

Vocal performers require accommodations to their care that honor their complex demands, atypical schedule, and significant athletic challenges. 

Pre-operative view

Post-operative view

Challenges and Considerations

Complex Timing

This artist needed to have surgery but was in the middle of a tour. He was faced with possible tour cancellation, costing him and his bandmates. However, without surgery, he risked worsened injury and secondary injury that surgery could not treat. Navigating this requires a knowledge of the artist, specifics of their vocal needs, their genre, the likelihood of progression, and how to implement safeguards to prevent worsening. Surgery needed to be scheduled urgently, once a window of time was opened. At CVH, we have protocols to expedite scheduling within days of getting the green light from management and the artist.

Rehabilitation During Tour

It may be impossible to follow a traditional rehabilitation schedule when there has been lost time due to surgery and voice rest. Rehabilitation needs to be flexible or even mobile, coaching the artist through intense voice use safely during recovery. The team of professionals at the Center for Vocal Health has expertise in voice rehabilitation and adapted their regimen to the specific demands of this patient. 

Performance Rehabilitation

Rehabilitation of the performing voice is far more complex than traditional speech and voice therapy. This performer had intense vocal demand and had to re-learn how to access falsetto after years of compensatory muscle use. This is one of the most complex vocal tasks and re-education and training require specialists like those we have at the Center for Vocal Health. This patient regained his head voice within 4 weeks of surgery, having not been able to access it for 5 years, due to expert rehabilitation and training.