Vocal overdoer syndrome is a term coined by Dr. Anat Keidar and Dr. Bastian ((Bastian RW. The vocal overdoer syndrome: a useful concept from the voice clinic. Journal of Singing. 2002; 58(5): 411-13.)) to designate an individual whose amount and manner of voice use can be considered excessive and to thereby put the person at risk of mucosal injury. Typically, the vocal overdoer syndrome comprises two parts: 1) innate talkativeness; 2) a life circumstance (occupation, performance, family, hobby, social) that permits, invites, or demands much voice use.
Vocal cord swelling and mucosa (1 of 4)
This young “dramatic” soprano is also a bona fide vocal overdoer. Her vocal capabilities have been diminishing for over two years. In this medium-range view, note the rounded swelling of the right cord (left of photo), but more significantly as we shall see, the increased vascularity and mottled appearance of the mucosa.
Same view under strobe light (2 of 4)
Under strobe light, at open phase of vibration at C#5 (523 Hz), we see a projecting, polypoid swelling of the right vocal cord, but not yet the more difficult problem.
Closed phase (3 of 4)
Closed phase of vibration, at the same pitch of C#5 shows the mismatch of the vocal cord margins. Is this the entire explanation for this patient's hoarseness? Read on.
Glottic sulcus is visible (4 of 4)
At close range and high magnification, the open mouth of a right-sided glottis sulcus is seen. This side can be operated safely due to the excess, thick mucosa and would be expected to improve the margin match. On the left (right of photo), a sulcus is also seen, but the thinner mucosa makes successful surgery on the left more challenging.