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The : "Aerosmith Postpones Farewell Tour After Steven Tyler Fractures Larynx."

Me (a physician who seriously considered going into ear, nose, and throat medicine): Wait, is fracturing your larynx/voice box even a thing?

Indeed, that's how the band the vocal injury that Steven Tyler has sustained. And if anyone was prone to some kind of unusual voice pathology, I'd say Tyler would be at the top of any list of likely candidates. Here's a called "Top 10 Steven Tyler screeches/screams of all time."

That said, I suspected that whatever's going on in the pipes of The Demon of Screamin', it was probably just a more extreme case of a more common problem than a truly "broken larynx."

To find out what is most likely going on -- and indeed, if breaking your voice box is a thing -- I spoke to Seth E. Kaplan, MD, director of the Center for Voice and Swallowing Disorders at Lenox Hill Hospital in New York City. Kaplan is an assistant professor at the Zucker School of Medicine. His practice focuses on all disorders of the voice, swallowing, and the airway, and his typical patients include professional voice users such as singers, performers, and Broadway artists.

Just the doc we need!

Let's get into a high-yield Q&A:

Faust: Okay, what exactly is a larynx fracture? Is this cartilage or bone we are talking about here.

Kaplan: The larynx is a very complex organ made up of a lot of different nerves, cartilages, and muscle that work in a coordinated effort to bring us a voice. A laryngeal fracture could mean a "disarticulation" [separation] or break in any of these structures or components that make up the larynx, including the thyroid cartilage, the arytenoids, and the cricoid cartilage, and how they function and connect together.

Laryngeal fractures are exceedingly rare and they are almost always caused by excessive blunt force trauma [that is: external force like a punch or being struck with an object]. There are only a few case reports of non-traumatic laryngeal fractures.

My suspicion, having read the articles as well as the message put out by Aerosmith on their family page, suggests that a doctor may have used the term "larynx fracture" as a kind of metaphor. Most likely the singer is suffering from a vocal fold hemorrhage. (Of course, I am not directly involved in his care, so if there were more information, I might change my mind.)

Faust: Can this be caused by external trauma, internal trauma (aspiration of foreign body), or chronic wear-and-tear? All three?

Kaplan: Again, if we are talking about a true laryngeal fracture -- this would overwhelmingly be likely to have been caused by blunt force trauma. The most common causes including motor vehicle accidents, sports injuries (i.e., hockey puck to the neck), or penetrating neck trauma [stab wounds, gunshot wounds].

If this a vocal fold hemorrhage (as I suspect), it typically would be caused by voice overuse or misuse of the vocal folds. Typically, there can be inflammation of the blood vessels that run through the vocal folds and if one was to burst or hemorrhage it could leave a deposit of blood underneath the epithelium or lining of the vocal fold, leaving a kind of soot or residue in the very important gelatinous layer (called the lamina propria). This could potentially lead to scarring, if not managed appropriately.

Faust: So, in Steven Tyler's case, this is something that could have been caused by unhealthy/unsustainable singing, right? You don't have to be a voice coach at the Metropolitan Opera to know that this guy has been straining his voice his entire life.

Kaplan: This is exactly correct. In the case of a vocal fold hemorrhage, this is what we call "phono trauma." Essentially, this refers to the misuse, overuse, or overexertion of the vocal folds.

Faust: What are the risk factors for this condition? Can things like acid reflux play a role in local tissue becoming more sensitive over time? Is this a red flag for an undetected malignancy [tumors/cancer] or anything? How about smoking, alcohol, or other environmental exposures?

Kaplan: Risk factors typically involve excessive voice use, screaming, whispering (which strains the voice, just as yelling does), and not allowing adequate rest for your voice. Yes, acid reflux as well as tobacco use can lead to further inflammation of the vocal folds, which can exacerbate these types of issues. Any type of persistent "dysphonia" [difficulty using the voice] that lasts more than 2 to 3 weeks needs to be evaluated by an otolaryngologist to rule out any type of mass lesion [tumor] or malignancy [cancer].

Faust: What's the treatment?

Kaplan: In terms of a true laryngeal fracture, treatment is determined by the extent of injury. If there is just a laceration or potential cartilage exposure, treatment might just be observation. If there is concern for airway edema (swelling), or anything that could lead to airway compromise, making sure the airway is secure is a must. Sometimes for severe or comminuted [multiple piece] fractures, open airway surgery including fixation and reapproximation [i.e., bringing tissues back together after they have been separated], is necessary.

In terms of vocal fold hemorrhage, treatment includes strict and immediate voice rest. Again this means no speaking and/or singing. This can mean days-to-weeks of complete vocal rest to allow for appropriate healing. I advise increased hydration. I rarely give steroids unless there is evidence of acute inflammation. Steroids should not be used routinely as they can mask the extent of underlying injury and give a patient a false sense of healing, pushing them to voice use too early. After allowing for resolution of a vocal fold hemorrhage and time for inflammation to decrease, a consultation with a speech pathologist can help patients ease back into voice use.

Faust: What's a typical recovery time?

Kaplan: This can be days-to-weeks; sometimes months. Patients need to be counseled on this and advised not to push back into voice use too quickly as this can lead to irreversible damage.

Faust: Anything else of interest to know?

Kaplan: There are lots of misnomers regarding vocal hygiene and vocal misuse. One of the more interesting and surprising things for patients to hear is that whispering is just as bad as screaming and yelling. Whispering is in fact an exertion of the larynx, and not a comfortable way to speak. Whispering does not help or improve vocal function and integrity.

Faust: Thanks Dr. Kaplan!

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