Piero Bonamico: Thank you, everyone. It's such a pleasure to be here today to discuss a topic that's near and dear to my heart and, I believe, essential for singers and singing teachers alike: vocal health and surgery. Now, I know that the thought of surgery on a singer's voice can be frightening, but let's work together to "decatastrophize" vocal injury and view it as an issue that needs to be addressed.

Imagine a singer walking into a surgeon's office, worried about their voice. The surgeon, equally concerned, has to make critical decisions about the patient's treatment. It's a high-stakes world where operating on a professional voice user is not just a challenge, but a responsibility. Why? Well, let me share some insights I've collected from various experts in the field of vocal health, including Dr. Milan R. Amin of the NYU Voice Center and Dr. Robert T. Sataloff, a leading laryngologist.

First of all, operating on a professional voice user presents challenges for several reasons:

• Patients can be, well, a tad neurotic (understandably so!)
• The perception of surgery is generally negative
• There's always a risk involved
• Improvement is difficult to guarantee
• Surgical techniques can seem crude

So, when is surgery the right option? Dr. Sataloff says that "voice surgery is both an art and a science, and the decision to proceed should not be taken lightly." Dr. Amin also emphasizes that surgery should be considered as a last resort. Two major decisions come into play: whether to operate and when to operate. In making these decisions, surgeons must ask themselves:

• Can I restore better glottal function?
• Are the goals clearly defined?
• Will the patient feel better after surgery?
• Is this the right patient?
• Should I try something else first?
• Is the patient ready?
• Is there enough time to heal?
• Does this work within the patient's schedule?

The game plan for surgery depends on the surgeon's and patient's needs and comfort level. Factors to consider include the patient's risk aversion, goals, and unique characteristics.

Prepping for surgery involves reducing inflammation as much as possible. This can be achieved through pre-op voice therapy and the use of steroids. Setting expectations and obtaining informed consent are essential, as is gathering information from multiple sources, such as surgeons, singing teachers, and family members. Post-op care counseling is also crucial for the patient's recovery.

Dr. Amin highlights the Tenets of Phonosurgery, which emphasize restoring the normal glottal shape, among other untapped points. Healing is a complex process, and there's much we don't understand. For instance: