Monday, October 20, 2014

Recovery from a paralyzed vocal cord

For the last 6 months I have suffered from a paralyzed right vocal cord as a result of a viral neuropathy. Six months later I am beginning to progress and believe the nerve to be healing. I am able to gain some voice, though it is strained and croaky first thing in the morning. The rest of the time it sounds like a forced whisper with much improved breathing. Would I cause damage by returning to work as a teacher of 9-year-olds, or would it be more advisable to wait a while until my voice has healed properly?

Melissa Kim, M.S., CCC-SLP writes...

You will not cause any further damage by attempting to use your voice for teaching purposes - although you may experience a good deal of vocal fatigue. There are many treatment options available to individuals with a paralyzed vocal fold, however, including both surgical and therapeutic options... discuss available treatment with your physician.

Best of luck to you.

Monday, October 6, 2014

Vocal Cord Nodules Treatment

Hi, I have had acid reflux and asthma for a few years and since the summer have been experiencing chronic bronchitis which has worsened the asthma. I was hospitalized for a week and I have lost my voice since September 15th, 2014. Initially they thought laryngitis but I saw the ENT and had a stroboscopy and they found beginning growths, nodules and callous like growths on my vocals chords along with a lot of swelling and mucous and they could see the blood vessels. My throat and glands are painful and burn at times. They have put me on vocal rest until further testing and encourage me not to whisper. They said depending on what happens and the ENT decides after seeing the results will determine next steps. Is there anything I can do to help?

Melissa Kim, M.S., CCC-SLP writes... 

The treatment of choice for vocal cord nodules that are newly formed is voice therapy with a speech pathologist who specializes in the treatment of voice disorders; I would suggest that you ask your ENT if voice therapy would be indicated, and if so, if they have a referral source. Vocal rest is indicated if the nodules were observed to be particularly traumatic or hemorrhagic, though rest alone won't typically resolve nodules otherwise. In the interim, however, good vocal hygiene would be recommended, including conservative voice use, adequate hydration, and avoidance of irritants such as smoke and alcohol.

Best of luck to you!

Thursday, October 2, 2014

Throat Pain After Singing

I have a concert coming up and so was practicing some complex portions of my song. I think I overdid it a bit and now I am having pain in my throat area (and a little below as well). I do not have any symptoms of a cold, sore throat, etc. I do have slight acid reflux. I am planning to rest my voice for a day or two. What other home-made preparations/therapy could I use to soothe the pain? Could I take any pain killers as well?

Melissa Kim, M.S., CCC-SLP writes...

In general, voice rest and good vocal hygiene are the best guidelines, including increased hydration, avoidance of environmental irritants, and possibly, over-the-counter medications for inflammation. For a more detailed description of vocal hygiene recommendations, please see our webpage on Tips for Professional Voice Users.

Good luck to you.

Tuesday, September 30, 2014

Paradoxical Vocal Cord Motion

A friend of mine has been experiencing voice problems. She went to see a speech therapist and was told that she has "paradoxical vocal cord motion." What does this mean?

Melissa Kim, M.S., CCC-SLP writes...

Vocal cord dysfunction (VCD), also referred to as paradoxical vocal cord motion (PVCM), is a condition in which the vocal folds close (rather than open as they normally should) during inspiration, resulting in any number of symptoms including shortness of breath, wheezing, and/ or cough. The cause of this disorder is often unknown, although in many cases it is thought to be irritant induced, such as chronic laryngeal irritation from acid reflux. Treatment is primarily therapy with a speech pathologist, targeting respiratory techniques to help to manage episodes, in addition to medical treatment of any underlying or contributing disorder.

Thank you for your question.

Thursday, September 4, 2014

Care of Your Voice

You and your larynx... what you need to know

Vocal cordsYour voice reflects many different aspects of your personality. It's what makes you unique. Lifestyle choices and differences in daily vocal use or misuse can affect the health and stability of your vocal cords. We do know that the effects of smoking and drinking alcohol can have detrimental effects on the voice and may lead to cancer of the larynx. Keeping a healthy voice throughout your lifetime.
1.Don't smoke! Don't smoke! Don't smoke! Also, stay away from smoke-filled environments.
2.Hydration matters. Drink at least 8, 8-ounce glasses of water per day (64 ounces); more if you drink caffeine, alcohol, or if you're exercising. Hydration appears to affect voice in at least two ways. First, well-hydrated vocal cords vibrate with less "push" from the lungs. Second, well-hydrated cords resist injury from voice use more than dry cords, and recover better from existing injury than dry vocal cords. Increased systemic hydration also has the benefit of thinning thick secretions (Titze, 1988; Verdolini-Marston, Druker, & Titze, 1990; Verdolini, Titze, & Fennell, 1994; Verdolini et al., 2002; Titze, 1981; Verdolini-Marston, Sandage, and Titze, 1994).
3.Eliminate excessive throat clearing. Chronic throat clearing can result in irritation and swelling of the vocal cords. Try sipping water, humming, or using a "baby" throat clear.
Limit alcohol intake.
4.Alcohol irritates laryngeal epithelium and mucosa, and has been linked to laryngeal cancer risk.
5.Avoid vocally abusive behaviors.
  • Decrease overall volume; if you're talking one-on-one in a small room, talk quietly!
  • No shouting/yelling; find another way to let people know that it's dinner time or that they have a phone call!
  • Watch excessive phone talking; you may not realize how loud you're talking while on the phone. Ask your listener!
  • Don't whisper! It may actually make your voice worse!
  • Don't talk in the presence of a lot of background noise! Talk to someone only when they are an arm's length away.
  • Don't try to talk or sing when you have a bad cold or laryngitis.
6.Avoid chronic use of mouthwash. Most mouthwashes have a high alcohol content, which can be irritating to the larynx. If you wish, use mouthwash to rinse your mouth... if you must gargle, switch to a mouthwash without alcohol or use warm salt water.
7.Posture matters. Good posture allows better airflow and reduces tension and strain. Poor posture can be improved with an exercise program designed to strengthen and realign the body for optimal support.
8.Exercise regularly to keep your body, mind, and spirit healthy. Try yoga for the extra benefit of stretch, relaxation, and strengthening, as well as good posture.
9.Get sufficient sleep daily .Early to bed, early to rise makes your voice healthy and wise.
10.Always warm up your voice before or cool down after prolonged speaking or singing. Try quiet lip or tongue trills up and down your range, or softly and quietly hum five-note descending scales in the middle of your range.

Monday, July 14, 2014

Multidisciplinary Comprehensive Rehabilitation Following Laryngectomy 2014

September 12 - 13, 2014


About the program:
Although the goal of every clinician is organ preservation, a total laryngectomy is often unavoidable
 in patients with advanced stage laryngeal and hypo pharyngeal cancer or recurrent disease.
Fortunately, the quality of life following a total laryngectomy is very good provided surgical
and rehabilitation efforts are optimal. Over the last several decades considerable progress in voice,
pulmonary and olfaction rehabilitation of the total laryngectomy patient has been made. This
course will share current trends and practices in post-laryngectomy rehabilitation. A cadaver
resection lab offers attendees a unique and powerful learning experience in surgical techniques
for total laryngectomy. Additionally, a hands-on lab with patient volunteers provides attendees
the opportunity to learn techniques of tracheoesophageal prosthesis replacement.

Program Objectives

By attending this program participants will:
  • Describe the surgical techniques of total laryngectomy as learned through the cadaver
    lab component of this course.
  • Describe the latest in surgical techniques for voice restoration following total
  • Differentiate between primary and secondary voice prosthesis placement and identify
    pros and cons of each.
  • Describe the decision making process in selecting the appropriate voice prosthesis.
  • Discuss the benefits of heat moisture exchangers (HMEs) and free hands valves.
Please call Barbara Messing, M.A., CCC-SLP, BCS-S at 443-849-8451 for questions
regarding any of our upcoming conferences. 

Wednesday, June 18, 2014

Neck Dissection - Voice Change

I was diagnosed with squamous cell skin cancer with mets to my throat. I underwent neck dissection with one pos node found at mskcc in NYC. Because of the one node I did chemo and rads. However, after more than three months after treatment ended, I developed a voice about 5 octaves lower than normal with sore throat and extreme hair loss. I was a teacher and am trying to return to work, but at this point, could not talk all day. I had a recent pet scan and all is clear. There is some lymphedema under my chin. Thank you.

Melissa Kim M.S., CCC-SLP replies...

A change in vocal quality is a common side effect of radiation therapy to the neck, and in many cases there is some degree of permanent change in vocal quality and/ or pitch. However, there are any number of additional reasons as to why you may be experiencing these vocal symptoms, and an evaluation by an Ear, Nose, and Throat physician is certainly warranted.

Best of luck to you!