Wednesday, February 3, 2016

Singing Voice

Good afternoon,
I have been a vocalist since I was in high school. Approximately 15 years ago (I am now age 41), I started to notice a weakness in my voice, my voice would crack and "cut out." After several years of trying to adapt to this change and after becoming frustrated with the lack of confidence I had when performing, I sought out a consult from an ENT about 7-8 years ago. My expectation was for him to find nodes, GERD or something relatively treatable. I informed him that while I had no pain, I could "feel" the weakness was coming from the left side of my vocal cords. After a basic exam he noted that my vocal cords were not "aligned" and appeared that I had damage to the nerve that supported the left cord. I was referred to an ENT that had more comprehensive testing. A video strobe was done and confirmed that there was indeed nerve damage and the left cord was not moving in sync with the right. I was asked if I had a hx of previous neck trauma, surgery, a traumatic intubation or head/neck cancer. I had none of these. Perhaps it was from an intubation during routine surgery I had? I also had chicken pox as a young adult when I was in nursing school and it was discussed that possibly the virus may have attacked the nerve.... An MRI of the head and neck was performed to r/o things like a brain tumor that may be causing the nerve compression/damage. This was a normal study. Swallowing study was also done to r/o aspiration because I occasionally experience "coughing fits" when drinking liquids. This was also normal. Essentially I was told that unfortunately there was nothing that could be done to fix the problem. 

So, after several more years, I am seeking out additional information and potentially a second opinion knowing that there may be advancements in this area. I am finding that public singing/vocal performances for weddings, leading worship at our church, giving voice lessons etc is becoming more and more frustrating as I fear issues with my voice. Especially being aware that the dysfunction is present. My throat now seems to tense up even more as I try and "compensate" for the vocal dysfunction. I saw an ad come up on my social media for the Hopkin's Voice Center and watched the video and decided it was worth it to try and contact someone to see what, if any, next steps would be. Thank you.

Melissa Kim, M.S., CCC-SLP writes... 

While it is certainly possible that you experienced some trauma during a routine intubation that resulted in a vocal fold motion impairment, in many cases of motion impairment there is no discernible cause and a viral source is suspected. The most common procedural interventions now offered for individuals with a vocal fold motion impairment are vocal fold injection augmentation or medialization laryngoplasty.

Injection augmentation is done using a filler material to "plump up" the injured vocal fold, moving it closer to midline and improving vocal quality and strength. Filler materials are either temporary, lasting approximately 2 - 3 months, or "durable," in which results last closer to a year. The procedure can be done in the operating room but is now done routinely in the office with great success.

Individuals who have a long-standing paralysis - if that is the diagnosis you've been given - often opt instead for surgical medialization. This involves the placement of an implant to push the vocal fold closer to midline, and is considered a permanent "fix." This procedure is only performed in the operating room.

A laryngologist - an ENT with specialty training in voice disorders - is the professional most experienced in these types of procedures. We would be happy to evaluate you here at the Johns Hopkins Voice Center at GBMC.


Thank you for your question!

Wednesday, January 13, 2016

Pediatric Speech-Swallowing & Voice


Pediatric Speech-Swallowing Services

Our pediatric speech-language pathologists at the Milton J. Dance Jr. Head and Neck Center evaluate and treat children of all ages who have difficulty communicating.

Speech
Children who need help with their speech development may be hard to understand. They may have trouble saying sounds and words correctly or may not be speaking at all. At our Center pediatric speech pathologists specialize in helping children with a variety of speech problems including: articulation difficulty, apraxia of speech, phonological processing disorders, stuttering, voice disorders, and speech-resonance issues associated with cleft lip and palate.

Language
Children who need help with language development may struggle with understanding spoken or written information such as directions, questions, and stories (receptive language). They may have trouble using words or symbols to communicate, using correct grammar, or may not speak at all (expressive language). Children with language disorders or delays may also have trouble with social communication (pragmatics) and have trouble interacting with others, making proper eye contact, or staying on topic. Our pediatric speech-language pathologists specialize in helping children who have language difficulty due to these communication barriers.

Monday, December 14, 2015

Voice Screenings

Voice screeningsThe Johns Hopkins Voice Center would like to announce our voice screening program! The speech-language pathology team provides assessments to professional and semi-professional voice users, or any lay person experiencing vocal difficulties. This program may also be beneficial for healthy voice users as a tool to establish baseline vocal performance, which may be a source of comparison if one encounters problems in the future.
Voice screenings are offered on the last Tuesday of every month from 3:00 - 5:00 pm; the charge for the screening is $15.00 that may be paid at the time of the appointment. 
Your voice screening will include:
  1. A review of your voice history to identify any potential problems.
  2. Visualization of the larynx with a small endoscope (camera) that is passed (painlessly) through the nose. This is optional for the squeamish, but the most objective way to look at the vocal cords.
If there is any indication of a voice disorder, you will be referred for a full voice evaluation under the supervision of both a physician and speech-language pathologist to make a formal diagnosis. A full evaluation will require a referral from your primary care physician, and you will be required to ensure authorization and coverage by your insurance. If you have questions regarding your insurance coverage for a full voice evaluation, please call 443-849-2087.
Speech-language pathologists cannot provide a formal diagnosis but can isolate need for further evaluation with a physician. At that time, the two professionals will discuss your case and determine any need for therapy, surgery, medications, etc.
Participants may register by calling 443-849-2087, or e-mail questions or to mkim@gbmc.org. E-mail requests will be confirmed with a reply.  Looking forward to sharing this great opportunity with you!

Tuesday, November 24, 2015

Singing the Praises of the Johns Hopkins Voice Center at GBMC

Singing the Praises of the Johns Hopkins Voice Center at GBMC

The Johns Hopkins Voice Center located at GBMC's Milton J. Dance, Jr. Head & Neck Surgery Center is hitting the right notes as it mends damaged voices with a little help from Fender Musical Instruments Corporation. Read the full article featured on The Baltimore Sun

Tuesday, November 3, 2015

Voice Change After Surgery

I had cervical disk fusion surgery on 4/21/15.  After surgery my voice was very hoarse and now several months after I have this feeling in my throat as if there is something in there, but this was also happening right after surgery. My voice gets hoarse now and then especially when I bend forward it gets worse. Is this going to get better?

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

A temporary change in vocal quality is not uncommon after this type of surgery, though I wouldn't anticipate the change persisting this long after your procedure. I recommend that you see a laryngologist (an Ear, Nose, and Throat doctor who specializes in voice disorders) for a full evaluation and treatment recommendations. Ask your surgeon for a referral or visit the American Academy of Otolaryngology/ Head & Neck Surgery at http://www.entnet.org/ to search for a physician by subspecialty.

Good luck!

Tuesday, October 13, 2015

Voice is Still Hurting

My wife and I are in need of serious help. My wife has been having speech difficulties for up to three years now. It causes pain for her to talk and resting only helps but doesn't seem to cure it. Though we haven't done an extensive rest for it. We have been to multiple specialists and have gotten multiple answers. My wife was once told she had polyps on her vocal cords. Then we went back to a different doctor a few months later and after scoping her he told us there was nothing there and he saw no problem at all. Which makes no sense to us because her voice is always in a differing state of pain. From slight to great. She used to have serious problems with acid but we have gotten that under control. She has never drank or smoked. We we're thinking it could be either contact ulcer or possible Chronic Non-Specific Laryngitis but we really have no idea. Her last two scopes showed nothing, but her voice is still hurting. We are really desperate to figure this out! Why could there be nothing on the scope but still she is having this problems? I hope you might be able to help. Thank you for your time and support.

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

In some cases, odynophagia, or pain with voicing, is related to how the voice is being used, rather than the presence of pathology. Muscle tension dysphonia (MTD) is a general term to describe excessive and unnecessary tension of laryngeal muscles during voicing. MTD is often referred to by many different names, including hyperfunction, functional dysphonia, ventricular or false vocal fold compression, etc. The condition is treated in voice therapy with a speech pathologist experienced in the treatment of voice disorders.

Best of luck to you both!

Wednesday, September 9, 2015

Hanna Somatic Education and Treatment

Hanna Somatic Education
Hanna Somatics is an integral part of working not only with vocal performers but with anyone experiencing tensions, misalignments and pain that limits their vocal life and overall wellness. Many of the vocal problems people have are not isolated to the larynx. Things that are happening all throughout the body can have an impact on the vocal sound we create. Chronic muscular tensions that affect ease of movement, breathing, and speaking and singing are not merely muscular tensions, they are (neuro)muscular tensions. Hanna Somatic Education changes the communication patterns between the brain and the muscles and within the sensorimotor areas of the brain itself.  

To schedule an appointment, please call the Johns Hopkins Voice Center at 443-849-2087 or click here.   

Dan Sherwood, MS/CCC-SLP, HSE, Speech Pathology Clinical Specialist
Dan Sherwood, MS/CCC-SP, HSE, Speech Pathology Clinical Specialist
Focusing on rehabilitation and retraining of the professional voice. Special interests include breathing retraining and movement education, with training in alternative/complementary disciplines, including Hanna Somatics®, Associative Awareness Technique™, Optimal Breathing®