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!

Thursday, June 12, 2014

10th Annual Voice Conference:

Advanced Topics in the Diagnosis and Treatment of 
Laryngeal Disorders Laryngeal Stroboscopy
in Clinical Practice with Hands-On Instruction
Friday & Saturday June 27 & 28, 2014

About the Program
This is a two-day program designed to educate otolaryngologists and speech-language
pathologists in advanced topics in the diagnosis and treatment of laryngeal disorders.
The conference will cover the fundamentals of laryngeal stroboscopy, including clinical
applications, diagnostic and clinical challenges with case study review in a team
approach. Specialized voice therapy techniques for a variety of vocal pathologies
including therapy for the performing voice. Hands-on instruction in both rigid
and flexible endoscopy will be provided.   

Program Objectives
By attending this program, participants will:
  • Discuss the fundamentals and limitations of the laryngeal stroboscopic examination.
  • Discuss differential diagnoses of laryngeal pathologies.
  • Discuss voice therapy techniques for a variety of vocal pathologies.
  • Discuss therapy interventions for the performing voice.
  • Discuss techniques and protocol performing for rigid and flexible endoscopy.
Please call Barbara Messing, M.A., CCC-SLP, BCS-S at 443-849-8451 for
questions regarding any of our upcoming conferences. 

Thursday, May 29, 2014

Professional Voice User - Acid Reflux

I have acid reflux diagnosed by Stanford University. Prescribed Omeprazole 40 mg 2 x day. Your article recommended other products, and I didn't see this one. Article discussed liquid medication like Maalox, Pepcid and a few others, I didn't see Omeprazole. Which is the better choice? I have an important speaking engagement June 18 and vocal cords are somewhat swollen and irritated due to previously undiagnosed acid reflux. HELP!

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

The information provided on our website mentions over-the-counter products only; prescription medications should be recommended by a physician. Although Omeprazole is now offered over-the-counter (Prilosec OTC), it is still a medication frequently prescribed by physicians to treat acid reflux, and is considered very effective. I would suggest that you follow your doctors recommendations; however, additional over-the-counter medications can be used to address breakthrough symptoms.

Best of luck to you!

Thursday, May 22, 2014

Professional Voice User

For years now, I've struggled with vocal hoarseness after about an hour of singing. Recently, however, after singing, my entire body becomes achy and sore along with my throat hurting. I've seen voice specialists and they say that my scope shows everything's fine. I've worked on my vocal technique with voice teachers, but this issue remains. Lately, I've been searching online for others who experience this body soreness after singing, but haven't found anything similar. I'm a professional commodities trader by day, so I do yell quite a bit in the trading pits, but I never experience any pain or aching. Please advise.

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

It certainly sounds as though you are frustrated by this soreness that occurs only after singing. Although I have not personally evaluated you, some singers can develop muscle tension dysphonia, a condition that occurs when muscles around the larynx become unnecessarily active during vocal function. This can result in pain and discomfort, which is usually intermittent. Likewise, people can develop compensatory muscle tension in other parts of their body. I would be interested to hear what your voice teachers have recommended and if your singing posture has been evaluated. It might be beneficial to have your larynx examined by a laryngologist (an Ear, Nose, and Throat physician who specializes in voice disorders) while you are singing to determine if muscle tension is in fact causing your discomfort. Our medical team would be more than happy to see you; appointments can be made by calling 443-849-2087.

Good luck!