Wednesday, December 28, 2011

Vocal Damage

Well, I have a somewhat long and complicated history with vocal health, and I was hoping I could obtain some advice on it. I used to be a singer, and when I was eighteen I got the nodes, (I'm 21 now), but recovered from them after four weeks of vocal rest. The problem was I didn't have money for a good coach and I really didn't feel like my voice was quite what it was before, not even in terms of range but in terms of fatigue. Ironically, I sort of abandoned music and playing in bands for a time in pursuit of philosophy and poetry. What these fields brought me to was my true calling all along, which is rap. Now this may seem strange that a rapper is seeking consultation on the matter of vocal health, but I assure you I am in need of aid. I've been very careful with my voice, anytime I've overdone it performing at a show I always made sure to give it rest and proper hydration. I quit smoking which also helped. The main problem is that after a show in the summer, I experienced a bad bout of vocal fatigue, something that hadn't really bothered me in quite sometime. I gave it weeks of rest, and went to an ENT who told me my vocal cords look great. The problem is they don't feel "great" and get worn out super easily making it impossible to pursue my career. I tried doing some of the vocal warm ups I was taught in vocal therapy when I originally had the nodes, but those end up hurting a day or two later. That's the strange problem with my cords, I don't feel pain from "abuse" if you want to categorize it as that, although I'm pretty careful about my vocal habits, until two days after the fact. I never fully mastered using my head voice and diaphragm, as much as I tried, so I'm sure I'm guilty to some degree of improper use, but I also feel like I've been quite generous and kind to my cords in terms of rest and over usage. This has been going on for months, and has taken a toll on my social life and performing abilities. Any thoughts you can give me would be greatly appreciated. I just pray there's hope I'll recover.

Melissa Kim, MS, CCC-SLP replies... 
Thank you for the detailed history! In it, I think you have answered your own question. The symptoms you describe sound very much like supraglottic hyperfunction, or excessive tension of laryngeal muscles with speaking or singing. This is not something that you would "realize" you were doing, but can result in vocal fatigue/ effort, pain, hoarseness, and limited pitch range. I would suggest that you see a laryngologist - an Ear, Nose, and Throat physician who specializes in the voice, and ask for a referral to a speech pathologist specializing in the treatment of voice disorders. This is a condition that can improve dramatically with voice therapy.

Best of luck to you!

Monday, November 14, 2011

Semi-Professional Singer

I am a semi-professional singer, elementary school, and private voice instructor. Starting last spring, I noticed I was having difficulty with my middle register. This fall I noticed that my speaking voice has dropped in pitch and it is now almost impossible to produce a tone in the a-c' area. I am using my chest voice to a much higher degree then ever before. I had a sinus infection a few weeks ago and was hoping conditions would improve after it cleared up but the contrary seems to be happening. I am getting worried that something serious might be going on. Please let me know if you can give me some direction. Thank you.

Melissa Kim, MS, CCC-SLP replies...

The only way in which to determine the cause and appropriate treatment for your symptoms is to seek evaluation by a laryngologist, an Ear, Nose, and Throat physician who specializes in care of the voice. 

Best of luck to you.

Wednesday, October 12, 2011

Ask an Expert - Vocal Health

First I have to start off with some medical history. Two years ago I began getting sinusitis, about 8 times or more a year. I went to an ENT who specializes with singers. (My future career) I was having CONSTANT post nasal drip, and I have a 70% deviated septum. We began experimenting with treatments. I used nasal rinses, nasal sprays, over the counter allergy medicine, prescription allergy medicine, and many antibiotics. The doctor finally decided that I needed my tonsils and adenoids out. So I had them removed in April. It was all fine for a few months. But then my nasal drip started again. At this point, I've had a sinus infection for over a month and antibiotics will NOT help. I have noticed a lack of breath support, swift fatigue and hoarseness. I have an appointment with the specialist on Friday. I need to know what he should be doing. Should he be sticking camera's in my nose and throat to get a good look and to see my vocal folds and chords? I am a 17 year old male singer. I do not know what could be wrong with me.

Melissa Kim, MS, CCC-SLP replies...
Today's gold standard for evaluating the vocal cords is laryngeal stroboscopy, a procedure that requires specialized equipment using a xenon light. The procedure is done with placement of a flexible endoscope through the nose or a rigid endoscope through the mouth, and is not painful. Keep in mind that these endoscopes can be utilized without stroboscopy as well, so if you are seeing the doctor primarily for voice concerns, it would be worth asking if they have the equipment necessary to perform a stroboscopic examination.

Thursday, October 6, 2011

Research and Resources on the Larynx

Helpful websites related to voice production and disorders.


Voice AcademyTeachers are thirty-two times more likely to experience voice problems than individuals in any other profession. With information, teachers can self-manage or prevent most voice problems on their own. The Voice Academy is a no-cost, self-directed, virtual school built for the vocal health of U.S. teachers.
http://www.voiceacademy.org

American Academy of Otolaryngology - Head and Neck SurgeryA great source of information on the ears, nose, throat and related structures of the head and neck. Updates and fun facts about the specialty of otolaryngology, resources, and current research. Search for an otolaryngologist by name, location, or subspecialty!
http://www.entnet.org/

The National Center for Voice and SpeechDedicated to studying the powers, limitations, and enhancement of the human voice and speech. Choose from the menu of short, single-topic voice research columns about the singing voice or check out Dr. Ingo Titze's top vocal warm-ups for singers!
http://www.ncvs.org/

The National Association of Teachers of Singing (NATS)A nonprofit organization dedicated to encouraging the highest standards of singing through excellence in teaching and the promotion of vocal education and research. Search for a voice teacher on their Voluntary Teacher Database by location, voice type, and style of music.
http://www.nats.org/

The Voice and Speech Trainers Association (VASTA)
An international organization that serves the needs of voice and speech teachers and students in training and practice. They encourage and facilitate opportunities for ongoing education and the exchanging of knowledge and information among professionals in the field. Search for a voice coach by location.
http://www.vasta.org/

Blue Tree PublishingA publishing service that designs and produces a series of multimedia programs to facilitate educational experience in the professions of otology, laryngology, speech pathology, and audiology. Offers books, software, and other tools needed by doctors, clinicians, and therapists for successful education, diagnosis, and treatment.
http://www.bluetreepublishing.com/index.cfm

Virginia Tech Multimedia Music DictionaryLook up any musical term, listen to audio samples, take quizzes, and view simulations on this comprehensive site of musical terminology!
http://www.music.vt.edu/musicdictionary/

Voiceproblem.org, The Voice Problem WebsiteVoiceproblem.org, The Voice Problem Website, is dedicated to the support of patients with voice disorders. Informative topics include anatomy and physiology of voice production, voice disorders, diagnosis, treatment, and prevention.
http://www.voiceproblems.org/

Entertainer's Secret Throat ReliefEntertainer's Secret Throat Relief is a spray formulated to resemble natural mucosal secretions and designed to moisturize, humidify, and lubricate the mucous membranes of the throat and larynx.
http://www.entertainers-secret.com

Thursday, September 15, 2011

Voice Disorders: The Relationship Between Your Medical Health and Your Voice

The cause of a voice disorder may be attributable to a wide range of structural, medical, neurological, or behavioral conditions. Complete evaluation by an otolaryngologist and a speech-language pathologist is highly recommended. Voice Disorders - View Brochure

For more information on voice disorders CLICK HERE.

Monday, August 29, 2011

Thyroplasty

I have been thinking about thyroplasty as a way to deepen my voice.  I don't have any medical condition per se, but as a guy it's really hard to have a voice like this. I am having a hard time finding out more about this type of surgery.  Would most surgeons advise against it for my condition?  Is it very dangerous?  Is it available in the US?  Are there less invasive ways to change my voice?

Lee Akst, M.D. replies....

Hello,
I can only answer generally but cannot comment specifically about your case as I have not personally evaluated you.  While a particular type of thyroplasty has been described as a way to deepen voice, it is not a commonly performed procedure - its greatest utility is in transgendered individuals, and I believe that there are some phonsurgeons in the United States that cater to this patient population.  The reason it is not more commonly performed is because in males with a voice so high as to be appropriate for the surgery, there is often another reason for the high voice which is amenable to less invasive correction - for instance, puberphonia can be treated with voice therapy, and a laryngeal web can be treated with endoscopic lysis.  If you have  not been evaluated by a laryngologist, then your first step would be to consider specialty voice evaluation in an academic voice center.
Best regards,
Lee Akst, M.D.

Wednesday, August 3, 2011

Voice

Hello,
I have always been able to sing ever since I was a little girl. A couple of years ago I had a lot of problems with my throat. I kept getting the strep throat over and over again. Directly after that I could not sing. But its been about two years now and I can sing a little now, but it is not like I used to. I can not hit any high notes and if I try I go horse. I go horse if I sing one entire song. I do not know what is going on with my voice but I hope you can help me. PLEASE!

Melissa Kim M.S., CCC-SLP replies...
In some cases, chronic irritation caused by an upper respiratory infection can result in compensatory hyperfunction of the muscles of the larynx. Symptoms of hyperfunction are most commonly effortful, strained voice, reduced pitch range, and in some cases, hoarseness. Treatment for this condition is voice therapy with a speech pathologist.

That being said, there are also many other possible explanations for your symptoms. The only way to know the reason for your voice difficulties is to be evaluated by an Ear, Nose, and Throat physician.

Good luck!

Melissa Kim M.S., CCC-SLP
Speech Pathology Coordinator
Clinical Specialist, Head & Neck Cancer Rehabilitation
The M.J. Dance, Jr. Head & Neck Center at GBMC
Phone: (443) 849-8043

Thursday, July 21, 2011

Voice Problems

Talking voice is scratchy, slightly unclear, tires easily, and sometimes it's difficult to speak altogether. The muscles around my neck are very tense. This problem has been occuring for a little over a year, before I was to audition for a performing arts school, could this have happened from improper singing technique? Also, my tonsils have been removed. Thank you.

Melissa Kim M.S., CCC-SLP writes...
Your symptoms could certainly have stemmed from improper technique; working with a voice teacher may help you to pinpoint any issues. To rule out any other possible contributing factors, see an Ear, Nose, and Throat physician for a thorough evaluation.

Research and Resources on the Larynx

Helpful websites related to voice production and disorders.

Voice Academy
Teachers are thirty-two times more likely to experience voice problems than individuals in any other profession. With information, teachers can self-manage or prevent most voice problems on their own. The Voice Academy is a no-cost, self-directed, virtual school built for the vocal health of U.S. teachers.
http://www.voiceacademy.org

American Academy of Otolaryngology - Head and Neck Surgery
A great source of information on the ears, nose, throat and related structures of the head and neck. Updates and fun facts about the specialty of otolaryngology, resources, and current research. Search for an otolaryngologist by name, location, or subspecialty!
http://www.entnet.org/

The National Center for Voice and Speech
Dedicated to studying the powers, limitations, and enhancement of the human voice and speech. Choose from the menu of short, single-topic voice research columns about the singing voice or check out Dr. Ingo Titze's top vocal warm-ups for singers!
http://www.ncvs.org/

The National Association of Teachers of Singing (NATS)
A nonprofit organization dedicated to encouraging the highest standards of singing through excellence in teaching and the promotion of vocal education and research. Search for a voice teacher on their Voluntary Teacher Database by location, voice type, and style of music.
http://www.nats.org/

The Voice and Speech Trainers Association (VASTA)
An international organization that serves the needs of voice and speech teachers and students in training and practice. They encourage and facilitate opportunities for ongoing education and the exchanging of knowledge and information among professionals in the field. Search for a voice coach by location.
http://www.vasta.org/

Blue Tree Publishing
A publishing service that designs and produces a series of multimedia programs to facilitate educational experience in the professions of otology, laryngology, speech pathology, and audiology. Offers books, software, and other tools needed by doctors, clinicians, and therapists for successful education, diagnosis, and treatment.
http://www.bluetreepublishing.com/index.cfm

Virginia Tech Multimedia Music Dictionary
Look up any musical term, listen to audio samples, take quizzes, and view simulations on this comprehensive site of musical terminology!
http://www.music.vt.edu/musicdictionary/

Voiceproblem.org, The Voice Problem Website
Voiceproblem.org, The Voice Problem Website, is dedicated to the support of patients with voice disorders. Informative topics include anatomy and physiology of voice production, voice disorders, diagnosis, treatment, and prevention.
http://www.voiceproblems.org/

Entertainer's Secret Throat Relief
Entertainer's Secret Throat Relief is a spray formulated to resemble natural mucosal secretions and designed to moisturize, humidify, and lubricate the mucous membranes of the throat and larynx.
http://www.entertainers-secret.com

Thursday, July 7, 2011

National Referral Database

This list consists of physicians and specialists who have designated themselves as competent in the area of the treatment of voice disorders. The Johns Hopkins Voice Center at GBMC has no first-hand knowledge of the extent of their interest in treating voice disorders. It remains the users responsibility to evaluate their talents for caring for you. The American Academy of Otolaryngology at http://www.entnet.org also maintains a database of physicians who may list laryngology as their subspeciality.


View National Referral Database in a larger map

Monday, June 6, 2011

Support Groups for Individuals with Head & Neck Cancer


An important part of the healing process!

Support groups have been proven to be an important component of wellness. In the last decade, research has shown that membership in groups improves overall quality of life. Psychological distress is reduced with ongoing participation. Groups provide in informal and supportive atmosphere in which to share common treatment experiences, coping strategies and feelings.

At the Dance Center there are three groups, each with a different focus. The groups seek to provide education and information about the disease along with a forum for open discussion. Patients may attend more than one group. Caregivers, family members, and significant others are welcome (and are encouraged) to attend.

The Patient & Family Support Group The group is open to patients who have been diagnosed with cancer of the head and neck, their family members and significant others. The group is co-led by the Center's Social Worker and Head & Neck Rehabilitation Nurse in an effort to provide a supportive atmosphere in which to share feelings associated with your diagnosis. All meetings are held in the Physician's Pavilion East Conference Center on the third floor (main floor) of Physician's Pavilion East at the Greater Baltimore Medical Center. Dress is comfortable and casual, and beverages are served. Meetings are the third Tuesday of every month from 7 p.m. to 8:30 p.m.

The Laryngectomee Interest Group The purpose of this group is to provide new information and options regarding post-laryngectomy rehabilitation - and to share ideas and experiences with others. The group is open to patients, spouses and significant others. The group is led by a Speech-Language Pathologist and Social Worker. All meetings are held in the Physician's Pavilion East Conference Center on the third floor (main floor) of Physician's Pavilion East at the Greater Baltimore Medical Center. Dress is comfortable and casual, and beverages are served. Meetings are the first Tuesday of each month from 12 noon to 1 p.m.

Thursday, April 28, 2011

My Voice - After 39 Radiation Treatments

I need to regain my voice after 39 radiation treatments for Head & Neck Cancer. I am a professional singer. I am 4 & 1/2 months out of treatment and I am wondering if I will ever get my singing voice back.

Barbara P. Messing, M.A., CCC-SLP replies...
I understand your concerns.  I would suggest that you come in for a laryngeal stroboscopy/voice evaluation with our laryngologist and speech pathologist.  It is necessary that we visualize your vocal folds/larynx in order to make appropriate recommendations.

Please let me know if you have further questions.  If you wish to make an appointment for an evaluation, please call 443-849-2087.

Kind regards
Barbara

Barbara P. Messing, M.A., CCC-SLP, BRS-S
Administrative-Clinical Director
The Milton J. Dance, Jr. Head and Neck  Center
Johns Hopkins Voice Center at GBMC
Board Recognized Specialist in Swallowing Disorders
Clinical Specialist, Head and Neck Rehabilitation
Baltimore, Maryland 21204
bmessing@gbmc.org
www.gbmc.org/voice
www.gbmc.org/mjdanceheadandneck

Voice Screenings

The Johns Hopkins Voice Center at GBMC would like to announce our voice screening program! The speech-language pathology team provides assessments to professional and semi-professional voice users, or any layperson 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 Thursday 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. Acoustic analysis of the quality of your voice using state-of-the-art equipment to determine if there is any indication of potential vocal cord pathologies.
  3. 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.
You will receive a printout of your vocal quality parameters as well as a photo of your larynx by request.

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.

Questions regarding insurance can be directed to our administrative assistants or clinic manager.

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, April 12, 2011

Chemical Burn on Larynx

Five weeks ago, a singer friend of mine used bleach to clean a small room. They then applied KILZ followed by paint over a three day period. My friend is chemically sensitive and evidently the fumes from this mixture of household chemicals produced a chemical burn on their larynx. It has been 5 weeks and their voice does not seem close to being restored. We are in the care of an ENT specialist, however the ENT has not prescribed any medications and has done nothing other than visually observe the healing process every two weeks. Also, we would like some sense of milestones or benchmarks to determine if progress is being made at a normal rate. Can anyone give an idea how long is customary for a person to recover from accidentally breathing these types of household chemicals? Of course it will vary from person to person, but should we be thinking in terms of 6 weeks, 3 months, 6 months, etc? Any metrics we can use to measure progress? Thank you

Barbara Messing, M.A., CCC-SLP, BRS-S replies...

I understand your concern for your friend.  However, we do not have a structured protocol or metric that I can share with you regarding chemical exposure.  Possible medication interventions and course of recovery is multi factorial.  A complete examination by an ENT as your friend has sought is very important.  I suggest obtaining a second opinion via a complete evaluation by an otolaryngologist and speech pathologist.   This is the only way to assess the extent of irritation and mucosal changes caused by the chemical exposure.

Please let me know if you have additional questions and concerns.

Barbara Messing, M.A., CCC-SLP, BRS-S
Clinical Specialist in Head & Neck Rehabilitation and Swallowing Disorders
Voice Clinician
The Milton J. Dance, Jr. Head & Neck Center
The Johns Hopkins Voice Center at GBMC

Loss of Voice

One week ago I had an incident of acid reflux during the middle of the night. For three days I had a very sore throat and swollen glands.   After that I lost my voice.   I am now without a voice for five days  (no sore throat).   Will it come back if I rest it?  Thank you.

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

Your voice may certainly improve with rest, but five days without any voice warrants an evaluation by an Ear, Nose and Throat physician.
Best of luck to you! 

Melissa Kim M.S., CCC-SLP
Speech Pathology Coordinator Clinical Specialist, Head & Neck Cancer Rehabilitation
The M.J. Dance, Jr. Head & Neck Center at GBMC
Phone: (443) 849-2087

Monday, March 28, 2011

Calluses on Vocal Cords

I had a severe cough for about 2 years that had gradually improved and then disappeared. I had been to the Dr. a couple times but no one ever knew what it was from. After having that problem, I had a significant change in my voice. Being that I cannot even get a sound out when I try to sing or its horribly strained, and my voice seems deeper. When I went to an ENT for sinus issues, he noted that I had pretty good calluses on my vocal cords. But he said it wasn't a problem. It is to me, because I want my voice normal...even if I'm not a professional singer, I love to sing and I miss being able to and I don't like my voice being changed. Is there anything that can help with this or can make the calluses go away ? Thank you.

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

When and Ear, Nose, and Throat physician refers to "calluses" on the vocal cords, he/ she is most often referring to what are known as vocal cord nodules. Vocal cord nodules are the most common benign vocal cord lesions, and are sometimes referred to as "singers nodes." Treatment is usually voice therapy with a speech pathologist, which can often result in successful resolution of the nodules; in some cases where therapy is not effective, surgery may be indicated to remove the nodules and therefore improve the voice. Ask your physician for a referral to a speech pathologist experienced in the treatment of voice disorders.

Best of luck to you,

Melissa Kim M.S., CCC-SLP
Speech Pathology Coordinator

Tuesday, February 15, 2011

Mucous in Throat

Should I be concerned when there is mucous present in the throat which requires me to clear my throat often. If I feel that there is a lump in my throat for longer than a month should I be concerned? Can post nasal drip be a factor?

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

There are any number of reasons for the sensation of excessive mucous in the throat, lump (globus), and frequent throat clearing. A very common explanation for these symptoms is laryngopharyngeal reflux, irritation to the larynx from acid exposure, which often occurs even in the absence of symptoms such as heartburn, indigestion, etc.

I would suggest that you see an Ear, Nose, and Throat physician for an evaluation.

Good luck to you,

Melissa Kim M.S., CCC-SLP
Speech Pathology Coordinator

Glottal Fry

Could you address glottal fry and how effective is therapeutic invention (29 yr old male)? What diagnostic procedures are involved? There is no Reflux condition. Thanks...

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

Anyone experiencing a persistent voice change should be evaluated by an Ear, Nose, and Throat physician, who will most likely visualize the vocal cords using a flexible or rigid endoscope. In the case of glottal fry, we often observe hyperfunction, or excessive strain, of the laryngeal musculature. Glottal fry is the lowest register of the voice, in other words, the voice produced at the lowest end of one's pitch range. Because persistent glottal fry is most often associated with inappropriately low pitch or loudness of the voice, voice therapy primarily targets behavioral modification of pitch and loudness. Voice therapy with an experienced speech pathologist, which is the only treatment available to treat habitual glottal fry, is very effective in most cases.

Best of luck to you.

Melissa Kim, M.S., CCC-SLP
Speech Pathology Coordinator

Tonsillectomy and Voice Change

I'm a singer and there is a possibility I will have to have a tonsillectomy. What will the tonsillectomy do to my voice? I heard that I might lose part of my upper register. Is that true? Also how long after a tonsillectomy can I begin singing again?

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

In the short-term, individuals who have had a tonsillectomy may experience an alteration in resonance, but this resolves completely in most cases (in some cases, singers actually report improved resonance as removal of their often enlarged tonsils allows for greater resonating space!) There is no specific surgical consequence in which reduced pitch range would be expected, although sometimes a brief change in vocal quality may be noticed secondary to vocal cord swelling because of placement of the endotracheal tube for ventilation during the surgery; this typically resolves in a day or two.

Best of luck to you.
Melissa Kim, M.S., CCC-SLP