Friday, December 28, 2012

Improving Voice Hoarseness After Paralysis

Is there a way that my hoarse voice can be treated and restored to normal? Since 1994 I am suffering from voice hoarseness due to left vocal cord paralysis. This was due to the left aortic bulging (traumatric aneurysm) caused by a car accident that damaged the nerves on my left vocal cord. I have undergone a surgical operation to repair my aorta last March 1994, but until now I still have voice hoarseness. I was thinking if new procedures such as innervation or magnetic treatment may help?

K. Chuck Fletcher, MD, Laryngologist replies...
There are many options to improve the voice in the setting of a unilateral vocal cord paralysis. The paralysis causes a diminished ability for the vocal cords to close leading to air escape and therefore vocal hoarseness. There is no current way to return vocal cord function to a paralyzed vocal cord, however, there are approaches that allow the vocal cord to be medialized so that the functioning vocal cord can approximate the nonfunctional cord and create closure and then resultant improvement in vocal strength and reduced vocal hoarseness. There are nuances obviously regarding the specific case and those are determined by a laryngologic exam. I would recommend seeing a Laryngologist with expertise in these techniques for a full evaluation and to discuss your specific options.
 

Voice Loss - Dryness at End of Day

I work in an office environment. I have noticed that on days when I have not had to talk much during the day, once I do have time at the end of the day, I have a difficult time. My voice will not project, I start coughing - sometimes so much I can't get out what I am trying to say. Water, gum, cough drops do not work. This only happens when I have not spoken in a while. What could be causing this? 

Melissa Kim M.S., CCC-SLP replies...
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck!

Problem With Voice

I sing in the church, but my voice blocks after a short time and the throat itches.  What should I do?

Melissa Kim M.S., CCC-SLP replies...
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Thank you for your question.


Voice Changes

My voice is usually deep, but when I talk to this one dude my voice becomes soft.  Why does this happen?

Melissa Kim M.S., CCC-SLP replies...
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Thank you for your question.


Voice Loss After Intubation

I had surgery and was intubated during the surgery. After the tube was removed, my voice has been a whisper for 6 weeks. While I was in the hospital, an ENT used a camera to view my vocal cords and said they were not paralyzed but one was moving less than the other and that my voice would probably return in several weeks. When I try to force my voice my throat gets sore? Do you have any suggestions? Should I rest my voice and just wait? Is there anything the doctors can do if I try to go to an ENT?

Melissa Kim M.S., CCC-SLP replies...
Intubation injuries to the larynx are not uncommon, and often present in the form of a vocal fold motion impairment such as you describe. Resting your voice will not help or hinder your recovery. A vocal fold paresis (weakness) can be treated in a temporary manner by injecting the affected side with a filler material, given that the physician that initially evaluated you reported anticipation of return of function. Voice therapy with a speech pathologist may also be helpful, particularly in regards to the soreness you describe when trying to "force" your voice. See an Ear, Nose, and Throat physician for re-assessment and treatment recommendations.

Good luck!


Vocal Cord Pain

My husband received radiation for squamous cell carcinoma on his left vocal cord. Since it began and now 2 months after, he still has no voice and extreme & constant pain on the opposite side of where the cancer was. No explanation from radiologist besides it's not from the radiation. Looking for help on what could be causing the pain which goes from his throat to his ear & sometimes his head. Looking for suggestions.

Melissa Kim M.S., CCC-SLP replies...
Radiation to the larynx can result in chronic hoarseness secondary to fibrosis of the delicate vocal fold tissues, and is unfortunately often an unavoidable side effect of this type of treatment. Chronic pain, however, is concerning given your husband's history of cancer, and warrants a thorough evaluation by an otolaryngologist or head and neck surgeon.

Best of luck to you both!

Can No Longer Sing After Being On a Ventilator

Ever since I came off of the ventilator 5 yrs. ago, because of double pneumonia, I can no longer sing! My whole upper registry is gone completely and at times my singing voice all together. What could possibly be wrong, and do you think it's fixable? MY VOICE IS MY GIFT FROM GOD, AND I NEED TO BE ABLE TO USE IT AGAIN.

Melissa Kim M.S., CCC-SLP replies...
Emergent and/ or prolonged intubation does carry a risk of damage to the larynx, which most commonly would present in the form of vocal fold motion impairment or development of granulation tissue. Treatment options would depend on an accurate diagnosis; see an Ear, Nose, and Throat physician for a thorough evaluation.

Best of luck to you!

Changed Voice

I am a white man with no voice problems.  I have to yell at my son forcefully for 5 min. It has been four days and my voice is hoarse. Any recommendations? Thank you.

Melissa Kim M.S., CCC-SLP replies...
Persistent hoarseness following an episode of vocal abuse/ overuse warrants a trip to an Ear, Nose, and Throat physician. In the meantime, rest your voice as much as possible, drink plenty of non-caffeinated fluids, and avoid any environmental irritants, such as smoke.

Good luck!

Wednesday, December 19, 2012

Voice Issues

I recently noticed that I easily lose my voice after singing. I have pains in my throat and my voice is getting deeper. What could be the problem and what is the solution?

Melissa Kim M.S., CCC-SLP replies...
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by a physician; I would recommend that you seek out a laryngologist (an Ear, Nose, and Throat physician who specializes in voice).

Best of luck to you!

Getting a Good Voice

My speaking voice really sounds horrible. I am a girl but with a very low-pitched voice.  They always ask me with that annoying question "Are you a boy?"  I don't know what to do with it since I was born with that voice.  I was expecting an answer which can improve the sound of my voice.  Thank you.

Melissa Kim M.S., CCC-SLP replies... 

There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck!


Monday, December 17, 2012

Repeated Loss of Voice

My husband had upper GI done two years ago.  They found stomach lining tissue growing in the esophagus.  For the last year he has been losing his voice.  This happens about every other month.  Should we be concerned with this?

Melissa Kim M.S., CCC-SLP replies... 
Voice loss, even only as frequent as every other month, warrants evaluation by an Ear, Nose, and Throat physician.  


Best of luck to you!

Friday, December 14, 2012

Bad Base Voice

I'm from India. I love to sing (I'm a girl) but unfortunately I cannot sing some songs because I have a poor base voice. I have no problem with high notes. I can go till high E, and higher in falsetto, but my base voice is so poor that middle A is a problem. I have also noticed that early in the morning and at late night, I can go till low D.  It's only in the mornings that I can reach the low notes, never during normal day time.  This is a problem because it forces me to shift every song higher to fit my range, and in the process the song loses its essence, and is an inconvenience to the band members.
I know most people have a problem with high notes, my case is the opposite.  I hope you help me out with the problem. I am a hard worker and I promise that the vocal exercises or other advice will be followed strictly.  I would also like to mention that my daily diet has a good amount of spices and oil(its Indian food, can't help) and I have "pani puri" regularly. I hope you don't ask me to completely quit such food items.

Melissa Kim M.S., CCC-SLP replies... 
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck to you!

Left Vocal Cord Paralysis

After recovering from injury due to a car accident I suffered hoarseness of voice that resulted to left vocal cord paralysis. It's almost 18 years since then that my left vocal cord paralysis still subsis. How can it be treated ? How can I regain my nice voice which I used as an announcer and singer? Please help me. 

Melissa Kim M.S., CCC-SLP replies...
While there is no treatment to restore motion to a paralyzed vocal cord, there are a number of treatment options to address the symptoms of the paralysis - breathy, rough vocal quality with poor volume/ projection, and in some cases, swallowing difficulty. Surgical approaches to treatment include injection medialization, which is the injection of a filler material into the paralyzed cord (e.g., Radiesse) to achieve improved closure of the vocal cords, or medialization laryngoplasty, a procedure in which an implant is placed on the side of the paralysis to push the affected cord closer to midline. Both procedures are performed commonly by laryngologists (Ear, Nose, and Throat physicians who specialize in the treatment of voice disorders), and can greatly improve vocal quality and efficiency in someone with a paralyzed vocal cord. A more conservative approach would be to try to improve symptoms in voice therapy with a speech pathologist.

Good luck to you!

Voice Loudness Decreased?

I was diagnosed with a giant cell tumor in my cricoid cartilage. Since the tumor is rare and the positioning of it is even more rare there are not a lot of treatments available other than a full laryngectomy. A giant cell tumor is resistant to radiation and cannot be put in remission that way. The tumor is benign and only grows into my airway. I underwent so far two debulking surgeries which opened my very constrained wind pipe (trache) up again.

Coming out of my 2nd surgery I was speaking at a normal volume level. However roughly 4-5 days after the surgery my voice became horse in such a way that I can't speak loud anymore. If I am in a normal environment people can understand me fine, but if I am for example in a restaurant my voice gets hard to understand. I tried yelling to see how loud I can get and it is nowhere near where it used to be.

What could be the reason for this? Plus have you heard of any treatments for a giant cell tumor in the cricoid area besides a full laryngectomy?

Thank you.

Melissa Kim M.S., CCC-SLP replies...
It is possible that you've experienced post-operative nerve or muscle damage that is contributing to your vocal symptom of decreased volume. Only an examination by an Ear, Nose, and Throat physician will reveal the cause of your vocal difficulties. As for the options for treatment in the case of your tumor, I would defer to your surgeon. If you feel that all options have not been explored by your current surgeon, I would certainly recommend that you seek out a second opinion.

Best of luck to you!

Wednesday, December 12, 2012

Problems With Voice

Hi. In September of 2012 I got this really bad throat infection and sinus infection, and I sang during this period and kept overusing my voice instead of resting. I used to have a very wide range and very powerful vocals, but they have ceased and diminished. It has even affected my singing voice, and I'm growing exhausted after every note I attempt. Only until the beginning of December 2012 did I dismiss my ignorance by beginning vocal rest, but I want to know what's happened to my voice, because without my voice it'd be like ripping out my heart. HELP! Plz. :(

Melissa Kim M.S., CCC-SLP replies...
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck to you!

Vocal Cord Functional Problem

I am a singer. I underwent endoscopy of my throat recently, the findings according to ENT specialist are the structure of vocal cords are normal, but there is a 1) minor gap between the vocal cords 2) the left side false vocal cord is getting closer to the vocal cord 3) the vocal frequency is noted to be 160Hz. I am a male singer so, reportedly this is an unusual frequency according to the doctor. He advised me to visit a vocal therapist. Request you to please suggest me, if my condition will improve on taking therapy and can I get my vocal cords to normal position? Awaiting your response.

Melissa Kim M.S., CCC-SLP replies...
A persistent glottic gap with voicing (in the absence of an appreciable motion impairment) may be the result of excessive laryngeal tension. This would correlate with a finding of false vocal fold compression. Frequency of vocal fold vibration - which determines pitch - is not static, so the 160 Hz you describe may have been appropriate for that moment in time. If you feel that your average fundamental frequency is inappropriate, this is certainly something that can be addressed, along with the finding of hyperfunction, in voice therapy with a speech pathologist.

Best of luck to you.

Vocal Cord Damage

I'm 17 and an aspiring singer/musician. In December last year I decided I really wanted to sing professionally and I started writing a whole lot of songs and I sang non-stop everyday. By the end of June this year I realized my voice sounded different when I tried to sing and my throat literally felt like it was on fire and I could almost taste blood in my mouth after I wrapped up my singing sessions. I told my dad about it but him being him told me it wasn't a big deal so he took me to a doctor and he gave me pills and the pain went for a while but my voice has never been the same. If I want to make it big I need to sing but I've lost a lot of my vocal range, my voice sounds scratchy and hoarse and every time I sing my throat hurts. I've tried going on vocal rest but when I'm done with vocal rest and I try singing my voice gives up on me and it hurts almost like a cut .I've been crying because I don't know if I'll ever get my voice back and its imperative that I do because it's all I have.What exactly is wrong with my vocal cords and can you help?

Joanna Lott, M.A., CCC-SLP replies... 

If you were singing "non-stop every day" you may have a use-related injury. That is, you may have formed something like a callous or blister (or even a hemorrhage) on one or both of your vocal cords. If this is the case, voice rest will help, but only temporarily (if at all) -- and then as soon as you start using your voice again, the symptoms will return. To know for sure what is going on, you need to make an appointment with a laryngologist for a video stroboscopy. Try to find a laryngologist who specializes in working with singers. If you are near Baltimore, we would be happy to see you here:
http://www.gbmc.org/home_voicecenter.cfm?id=1546. If not, our national referral database may be helpful to you: http://www.gbmc.org/home_voicecenter.cfm?id=1551. Best of luck!
 

Monday, December 10, 2012

Lose My Voice Daily

On a daily basis my voice becomes weak and soft in the afternoon. It is really frustrating and actually makes me not want to talk. Any ideas why?

Melissa Kim M.S., CCC-SLP replies...
There are any number of possible explanations for your vocal symptoms. The only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.

Good luck to you!


Hoarseness & Fatigue

I am a voice teacher and performer. I'm 42 and have never had any real vocal issues. Last Sept we had a huge house fire and were out of the house for 9 months. I did not teach or sing much from May-Aug. Since returning to the house in July, I have suffered from vocal fatigue, hoarseness and vocal swelling. At first I thought it was because I had not been singing/talking much. Recently I played Maria in The Sound of Music and struggled throughout the 3 months of rehearsals and six performances. I have been to my ENT several times. She increased my acid reflux meds a little but says other than mild swelling my chords are OK. She has referred me to another ENT who has a singing background but I cannot get in for a month. My chords come together when I sigh but it takes effort and doesn't feel good. My speaking voice is raspy and extremely fatigued and I have little upper range. My ENT thinks there may be a connection with the fire but I am not sure and she doesn't think there is a way to know for sure. I am worried I may have "ruined" my voice during the show although I didn't sing incorrectly. I am desperate to get better and have a lot of singing to do during the holidays. Any suggestions?

Joanna Lott, M.A., CCC-SLP replies... 
If you can, take a break from singing until you've seen the ENT who specializes in singing. It could be something very simple -- maybe your voice, which had previously been in great shape from regular use and exercise, was out of shape when you started teaching and singing again. Maybe you overdid it or jumped back in too quickly. But it is possible that there is more to it. 

Make sure that the doctor performs an examination using video stroboscopy. This is the only type of exam that shows us how your vocal folds are vibrating and can reveal even subtle flaws that other cameras can't pick up. If the new doctor can't offer that to you, find someone who can. 

If you absolutely can't stop singing before your appointment, know your limits. Stop singing when fatigue sets in. Prioritize your voice use so that you have the strength and energy to get through what is required. This may mean saying no to anything that isn't required, such as social events and time on the phone. Obviously you should avoid shouting and screaming (at sporting events, at kids, at pets, etc.). Drink 64 ounces of water per day and more if you feel thirsty. Rely on short and efficient warm-ups and don't forget to cool down after singing (lip trills are good for this). Best of luck!

Wednesday, December 5, 2012

Girlish Voice Problem

I am 26 yrs old. My problem is my voice sounds girlish on the phone because it is too low to hear. What should I do? 

Melissa Kim M.S., CCC-SLP replies... 
I would first suggest that you seek out an evaluation with a laryngologist (an Ear, Nose, and Throat physician with specialized training in voice disorders) in order to determine if there are any anatomic or physiologic factors contributing to your vocal difficulties. If your larynx is determined to be structurally normal, you may be experiencing what is referred to as "puberphonia." Puberphonia is the persistence of abnormally high pitched voice following the onset of puberty, and can often be successfully treated in voice therapy with a speech pathologist.

Good luck to you.

Vocal Cords

Hi.  So I've been sick recently and still am sort of recovering but I'm just curious as to what may have happened to my voice. I'm 14 and I sing practically every day so I'm concerned about the damage to my vocal cords. For the past four days I've been coughing and have had a sore throat. It's so bad that I've lost my voice somewhat, so it's down to a whisper. I've been talking during those four days, which I know I shouldn't have, so I'd like to know how bad this may have damaged my voice. I'm in my school choir so I need to know if I do recover soon will my voice be damaged. I'm in soprano 1 and I've heard people saying their ranges have shrunk so that kind of bothers me. I'm very passionate about singing so this really scares me because I'm hoping I didn't completely ruin my vocal cords.
Thank you so much! Sorry if there are grammatical errors anywhere, I just really need some information or help.

Melissa Kim M.S., CCC-SLP replies... 

It is unlikely that you "completely ruined" your vocal cords... although I agree that I would have recommended that you try to rest your voice if you had a cough and sore throat. From this point on, rest your voice as much as possible, drink plenty of fluids, and visit your physician to address your cough (coughing is very abusive to the vocal cords). If you continue to experience hoarseness or voice change after your cold symptoms have resolved, see an Ear, Nose, and Throat physician for an evaluation.

Good luck!

Tuesday, December 4, 2012

Difficult to Sing

I am 13 yrs. old. In September I got this bad throat infection and did not take any medication. I also sang during this period. Not only vocal range and speaking ability dramatically, but my ability to sing faded. It's very difficult to sing, and any attempt of a high note I wouldn't even consider a high note is very difficult, and when attempted, it is painful and follows by near exhaustion and being light-headed. I really need help! I want to know what's happening to me so I can get it solved as soon as possible, instead of dealing with this extreme morose depression I experience everyday due to the loss of my voice. PLEASE help!

Joanna Lott, M.A., CCC-SLP replies...
I recommend that you find a laryngologist who works with singers to perform a video stroboscopic exam as soon as possible. Though there are many possible reasons for your vocal difficulties, it is always best to rule out damage to the vocal folds right away. It is possible that you simply formed some new habits while you were sick that have stuck with you even as you got better. A speech-language pathologist who specializes in voice can help you to "unlearn" those bad habits and replace them with new vocal skills that facilitate good vocal health. But if there is damage to the vocal folds, it is best to find out right away so that you can get started on an appropriate treatment plan.

Thursday, November 29, 2012

Voice Maturity

I am 20+ but my voice has not yet matured.  I have two voices. When I speak normally have a kid like voice, but when I speak a bit louder, the voice comes from my throat and is like a 40 year old man. So I want to know which is my real voice and how can I speak to people?

Melissa Kim M.S., CCC-SLP replies...
I would first suggest that you seek out an evaluation with a laryngologist (an Ear, Nose, and Throat physician with specialized training in voice disorders) in order to determine if there are any anatomic or physiologic factors contributing to your vocal difficulties. If your larynx is determined to be structurally normal, you may be experiencing what is referred to as "puberphonia." Puberphonia is the persistence of abnormally high pitched voice following the onset of puberty, and can often be successfully treated in voice therapy with a speech pathologist. 

Although I would guess that your "real voice" is the one that sounds like a grown man's voice, I hesitate to make that judgment without personally evaluating you.

Good luck to you!

Loss of Voice From Stretching

Sometimes I will stretch my arms above my head, like you do in the morning, or reach from a seated position to get something off the floor and if I push a tad more than the usual amount, I will lose my voice for about 10-20 seconds after. Air will pass through like I am talking but it is below a whisper and no actual voicing will happen. Sometimes it just switches back on and sometimes it takes a few seconds to progressively go from a foggy voice to my normal voice. I am female and 32 years old, have not smoked for a year, and have seasonal allergies for every season. Thoughts?

Melissa Kim M.S., CCC-SLP replies...
I suppose that it is possible that there is a muscular explanation for your symptom, but I would suggest seeing an Ear, Nose, and Throat physician, where you could attempt to replicate the problem while the physician is visualizing the larynx.

Thank you for your question!

Loss of Voice After Surgery

I had surgery on my C6 & C7 disc on October 12th of this year. The doctor went through my neck, and I knew I would lose my voice but I still haven't gotten it fully back.  How long will that take, and what can I do to help?

Melissa Kim M.S., CCC-SLP replies...
Individuals who have had anterior cervical disc surgery are at risk for voice disorders given the chance of injury to the recurrent laryngeal nerve. In some cases, a vocal cord paralysis will result, but persistent hoarseness can also be the result of simple edema and/ or excessive muscular tension with voicing. The only way to know the reason for your ongoing voice difficulty, prognosis for recovery, and potential treatment options, is to have your larynx examined by an Ear, Nose, and Throat physician.

Good luck to you!

Vocal Issues: 28 yr old Female

I rely on my voice to do my job as a music therapist. A few years ago I suffered though about 8 months of problems before I finally went to an ENT and they told me I had no nodules. It was just really bad sinuses and a nasal spray helped me. My voice was back to normal and whenever I had an issue, it was usually just a sinus infection or sinus pressure and a simple medicine would make it go away. Well I don't believe that is the case here. Back in March I got myself checked for nodules again because I started noticing changes in my voice- speaking primarily and was told again that I have no nodules. Now starting about 2 months ago, my singing voice is sounding very weird. I have no confidence because my range used to be pretty even and flexible through out and now I am just weak on certain shapes and I don't feel as flexible and at some points- I sound like I am going though puberty. My voice gets tired easily and when that happens it gets airy and cracks. I have a wide range. Please help. Thank you.

Melissa Kim M.S., CCC-SLP replies...
There are any number of conditions, other than vocal fold nodules, that might result in the symptoms you describe. Other than your ENT telling you that don't have vocal fold nodules, what diagnosis was suggested? If you feel that you have not been diagnosed accurately, I would suggest that you seek out a laryngologist, an ENT who specializes in voice disorders. See the American Academy of Otolaryngology to search for an ENT by sub-specialty at
http://www.entnet.org/.

Good luck to you!

Acute Onset of Voice Change

I am a professional singer, female, age 50. I had a very bizarre experience today where my voice suddenly cut out on me with no warning.One minute I was singing just fine, the next minute I was croaking. Not only was I extremely hoarse, I was suddenly unable to control the pitch. Just as suddenly about 3 hours later, it returned completely. No swelling, soreness, illness, congestion, dehydration, over-use, just a feeling of fatigue.   My voice has always been very reliable. Any ideas? Weird menopausal thing? Unusual virus? I am now afraid it will happen again in the middle of a concert.

Joanna Lott, M.A., CCC-SLP replies...
Any time there is an acute onset of voice change like that, we recommend being seen by a laryngologist who specializes in the singing voice just to be on the safe side. Even if it turns out that there is nothing wrong, at least you will have peace of mind. Check out our
national referral database for someone in your area. Good luck!

Monday, November 26, 2012

Hoarse Throat

I am 15 and I care a lot about my health and always try staying healthy. But 3 days ago I woke up with this weird feeling in my throat.  It felt very unusual but I decided to leave it alone and thought it would leave by the next day. The next day when I woke up and tried to speak my voice did not sound right and my throat felt a bit clogged. I had a hoarse throat and at the moment I still have it. I'm not sure what the cause was since I haven't been sick for months.  So my question is what does it seem like I have and what can I cure it with? I really need help because I'm worried.

Melissa Kim M.S., CCC-SLP replies...
The only way to determine the cause of your symptoms is to be evaluated by an Ear, Nose and Throat physician. Ask your primary care physician for a referral or visit the American Academy of Otolaryngology website at
http://www.entnet.org/ to search for a specialist.

Good luck!

Hoarse Voice

I went to an ENT today and he examined me and told me that my throat is normal and that he can't see anything wrong. But I know something is wrong. My voice used to be soft and high-pitched. I can reach high notes without difficulty. I have been singing since I was three. But now my voice is very raspy and hoarse. Last August, I was diagnosed with laryngitis and my doctor made me take some medicines but my voice never came back to normal. I already went to two doctors and they gave me medicines but my voice gets worse. Please help me. Not being able to sing is a torture.

Melissa Kim M.S., CCC-SLP replies...
Persistent vocal difficulties in the absence of an obvious structural issue may be related to a functional voice disorder (i.e., the way that you are using your voice). To determine if your symptoms are functional, or if there is an underlying medical reason for your symptoms that has not yet been determined, I would suggest seeking another opinion, this time with a laryngologist (an Ear, Nose, and Throat physician who specializes in voice disorders). See the American Academy of Otolaryngology website at
http://www.entnet.org/ to search for a specialist.

Good luck to you.

Potential Vocal Cord Damage?

I'm a male and I had a huge argument with my father which led to me screaming at the top of my lungs. Ever since then, I couldn't speak or sing properly. It didn't help that I got sick afterwards from the common cold and coughing a lot either. Now... I have a cough that won't go away and when I speak I feel pain. What should I do?

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

Voice over-use and a cold... the perfect storm! Persistent cough and pain with speaking warrants a trip to an Ear, Nose, and Throat physician. In the meantime, rest your voice as much as possible, drink plenty of non-caffeinated fluids, and avoid any environmental irritants, such as smoke.

Good luck to you!


Thursday, November 22, 2012

Repair of Cracked Voice

I am a singer and a nursery school teacher. We had a vigil in church 3weeks ago. After that vigil, my voice cracked. I have tried menthol, warm water etc. yet I still can't sing. What do I do? I am missing the choir.  

Joanna Lott, M.A., CCC-SLP replies...
If you have been overusing your voice, it will probably need a rest. I don't know how long your vigil lasted, but if you were singing for many hours, you should rest your voice for at least that long. Though menthol can feel soothing, it is actually an irritant for the voice and should be replaced with a glycerin-based lozenge such as Hall's Breezers or Grether's Pastilles. And when it comes to beverages, your best bet is always going to be room temperature water rather than anything very hot or very cold. If you can, take some time to rest your voice. And just to be safe, make an appointment for an exam with a laryngologist specializing in singers.

Steroid Treatment

Hi I'm a 23-year old classical singer who recently had bronchitis. My ENT found my vocal chords had swollen as a result of the severe cough and overuse, and so he prescribed steroids (cortisone) for 8 days, and told me to wait 72 hours afterwards to begin singing again.

Today was the first day I started singing again. However, after a few exercises, I feel weak and have a scratchy feeling in my throat. Is this normal? Does it mean the steroid treatment was effective? And how long should I expect to arrive at a full singing voice again after treatment of steroids? Thank you.

Joanna Lott, M.A., CCC-SLP replies... 
Steroid use does not generally prevent you from being able to sing. In fact, it is often used to get a singer through a performance while sick. The risk is that you can overdo it without knowing it. My guess in your case is that you need to ease back into singing after some time away from it. Don't try to do too much too soon. Try some lip trills and sirens to get warmed up and see how it feels. If it is uncomfortable or painful, you should see your ENT again. And make sure that your ENT is trained to work with singers.
 

Voice Improvement

I am a school teacher, but my voice strength is very low and I can't teach loudly, so is there any alternative to increase my voice strength?

Melissa Kim M.S., CCC-SLP replies...
I would recommend an evaluation by an Ear, Nose, and Throat physician to rule out the possibility that something structural/ functional is contributing to your low volume. In the absence of anatomic or physiologic abnormality, abnormally low volume can be the result of a functional voice disorder (i.e., how you are using your voice), and can be treated in voice therapy with a speech pathologist who specializes in the treatment of voice disorders.

Good luck to you!

Monday, November 19, 2012

Voice Destroyed

Is it possible that a specialist can see this video on YouTube of my laryngoscopy and give me a diagnosis?

http://www.youtube.com/watch?v=7yLkQsJnZD4

My voice is covered in extreme hoarseness and grogginess, I am a professional singer, and now I can only sing with strain and wrong posture so I get out a note. Only through yelling and straining can I produce a note that is not hoarse. When I try to sing in my mix voice with correct posture, everything sounds like it is extremely low pitched covered in groggy hoarseness. Same goes for normal speaking. Only through a bit of tension can I sound like I'm not hoarse and groggy.

Please help, endless gratitude.

Joanna Lott, M.A., CCC-SLP replies... 
It would be necessary to see you in person in order to give you a diagnosis. It sounds like you are having a lot of trouble with your voice -- you should make an appointment with one of our specialists or with someone in the national referral database at
http://www.gbmc.org/home_voicecenter.cfm?id=1551. Make sure that wherever you go they can offer you a video stroboscopic exam with a laryngologist specializing in voice, and voice therapy with a speech-language pathologist trained to work with singers. Good luck to you!

I Can't Sing

I've been singing since I was little and I haven't been doing it the right way. I used to have a decent range but now its withered away to nothing. I want to get a voice coach but haven't had time. Is there anything I can do to help get my voice back soon?

Joanna Lott, M.A., CCC-SLP replies... 

The best thing you can do is find a good voice teacher. Many offer 30 minute sessions, so it's not a huge time commitment. If it is really important to you, you will make it a priority. If you are concerned that there is something wrong, you should get checked out by a laryngologist and voice specialist. Best of luck!

Sunday, November 18, 2012

Paralyzed Vocal Cord

My sister has a paralyzed vocal cord on the left and a partially paralyzed vocal cord on the right. She has been told that she needs to have renervation surgery.  She lives in Reston, Virginia.  I trained at Kennedy Krieger Institute so wanted to contact your center to see where is the best place for her to be referred. Thanks.

Simon R. Best, MD, replies...
Vocal cord reinnervation surgery can be an effective form of treatment of vocal cord paralysis, but works best in younger patients (less than 50) or in those who have not had a paralysis for a long time (less than a year). Reinnervation takes a long time to have an effect, the end result is less consistent than medialization laryngoplasty, which is the surgery that I favor for paralysis. The results are immediate and more consistant than reinnervation, and the surgery can be performed in all age groups with any duration of paralysis.

I am happy to see your sister in consultation at the GBMC Dance Center if she would like to make the trip to Baltimore.  Please call 443 849 2087 for an appointment.

Friday, November 16, 2012

My Voice

I'm a singer and in the summer I noticed mucus build up and voice breaks when I would warm-up for about 20 minutes.  Then came show time and I was fine and my voice felt good. It was the same thing in the fall - some days more mucus build up which made it hard to sing and some days it was less and I was fine. I rested my voice for almost a week and it felt ten times better. I still rest my voice often now. There is still mucus but after 5 or 10 minutes I feel fine and there is no problem. My voice feels the best and loose after a show or a practice. What is this? Is my voice damaged?

Joanna Lott, M.A., CCC-SLP replies... 
My best guess is that you are dehydrated. If you don't drink enough water (64 ounces per day), your mucous will get thick and sticky and your voice will crack and break. Or it could be allergy related. If you have seasonal allergies and this seems only to happen during allergy season, a mucolytic such as Mucinex may help. Taken with a large glass of water, a mucolytic will thin out your mucous. Thin mucous is less likely to interfere with vocal fold vibration. Voice rest is always a good idea, especially if you have heavy professional vocal demands. It is a good sign that your voice feels at its best after a show or practice. If your voice were damaged, it's more likely that you would feel hoarse or vocally fatigued after a lot of singing. But if you are still worried, see a laryngologist who specializes in the singing voice. Best of luck!
 

Thursday, November 15, 2012

Can I Lose My Singing Voice?

I lost my voice on Saturday and I am regaining it now. Its still hoarse and I still cannot sing without me losing my voice. Is it possible for me to lose my singing ability all together? I am in choir and a good singer, please help.

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

It is unlikely that you would experience a permanent "loss" of your singing voice. I would suggest that you refrain from singing for the next several days, but if your hoarseness persists for more than a week or two, see an Ear, Nose, and Throat physician for a thorough evaluation.

Good luck!

Tuesday, November 13, 2012

My Friend's Voice

I have this friend and he's a tenor. He is currently 20 years old.  About two weeks ago, I went to his voice lesson with him, and it was amazing. However, a couple of days later... he wasn't able to sing. He used to sing up to a C and now he can barely go past an F... We thought it was laryngitis at first...and now we simply don't know. He isn't in pain, nor did he pull anything... Is it possible that his voice might be changing?? Is there a type of specialist he can see?

Joanna Lott, M.A., CCC-SLP replies...

When a singer experiences a sudden change in voice, he should be seen by a laryngologist specializing in the singing voice. Changes like this can be the result of phonotrauma (trauma to the vocal folds caused by type or amount of voice use), in which case he will likely benefit from voice therapy with a speech-language pathologist specializing in voice. That said, singers sometimes experiences voice changes due to allergies, illness, environmental factors, etc., that may resolve on their own over time. But his best bet is to establish care with a laryngologist and voice therapist who specialize in treating singers. If he is in the Baltimore area, we would be happy to see him here. Otherwise, our national referral database should provide him with a list of professionals in his area (
http://www.gbmc.org/home_voicecenter.cfm?id=1551). Best of luck!

Hoarse Voice

I just got a hoarse voice. I don't feel sick or anything, I just have a hoarse voice and a little bit of a cough. Anyways, this is the third year in a row that I have had a hoarse voice around this time. I don't understand why it's happening. Why IS it happening? Is there anyway to prevent it from happening a forth year? And if so, how? Also, last year when I got my hoarse voice, I didn't get my regular voice back fully until THREE weeks after I got it! Is there any way I can make it so that I don't have it for that long this year? If so, how?

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

A viral laryngitis can cause hoarseness with or without other upper respiratory symptoms. If the reason for your hoarseness is simply a viral laryngitis, then no, there isn't much you can do to shorten the duration of your symptoms, you simply have to let it run its course. The only way to know the reason for your symptoms, however, and to know if there is anything you can do or medication you can take, is to be evaluated by an Ear, Nose, and Throat physician. 

Good luck to you!


Cannot Hit High Notes

I am a singer who could sing the soprano notes and really sing high and hold my breath for long. And the voice quality was really good. Lately I noticed when I was talking continuously to my mother, I felt a stress in my voice as if it gave way after which I am unable to hit high notes, it is becoming hoarse whenever I sing or talk a lot. I consulted an ENT consultant and he told me there was nothing wrong and it would improve by the day. I am worried because that is not the truth, the voice seems like it is improving but goes back to the same condition.

I remember I had swallowed a fish bone inadvertently, you know once you are affected you seem to relate all possible reasons. Is this something serious that I am going through?  Can it be helped?  How and in what way?  Please let me know.

Joanna Lott, M.A., CCC-SLP replies... 

 When you consulted the ENT, did you ask him if he specializes in voice? Many ENTs specialize in sinuses or ear problems. If the doctor you saw did not specialize in voice, you should find someone who does. Did his exam include a video stroboscopy? If not, he is limited in the information he can obtain from his exam. The best advice I can give you without seeing you myself, is to find an ENT specializing in voice and have him or her take another look. (It is doubtful that the fish bone affected your voice since, unless you choked on it, it would not have made contact with your vocal folds.) Best of luck!

Dry Throat When Singing On Stage

Whenever I'm singing with family members or with friends or even with the church choir my voice is fine and flawless, but when it comes to singing for large groups of people my voice gets pitchy. I figured its just because I'm nervous so I tell myself to calm down and be confident before I sing on stage. Well yesterday I had to sing at my friend's father's funeral. I was more annoyed than nervous because I was the last one to sing on the program, but when I got up on stage I was confident and not one nerve in my body was against me. When I started singing it was fine but as soon as I got to the chorus my voice became very dry. It sounded terrible and everyone noticed, I tried to fix the problem by just singing with more emphasis but it didn't work for most of the song. I don't know what happened, I drank a little water before I was called up and my throat was cleared. Point is, I would like to fix that problem because all my friends were there I don't think I ever want to sing again after that episode. Can you help me please?

Joanna Lott, M.A., CCC-SLP replies...

This is not uncommon. Many singers struggle more when singing solo in front of an audience. Sometimes it is nerves, but other times it is the result of the environment. If you have been practicing at home or with your voice teacher, you can count on your voice behaving a certain way in those environments. But when you get to the performance space there are many factors that are not within your control -- such as dry air, dust, and fragrances (like flowers at a funeral home), not to mention the acoustics of the room. If the room had poor acoustics, you may have felt the need to push or strain to get the sound you wanted. This may have led to a feeling of dryness in the throat. Or it could be that the room was dry and dusty and you needed more water than usual to combat the dry air. Try to notice the environment as soon as you get to your performance space. Is it dry? Do you need to drink more water? How are the acoustics? And pay attention to how you feel while you are singing, more than to how you sound. In general, the best way to manage all of these unpredictable problems is to have as many tools in your "vocal tool box" as possible. That way, when you get into trouble you will know what to do. This means studying with a voice teacher trained in the anatomy and physiology of the vocal mechanism who can trouble shoot these issues with you. I hope you won't give up on singing. Best of luck!

My Voice

I am a 48 year old woman and have never been able to scream or sing as my voice is always in a low pitch noise.  I sound like a man.  It is very gruff sounding when I try to sing a high note.  My voice will only go in a low pitch.

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

I would recommend an evaluation by an Ear, Nose, and Throat physician to rule out the possibility that something structural/ functional is contributing to your symptoms. In the absence of anatomic or physiologic abnormality, abnormally low pitch can be the result of a functional voice disorder (i.e., how you are using your voice), and can be treated in voice therapy with a speech pathologist who specializes in the treatment of voice disorders.
Good luck to you!

Voice Problem

My father is a business man and he had construction in his shop in December 2011 and after the construction he got sick for 10-15 days and then he started to have a voice problem.  For a year he couldn't speak loud. Some ENT doctors say that he has fleshy mass on his vocal cord.  He gets some  pain in his throat a little bit and sometimes he gets muscle fatigue in his throat and larynx.  He drinks 3 glasses of pomegranate juice everyday for a week and ENT doctors say he should have an operation but he is scared of it. What should I do?

Barbara Messing, MA CCC-SLP, BRS-S replies...

I don't know what operation was recommended for your father by the ENT physicians, but it may be to obtain a biopsy of the lesion which is a reasonable first step. To determine pathology of a lesion, the physician will most likely recommend direct laryngoscopy and biopsy in the operating room. The physicians may also recommend imaging studies, that is, either CT scan, MRI or PET/CT. Once the pathology is known and imaging results are obtained then treatment options should be recommended. If you and your father do not feel comfortable with the recommendation then a second opinion by another physician is advised.  

Thank you for posting your question.


Voice Loss - Strep Throat

I had strep throat about 3 weeks ago, during which I experienced almost total vocal loss, lasting almost a week. I am now recovering from a sinus infection as well and I have had 2 steroid shots during this month-long period. I am a singer (soprano) and I have not regained my lower/middle range to any of it's normal strength and control. What could be the cause of this issue?

Joanna Lott, M.A., CCC-SLP replies...

Did you get the steroid shots in order to perform while you were sick? If so, it's possible that the false sense of vocal well being that steroids can cause led you to overdo it during your performances. You may have a phonotraumatic injury from singing while sick. Or you may just be going through a rough period of illness with a longer than expected recovery time. My advice, of course, is to see a qualified laryngologist specializing in singers who can do a video stroboscopic exam of your larynx. Come see us here if you are in the area, or check out our referral database for voice centers across the country. Best of luck.


Weight Loss and Voice Change

I am a soprano singer and can normally reach a high C.  However, I noticed in August this year my vocal range has reduced dramatically and my voice is slightly darker in colour - more of that of a mezzo singer. I have no idea what's happened.  The only changes are that I lost around 30lbs in weight in April-July and am wondering whether this could be the reason? My throat is a little tender at the moment but I've never experienced such dramatic change when having a sore throat before. Any ideas what may have happened? Thank you

Joanna Lott, M.A., CCC-SLP replies...
It is possible that the weight loss is a contributing factor to your voice changes. Sometimes when you lose a significant amount of weight, your vocal folds also loose mass, which can result in changes in pitch range and vocal quality among other things. The best advice I can give you is to get it checked out by a laryngologist. If you are in the Baltimore area, we would be happy to see you here. Otherwise, check out the national referral database for ENTs specializing in voice on our website. Good luck!

Cannot Use Falsetto Voice

I cannot use a falsetto voice for a few years now.  My breathing was difficult. Is this paralysis of the vocal cords?

Melissa Kim M.S., CCC-SLP replies... 

The only way to know the cause of your symptoms, vocal cord paralysis or otherwise, is to seek out an evaluation by an Ear, Nose, and Throat physician.

Good luck to you.


Monday, November 5, 2012

What Happened to My Voice?

Hello, I used to be able to sing really low songs such as Trololo, Chocolate Rain, and several other songs that no one else I knew could sing because of how low/deep they were. One day very recently, I just wasn't able to make my voice as deep, I wasn't able to hold the notes, and I can't sing those songs as a result. I'm an 18 year old male so I don't think it is a puberty thing. Should I let my voice rest or what should I do?

Joanna Lott, M.A., CCC-SLP replies...

If the change was sudden and you aren't experiencing an upper respiratory infection or other obvious cause for voice changes, you should see a laryngologist and voice therapist for a video stroboscopy. Hopefully they will be able to get to the bottom of the cause. If no cause if evident, the voice therapist should be able to work with you on your vocal technique as appropriate. If you are in the Baltimore area, we would be happy to see you here. If you are elsewhere, please refer to the National Referral Database on our website for a provider in your area:
http://www.gbmc.org/home_voicecenter.cfm?id=1551. Good luck!

My Voice is Cracked

I used to be a great singer - singing high notes after age of 16.  My voice has cracked and now I suffer huge loss with my voice.  How could I regain my voice?  Thank you.

Joanna Lott, M.A., CCC-SLP replies...

Based on this limited amount of information, my best guess is that possibly you are experiencing voice changes related to puberty. It is very common for the male voice to drop in pitch during this time. It is also possible that you have experienced a vocal injury. If you suspect this to be the case, you should be seen by a laryngologist specializing in voice. You may also benefit from working with a voice therapist and/or voice teacher to help you get through this adjustment. I hope this helps! Good luck!

Voice Skips

About four years ago I noticed my voice skipping when I raised my voice. As the years passed it has gotten worse so that it happens frequently during regular speech. A voice therapist told me I have Hypertension in my vocal cords. I have throat exercises but haven't noticed them benefiting me much. My throat feels so tight all the time. This problem causes me embarrassment and anxiety. Any helpful hints to get me through this?

Melissa Kim M.S., CCC-SLP replies... 

A hyperfunctional voice disorder (rather than "hypertension") is treated with voice therapy, but if you've not had success thus far, you may need to work with a different therapist or seek out as second opinion as to your diagnosis. Does your speech pathologist specialize in the treatment of voice? If not, I would ask your ENT for a referral to a specialist, or see a laryngologist (an Ear, Nose, and Throat physician who specializes in the treatment of voice disorders) for further assessment and treatment recommendations. 

Good luck!

Voice Problem for 2 Years

I am 21 years old I have had a voice problem since 2010. My voice sounds weak at times.  When I went to see my friend after a long time she said your voice has gone deep which it has, but my voice sounds deep and normal like once in a month. I went to see the ENT and they said you are suffering from acid reflux and the tablets they prescribed to me didn't work. Second time I went to see the ENT they said there is nothing wrong with your voice box. My voice problem is ruining my life and is blowing my confidence away and I avoid phone calls. My normal voice is deep but that only happens once in a month and back to the weak voice again. When I speak in the weak voice I can't feel the vocal chords vibrating. I always pray for my voice to be low the next day. Is thyroplasty surgery recommended for this problem? I just want to be confident and my proper low voice to come back again. I hope you can help me.

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

If an Ear, Nose, and Throat physician has determined that your larynx and vocal cords are healthy after a thorough evaluation, I would suspect that there is at least a component of a functional voice disorder (a problem with the way in which you are using the voice). To address a functional voice disorder, voice therapy with a speech pathologist who specializes in the treatment of voice disorders can be helpful. He/ she will be able to prescribe specific exercises to address specific concerns. 

Thyroplasty is a procedure done most often to correct a vocal cord paralysis. If you are still uncertain as to a diagnosis, which I suspect, I would suggest that you seek out a laryngologist (an Ear, Nose, and Throat physician who specializes in the treatment of voice disorders) for an evaluation and treatment recommendations. 

Good luck to you!

Very Hoarse Voice

I have a very hoarse voice.  I have had it for months.  I don't know what to do.

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

Persistent hoarseness warrants a visit to an Ear, Nose, and Throat physician for an evaluation and treatment recommendations.

Good luck to you.


Extreme Throat Problems

Hello, I am 50 yrs young. Started singing around 7. Was fine until about 21 yrs after I got out of the Army. My throat would get sore with extreme pain where I wouldn't swallow. It would happen at least 6-10 times a year. I was always just given an antibiotic with no success.Then one year my voice went away for at least a month with no pain, no swelling, you could barely hear me breathe, Docs didn't find anything wrong. After my voice returned I lost the high register and sometimes I get a painful cramp in my throat where I have to literary hold the base of my neck still while I twist my head to pop the knot in my throat. Now when my throat gets soar with mucus I get my high register back, when it gets well I lose it again. What do you recommend?

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

If an Ear, Nose, and Throat physician has determined that your larynx and vocal cords are healthy after a thorough evaluation, I would suspect that there is at least a component of a functional voice disorder (a problem with the way in which you are using the voice). To address a functional voice disorder, voice therapy with a speech pathologist who specializes in the treatment of voice disorders can be helpful. He/ she will be able to prescribe specific exercises to address specific concerns. 

If you have not seen an ENT, I would suggest that you seek out a laryngologist (an Ear, Nose, and Throat physician who specializes in the treatment of voice disorders) for an evaluation and treatment recommendations.

Thank you for your question.

Chronic Hoarseness/Fatigue

My voice is weak and tires easily. I'm told I have a "small" voice, in contrast to 5 years ago when I was told I'd make a good singer, and that my voice really "projects". I suspect problems arose from my being in denial of my natural range. I would really strain to hit those high notes. I visited an ENT who told me he couldn't see anything wrong. I was out of there in 5 minutes, and left wondering if he really looked. The vocal therapist he referred me to said she could notice my voice fatigues easily and suggested that maybe my trying to talk quiet to avoid strain, was actually I causing strain. I tried talking louder but my voice just tenses up and doesn't project like it should. I also choke and sputter on water if I'm not careful. Overnight my voice seems to gain some richness, but this quickly fades after a few minutes of speaking. It's been like this for a couple years now, and it might have gotten worse because I can't help but try and sing sometimes. I've heard vocal rest can help. Would this do me any good seeing as how my vocal problems seem to have already "set-in" after all this time? Many thanks. 

Melissa Kim M.S., CCC-SLP replies... 

If you're unsure as to whether or not an ENT actually looked at your larynx, I would suggest that you seek out an ENT who can perform laryngeal stroboscopy, which is the gold standard for visualizing the vocal cords. If it is determined that your larynx and vocal cords are healthy after a thorough evaluation, I would suspect that there is at least a component of a functional voice disorder (a problem with the way in which you are using the voice). To address a functional voice disorder, voice therapy with a speech pathologist who specializes in the treatment of voice disorders can be helpful. He/ she will be able to prescribe specific exercises (and not just make recommendations as to usage) to address specific concerns. This would be a better course of action than simple vocal rest. 

Good luck to you!

Thursday, November 1, 2012

Laryngitis

I'm a choral singer. Back in July I had bronchitis for a month and coughed my head off. First week of Oct had a URI and coughed a lot. On the 7th or 8th, lost my voice completely and while I can now speak, am still hoarse and can't really sing. Yesterday is the start of the 4th week of this. Have finished a whole bottle of Mary's Magic Mouthwash. Now gargling with warm water/salt/sugar/lemon. Have an ENT appointment at Indiana University on Nov 13. Trying not to talk and not singing. Question how likely is it I have developed nodes or granuloma...should I keep not talking and not singing? Is trying to sing worse than talking? Do I risk further damage if I try? I'm slightly panicked. Thank you very much.

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

Don't panic! Although I can't predict the likelihood of developing traumatic lesions such as vocal fold nodules, this diagnosis is easily made with an endoscopic examination performed by most ENTs. If it is at all possible, I would suggest that you continue to rest your voice as much as possible - particularly from prolonged singing - until you are seen by your ENT. What type of voice use is more damaging depends on the person... some individuals have technique issues with either or both speaking and singing.

Good luck!

I Want to Change my Voice

I'm 21 years old, but my voice sounds like a small child's voice.  I suffer a lot.  Everyone insults me.  I want to change my voice like a normal girl voice.  What can I do? 

Melissa Kim M.S., CCC-SLP replies... 

I would recommend an evaluation by an Ear, Nose, and Throat physician to rule out the possibility that something structural/ functional is contributing to your symptoms. In the absence of anatomic or physiologic abnormality, abnormally high pitch in young men or women is often referred to a "puberphonia," and can be treated in voice therapy with a speech pathologist who specializes in the treatment of voice disorders.

Best of luck to you.

Weak Voice

In 2010 and also in 2011 I had carotid body tumors removed. I have since had problems with my bottom lip function and problems singing. The lip function is much improved over time and unless you knew about it you would probably not notice it, but my voice is getting weaker and I can't hold a high note. Do you think anyone could help me?

Melissa Kim M.S., CCC-SLP replies... 

It is certainly possible that there was damage to the vagus nerve during surgery to remove a carotid body tumor, which would impact vocal fold function. The only way to know that type and extent of the injury would be to see an Ear, Nose, and Throat physician for an evaluation. If your vocal symptoms are due to a vocal fold motion impairment, which would be one potential outcome of this type of nerve damage, there are treatment options available.
Good luck!

Voice Nodules

Hi, I am 24-year-old female singer and teacher currently teaching English abroad in Japan. I visited an ENT here and was diagnosed with vocal nodules. I have already had vocal nodules once, when I was 17, at which time I went on vocal rest for several weeks but underwent no voice therapy or rehabilitation. This time, my doctor provided me with the poor advice of "reduce your talking." That's it. So I'm not sure what to do. Because of my job here, I can only afford to take one week of complete vocal rest, accompanied by several weeks of reduced talking and no singing. However, since I'm in a rural part of Japan and my Japanese level is low, speech/voice therapy here isn't a viable option. I'm wondering if you think one week of vocal rest would be enough time, if coupled with vocal rehabilitation. I'm also wondering if you know any opportunities for participating in online speech/voice therapy, or if you can recommend any general techniques for me to follow once I begin talking again. Thank you so much.

Melissa Kim M.S., CCC-SLP replies... 

It sounds as though you already know that prolonged vocal rest is not an effective treatment strategy for vocal fold nodules; however, short term vocal rest is often recommended to reduce any acute inflammatory changes associated with the nodules. Subsequent to that, voice therapy with a speech pathologist is the recommended treatment. Since you unfortunately do not have access to a voice therapist given your current situation, I would suggest general conservation of the voice when possible and that you practice excellent vocal hygiene for the duration of your assignment. I don't personally know of any voice center or program that offers web-based treatment, although that certainly doesn't mean if doesn't exist; please let us know if you discover such a program.

For detailed vocal hygiene tips, please see our web page at
http://www.gbmc.org/home_voicecenter.cfm?id=1558.

Good luck!

Loss of Singing Voice

I am a 55 year old female, been singing for many, many years. I have always had a deep voice but now its even deeper. I was hit in the throat, not very hard, about 10 years ago. I no longer able to sing and I miss it very much. I have had no sore throats or any throat irritations. I now sing monotone, no more high notes its almost like I am now a bass singer and I don't like it. Is there any exercises I can do to get my singing voice back?

Melissa Kim M.S., CCC-SLP replies... 

Your injury certainly may have impacted your ability to raise or alter your pitch. See a laryngologist (an Ear, Nose, and Throat physician with speciality training in the treatment of voice disorders) to determine if this is indeed the case. Only when the cause of your pitch change has been determined will you know whether therapeutic exercises prescribed by a speech pathologist will be helpful.

Good luck to you.

Monday, October 29, 2012

Can I Sing High Again?

I'm 22yrs old and I sing in church. I've had over five endoscopy's in the past two and a half years due to my trachea closing up on me and now when I sing my voice is very low.  I cannot sing high and I have Wegeners Disease. Will I ever sing high again? 

Lee M. Akst, M.D. replies...
Truly impossible to say what is going on here. I'm guessing, and it's only a guess, based on your few sentences, that you have subglottic stenosis and have required dilation. It's conceivable that airway stenosis or TVC scar may present a structural limit on high pitch; it's also possible that dome of this is functional. You should address your concerns with the surgeon who has been performing your endoscopy.

Joanna Lott, M.A., CCC-SLP replies...
I'm sorry to hear that you are having trouble with your singing voice. Though I can't say for sure without seeing you, I would guess that you may have some scarring of your true vocal folds which is making it difficult for you to reach your high notes. If that is the case (and I can't know for sure) you may benefit from examination and treatment by a laryngologist. Voice therapy may also be helpful, though scarring can be difficult to treat. If you are not being followed closely for the tracheal stenosis, I recommend that you find a surgeon to treat you for this. Meanwhile, if you are concerned that there is something going on other than the tracheal stenosis, I hope you will follow up with a laryngologist.
 

Lost Voice

I was cheering at a sporting event and my voice was sore after but I hadn't lost my voice and the next day my voice was normal but the day after that I hardly had a voice. It's been 5 days since the sporting event and my voice is getting worse. What is the cause and how can I help? And is it anything serious?

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

It is certainly possible that you experienced some vocal fold damage after the cheering episode... we often see a vocal fold hemorrhage or even the development of a polyp following a single vocally abusive incident. Given that your symptoms are continuing to worsen, I would suggest that you see an Ear, Nose, and Throat physician for a thorough evaluation.

Best of luck to you!

My Voice

About a week or 2 a go my throat kind of hurt so I went to the doctors and when he checked me he said I had nothing going on with my throat, but he still gave me medication and when I didn't feel my throat hurt anymore my voice won't fully come back. I can talk in a low volume but when I have to speak up I can't. Why and what can I do to get my voice back?

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

If you are experiencing persistent voice change after recovering from an upper respiratory infection, there may be an element of a functional voice disorder contributing to your symptoms. Ask your Ear, Nose, and Throat physician if he/ she feels that voice therapy might be helpful in your situation.

Best of luck to you!

Sunday, October 28, 2012

Strained Singing

I have been diagnosed with a 70% blockage in my right carotid artery. I am in a drama club play and after rehearsal I felt light headed and a little strained in the right neck area (singing soprano). Is it advisable to continue to try and strain and sing?

Barbara Messing MA CCC-SLP BRS-S replies...

I advise you to discuss symptoms of feeling light headed with your primary care physician. Stay informed of potential restrictions you should follow.  

Strain in the neck when singing may be related to vocal technique and the use of excessive muscle tension. Muscle tension dysphonia or vocal hyperfunction can represent a long term learned behavior that needs appropriately directed therapy or vocal training. It is important to discover the underlying reason. Consider being seen by a Laryngologist / Otolaryngologist and a Speech Pathologist for a laryngeal assessment through stroboscopy for the purpose of determining vocal issues that may be contributing to neck muscle strain and to rule out muscle tension dysphonia or any other contributing factors.

Thank you for submitting your question online.


 

Thursday, October 25, 2012

Two Tones at Once

In the past several weeks my falsetto has been voicing two tones at once - the intended note, as well as the fifth below it. For several years I have been experiencing a tightness in my throat when singing, and my range has been shifting lower and lower well into the bass range. My falsetto & upper range is pretty much gone. Help! Two tones out of one throat might sound cool on YouTube, but to me it sounds like I need to see an ENT...

Joanna Lott, M.A., CCC-SLP replies...

I agree! It does sound like you need to see an ENT. Diplophonia -- two tones produced by the vocal folds at the same time -- can be symptomatic of vocal fold weakness or of a vocal fold lesion. I recommend that you find a qualified ENT who specializes in voice and is experienced in working with singers, and who can perform a video stroboscopy as part of his or her exam. If you are in the Baltimore area, we would be happy to see you here at the Johns Hopkins Voice Center at GBMC.

Wednesday, October 24, 2012

Sound Like a Girl

I am a 16 year old boy, but my voice is like a girl's voice.  It is very soft.  How can I make it a boy's voice?

Melissa Kim M.S., CCC-SLP replies... 

I would first suggest that you seek out an evaluation with a laryngologist (an Ear, Nose, and Throat physician with specialized training in voice disorders) in order to determine if there are any anatomic or physiologic factors contributing to your vocal difficulties. If your larynx is determined to be structurally normal, you may be experiencing what is referred to as "puberphonia." Puberphonia is the persistence of abnormally high pitched voice following the onset of puberty, and can often be successfully treated in voice therapy with a speech pathologist.

Good luck to you.

Deep Voice

My daughter has had a very deep voice, if you walked into a room and didn't know she was there, you'd think it is a boy talking. It is embarrassing. Can anything be done to correct this?

Melissa Kim M.S., CCC-SLP replies...
I would first suggest that she see an Ear, Nose, and Throat physician to rule out the possibility that there is a structural abnormality contributing to her abnormally low pitch. If the problem is determined to be only a functional one, that is, a difference in the way that she is using her voice, then voice therapy with a speech pathologist experienced in treating voice disorders should be able to correct the problem.

Good luck!

Speaking in Falsetto While Sick

Is it healthy to speak in your falsetto while you are sick? I have heard that speaking in this register can reduce stress on vocal chords, but a more researched opinion would be awesome!

Melissa Kim M.S., CCC-SLP replies... 

The answer is a definite no! Speaking in any register that deviates from your modal pitch for extended periods of time can place additional strain on the vocal system as a whole. If you are experiencing voice changes secondary to an upper respiratory tract infection, best to just conserve your voice as much as possible, speak quietly when speaking at all, avoid hard coughing and throat clearing if at all possible, drink plenty of fluids, and rest!

 Thank you for your question.

Monday, October 22, 2012

Singing

I got sick recently and I am better now, but I want to join Choir at school and I can't sing the high notes anymore because after I got better my voice got really low and I don't know what's wrong with me. My parents just said that my voice is fine and that I am being very dramatic, but even my teacher said that something is wrong with my voice.

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

I would first suggest that you talk with your parents about seeing an Ear, Nose, and Throat physician to rule out the possibility that there has been some vocal fold damage that is contributing to your symptoms. If your larynx is determined to be healthy, your next step should be to seek out an experienced singing teacher to address any contribution that technique is playing in your vocal difficulties.

Good luck!

 
 

Vocal Range

I am a 38 year old female that has sung most all of my life. I was recently sick and completely lost my voice. Because of work I had to strain my voice and teach for 5 days with little or no voice. I am now unable to hit certain notes in my higher range. It has been about 3 weeks. I am extremely concerned. Should I be?

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

A voice change that persists for more than two to three weeks certainly warrants an evaluation by an Ear, Nose, and Throat physician. Visit the American Academy of Otolaryngology website to search for an ENT at
http://entnet.org/.
Thank you for your question.

Voice Problems

I have had a problem with speaking for at least 4 years now and I have been seeking help but I haven't gotten any diagnosis. The ENT specialists said there was nothing wrong and that they didn't understand why my voice was the way it was. All I can get out of my voice are whispered tones and I have to really strain and push to get one sound out and it is hard to maintain that sound for a full sentence.  Occasionally, I can talk a few sentences but my voice will go from voice to no voice at any second and continues to fluctuates. There is pain when I try to speak. And when I do speak there is this "werbolly tone" as one doctor described it. There is just this unstable sound to my voice and it is very unpredictable. I don't have any problems with the "high" pitch to my voice it is just the quality/clarity of it. THANK YOU SO MUCH FOR YOUR HELP!
I have been doing some research and do you think my condition is muscle tension dysphonia?   

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

If you've seen an ENT who performed a visual examination of your larynx (using either a flexible or rigid endoscope) and did not diagnose any obvious reason for your symptoms, I would suspect at least some element of a muscle tension dysphonia, or a problem with the way in which you are using your voice. If this is the case, voice therapy with a speech pathologist would be helpful. There are, however, additional voice conditions that might present in the way that you describe. I would suggest that you see a laryngologist, an Ear, Nose, and Throat physician who specializes in voice disorders, for another opinion. Visit the American Academy of Otolaryngology website to search for an ENT by subspecialty at
http://entnet.org/.

Best of luck to you!

Voice Loss

Last week I lost my voice for yelling at a show.  Now I have it back, but when I yell it comes out silent. What is that?

Melissa Kim M.S., CCC-SLP replies...
 
There are any number of possible explanations... the only way to determine the cause of your voice difficulties and appropriate treatment strategies is to be evaluated by an Ear, Nose, and Throat physician.


Good luck to you.





Voice Strained?

Today I was playing around with my voice like making "funny" noises to sound like monsters or whatever..to make people laugh but..now my singing voice isn't reaching what it was before it happened today it kinda cracks or my voice dies out. I'm guessing I strained my voice? And shouldn't do it again, but am I going to lose my singing voice?

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

It is possible to essentially "strain" your voice when using vocal pitch or quality that is unnatural for you. I would not guess that you have caused any long-term problems with this one incident, although I would suggest that you avoid this type of vocal behavior in the future now that you know that it has a negative impact on your voice. Practice good vocal hygiene until you feel that your symptoms have resolved; if they have not resolved in two to three weeks, see an Ear, Nose, and Throat physician.

For information on vocal hygiene guidelines, please see
http://www.gbmc.org/home_voicecenter.cfm?id=1558.

 Good luck to you.

Wednesday, October 17, 2012

Weak Voice

For as long as I can remember, my voice has been weak, scratchy and cracks often. I find in the morning it can be okay, but more often than not it becomes weak and strained. I have to clear my throat but it is still raspy and strained.

I'm not a singer, I'm 27 years old. I never noticed this to be a problem as a young teenager. It must have started at about 16. I've seen an ENT doctor who had no suggestions.

I often try to avoid situations where I have to talk, as it is that debilitating.

The morning after a big night out my voice is actually even and deep. But otherwise it is relatively high and scratchy.  Any ideas?

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

If you've seen an ENT who performed a visual examination of your larynx (using either a flexible or rigid endoscope) and did not diagnose any obvious reason for your symptoms, I would suspect at least some element of a functional voice disorder, or a problem with the way in which you are using your voice. If this is the case, voice therapy with a speech pathologist would be helpful. If your ENT did not examine you with an endoscope, I would suggest that seek out an ENT who can perform this type of examination for a more thorough look at your vocal folds.

Good luck to you.

Tremors in Voice

Where are they correcting voice tremors due to age? What dr. is using the implants? I saw it on the Doctors Show.

 Melissa Kim M.S., CCC-SLP replies...

The most common treatment for laryngeal tremor is an injection of botulinum toxin, which may or may not be helpful. A laryngeal "implant" is a treatment most commonly used to correct conditions in which the vocal folds don't fully meet, such as in cases of atrophy due to aging or in cases of vocal fold paralysis. A trained laryngologist (an Ear, Nose, and Throat physician who specializes in the treatment of vocal disorders) would be able to perform either of these procedures. Visit the American Academy of Otolaryngology website to search for an ENT by subspecialty at http://entnet.org/.

Good luck!


Loss of Voice/Hoarseness

Hx status asthmaticus, 2 recent intubations and now on Advair 500 twice daily. Out of hospital 2 weeks, ENT visualized vocal chords and no problems. Why am I still hoarse/raspy? These were my first intubations, both emergent/RSI. How concerned should I be? How long for return of my voice as I sing and can no longer do so?

Melissa Kim M.S., CCC-SLP replies...
A history of intubation would certainly put you at risk for swelling and inflammation of the vocal folds or even the development of a traumatic lesion such as a granuloma, although I would also be looking for subtle motion impairment that can also result from an emergent intubation. In addition, you also are at risk for swelling/ irritation and even fungal injection from use of an inhalant such as Advair. Ask your ENT about all of these possibilities, as they can all contribute to chronic hoarse vocal quality.

Best of luck to you.

Thyroid Surgery

I had a partial thyroidechtomy due to a benign sub-sternal goiter about 6 weeks ago. My surgeon made me pay $1500 dollars out of pocket for an "experimental" procedure to monitor my laryngeal nerve during the surgery.

The only discomfort I experienced was from the anesthesia. My speaking voice seems OK or even better than before the surgery, but I absolutely cannot sing in falsetto anymore.

Is this likely to improve over time, or did I waste my $1500?

Thank you so much.

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

Nerve monitoring can be very helpful during a surgery and it sounds as though you avoided a vocal fold paralysis, which is the result of recurrent laryngeal nerve (a branch of the 10th cranial nerve, or vagus nerve) damage that can be a complication of thyroid surgery. However, a change in the ability to alter pitch may indicate that the superior laryngeal nerve, another branch of the vagus nerve, may have been affected during the surgery. I would suggest that you return to your surgeon for assessment and treatment recommendations.

Best of luck to you!

Sore after Singing

I sang just as normal, doing my regular practicing, until the next day my throat started to feel a bit sore and kind of like a tiny bit of sharp pain too. I'm a bit worried that I might have damaged my voice permanently since it's the second day I have been having this problem. Should I take a break from singing until this problem stops?

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

A few days of refraining from singing is certainly called for if you are having pain, along with other basic vocal hygiene... increasing fluids, avoiding irritants, etc. If you continue to experience this pain once you resume your normal activities, however, a visit to an Ear, Nose, and Throat physician is warranted.


Thank you for your question.

Cannot Sing for Long

So I love to sing, and I do a lot of it in the car now that I"m not in any formal choir anymore. It is really hard for me NOT to sing along when I hear any song. Lately my voice has been getting tired a lot more easily than it used to. I can only sing for about 2 songs and then I can't hit the notes anymore and my voice gets really weak. I am 19 and this has been going on for almost a month. What should I do. What caused this? I was never sick, but I've been a bit more "mucousy" in my throat and nose but no other cold symptoms.

Joanna Lott, M.A., CCC-SLP replies...

Increased mucous can simply be due to a cold, allergies, or even just changes in the weather. Increasing your water intake can help to thin the mucous and allow for greater ease of voicing. However, it is possible that so much singing has left your vocal folds swollen and irritated causing you to work harder to get the sound that usually comes easily. Or, you may have been singing too much, too loud, or for too long at one time, and this can lead to phonotrauma -- a.k.a, overuse injury to your voice -– such as nodules, polyps, or vocal fold hemorrhage. I’m not suggesting that you have such a lesion, but if you do it is best to find out as soon as possible to prevent further damage. If the problem persists, I would recommend seeking treatment with a laryngologist (ENT specializing in voice) and an SLP voice specialist. Best of luck!