Monday, April 30, 2012

Chronic Voice Grogginess?

In January 2011 I got very sick and completely lost my voice. I could barely speak for nearly a month. They put me on antibiotics and eventually I got better, but my voice didn't (they diagnosed no pneumonia or any lung disease whatsoever). I was coughing out awfully green/yellow secretion for the next 3-4 months. About 2 months later my voice was still pretty hoarse and I couldn't sing a single note. I went to see a voice laryngologist/specialist who claimed there was nothing wrong with my vocal cords - no nodules, no polyps, no hemorrhages, no paresis, no nothing. He told me to take a good month's of complete rest and put me on some vitamin supplements. A month or two passed and unknowingly whether it was due to another antibiotic I took (in order to treat another bacterial infection I got sick from) the hoarseness went away.

However since then my voice has remained CONSTANTLY GROGGY. It has become so deep I sound like a Basso profondo (the deepest type of male singing voice). I am unable to sing without yelling. Forget singing... sometimes the voice is so deep it's hard to understand the words in between all the cracks that come out when I speak. Now to clarify a bit more - I can produce a normal voice sound when I speak in a falsetto-ish manner. But when I speak normally without any effort - it sounds groggy. Regarding singing: I have proper technique and have studied singing for many years.
This grogginess is preventing me to sing a single proper note and speaking properly without tension. I'd like to emphasize that it's grogginess we're talking about not the typical hoarseness most people get. I can't tell if it's a combination of hoarseness/crack-ness and grogginess any longer.
I have literally tried everything and am near losing all hope. I've seen 2 more specialists, and no one has diagnosed me with anything that might be contributing to the state of my voice. I've been on more antibiotics than any normal human being can bear. They say we've neutralized every possible bacteria. I've been hospitalized and have done x-rays on my lungs a few times, I've checked everything there is to check - thyroid, epiglottis, immune system tests, blood tests. The only thing I haven't checked is the possibility of tuberculosis - but everywhere I go and following every blood test I give they tell me that I don't have any signs or clues of tuberculosis and that it's pointless to do that - I will however check myself on that in the coming weeks.

 Now the weird part: Throughout this year and a half I got sick a few more times - but in December I caught another bacterial infection (hence another antibiotic) (just to note - I have treated the candida subsequent from the antibiotics.)- and I started coughing out very green and awful looking secretion and JUST LIKE A MIRACLE the voice came back. All of it. It came back one day when I coughed out a whole lot. Everyone thought that possibly the antibiotic cured whatever was the problem and I remained on vitamins and supplements only. And then the absurd thing happened - the moment the yellow/green secretion and the cough stopped - the voice went back to groggy mode. 2 more months went by and nothing changed. I got sick again - and the whole story repeated. This has happened a total of 3 times. The moment I start coughing out something horribly looking - the voice gets a bit better. How is this possible? Is there anything you could suggest that I try that I might have not? As I said I have had myself checked for nearly everything that could come to mind. I can provide more information if you require other details. Please my career as a singer has been on hold for a year and half now, I need to discover how to treat this. I am eternally grateful for your attention and I eagerly await your reply.

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

If several otolaryngologic examinations have a revealed a structurally normal larynx despite your ongoing issues with vocal quality changes, I would suspect at least some component of what is referred to as muscle tension dysphonia. When a singer or speaker encounters an undesirable vocal sound, which may be the result of any underlying irritation to the larynx, the first impulse is to compensate by unknowingly changing the way in which one is singing or speaking. These functionally abusive vocal behaviors, also referred to as muscle tension dysphonia, can exacerbate original vocal symptoms. See a laryngologist (an Ear, Nose, and Throat physician fellowship trained specially in the treatment of voice disorders) for evaluation and consideration of this diagnosis. The treatment for this condition is voice therapy with a speech pathologist who specializes in the treatment of voice disorders.  

Best of luck to you.

Thursday, April 26, 2012

Stroboscopy vs. Endoscopy

What is the difference between stroboscopy and FEES or endoscopy?

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

Laryngeal Stroboscopy is an vocal tract imaging system using a xenon light source that allows us to visualize the larynx/vocal folds and most especially the vibratory motion of the vocal folds. We are also able to clearly see vocal fold problems or pathologies such as nodules, polyps, cysts, etc. We use both rigid and flexible endoscopes during this procedure.

Flexible endoscopic Evaluation of Swallow FEES using a flexible endoscope to visualize the patients throat / larynx when they swallow food and liquid. This is a way to determine if a person has a swallowing problem. There are other ways to evaluate a swallow such as a Modified Barium Swallow Study which provides a fluoroscopic image [like in X-Rays] of a persons mouth, throat and esophagus as they swallow barium contrast and different foods and liquids coated with barium.

Endoscopy just means that an instrument is used to look inside the body. Therefore, we call the instruments endoscopes. Endoscopes are either rigid or flexible endoscopes. 

Thank you for posting your question.   


Tuesday, April 17, 2012

Your Voice is Important...Especially When You're On Tour with Justin Bieber

When you think of a DJ, you don’t typically think of them having to strain their voice too much. After all, doesn’t the music usually do the talking? Not when you’re Justin Bieber’s official tour DJ.

Baltimore native Taylor James started his interest in DJing at the tender age of 12. What started as a hobby turned into a profession and helped pay the bills through college. And that certainly paid off when, upon graduation, Mr. James was offered a full-time position on pop sensation Justin Bieber’s world tour.

Suddenly, Mr. James was using his voice like never before. Interviews with the Today Show, pumping up sold out crowds of screaming fans and emceeing events like Justin Bieber’s birthday bash. In December 2011, all this excitement caught up with Mr. James’ voice, bringing him to the Johns Hopkins Voice Center at GBMC.

“I thought I was just getting a really bad cold at first,” says Mr. James. “Then all of the sudden, my voice was completely gone. It came back just enough for me to go on the Today Show, but after that, I knew I had to go to GBMC.”

Mr. James saw Lee Akst, MD, Director of the Johns Hopkins Voice Center at GBMC and Barbara Messing, MA, CCC-SLP, BRS-S, who found the cause of his problem was vocal fold hemorrhagic polyps. “The evaluation procedure was quick, easy and painless,” says Mr. James. “It was also really convenient for it to be done right in the office.”

In order for his voice to perform at full capacity, vocal surgery was recommended and performed with excellent vocal results. Now, Mr. James is undergoing therapy to not only make his voice stronger, but to learn how to use it properly.

“At his therapy sessions, we focus on vocal exercises that help to mobilize the vocal folds and promote healing and vocal techniques to improve the balance between breath support and voice production while reducing excessive laryngeal muscle tension,” says Barbara Messing, MA, CCC-SLP, BRS-S, Administrative-Clinical Director of the Milton J. Dance, Jr. Head and Neck Center and the Johns Hopkins Voice Center at GBMC. “He now knows the best ways to perform warm up and cool down to minimize damage to his vocal folds while performing and rest his voice as needed.”

The treatment that Mr. James received from the Johns Hopkins Voice Center at GBMC put him on the road to recovery and back on the road with Justin Bieber.

For more information about Johns Hopkins Voice Center at GBMC, visit www.gbmc.org/voice.

Monday, April 16, 2012

Laryngitis Lasting Longer Than 1 Year

I've had severe laryngitis for over a year. It started when I caught a nasty bug with an accompanying terrible cough. I had an ENT specialist look at my throat at the time. I managed to swallow a chicken bone at the same time, so he actually looked in my throat twice initially. I went to see a speech therapist, but wasn't convinced that was going to help. Somehow speaking in falseto just didn't seem to be the answer for me. They put me on Spireva to help with the flu / cold and augment my other asthma medicine (Advair 500 / 50 twice a day). I was on Spireva for several months and finally stopped. It seemed to be giving me an abundance of sticky phlegm in my throat. I can now barely speak. I continue to have a cough, although it is not nearly as bad. When I can actually cough something up it's tinged brownish. I'm on 80 mg of Omeprazole because the doctors thought my problems were from GERD (I'm obese). The ENT has now looked down my throat a 2nd time and can see nothing wrong. I'm on 2 doses of Lasix because my breathing became so labored I couldn't make it from one side of my small house without taking a break to catch my breath. My feet swelled so much, my podiatrist was alarmed that I could be having heart problems. I am chronically tired. Walking from the car to the house wears me out, even when I can catch my breath. I've had breathing tests, an echocardiogram, and a stress test. Everyone says I'm just fine. But, obviously, something IS wrong. I'm scheduled to see a laryngologist (sp??) on 5/7 and want to make sure I ask the right questions so I can get some real help. My livelihood depends on my ability to talk -- I'm a recruiter. Any suggestions would be much appreciated. 

Melissa Kim M.S., CCC-SLP replies...
A laryngologist will perform what is called a laryngeal stroboscopic examination, which is the gold standard in the evaluation of the larynx and vocal folds. I'm sure that your laryngologist will be able to secure a dignosis, but be sure to ask about the possibility of muscle tension dysphonia, or a voice disorder characterized by excessive tension of the muscles of the larynx. This is often the situation when vocal problems persist despite what seems to be an essentially normal laryngeal exam; the treatment is voice therapy with a speech pathologist who specializes in the treatment of voice disorders.

Best of luck to you.

Monday, April 9, 2012

Perspectives on Voice and Voice Disorders


Perspectives on Voice and Voice Disorders Online Table of Contents Alert

A new issue of Perspectives on Voice and Voice Disorders is available online:

Vol. 22, No. 1

The below Table of Contents is available online at: http://div3perspectives.asha.org/content/vol22/issue1/?etoc



Articles



Coordinator's Column

Edie R. Hapner

Perspectives on Voice and Voice Disorders 2012;22 2-3
http://div3perspectives.asha.org/cgi/content/full/22/1/2

Dollars $$ Sense: Which Diagnostic Codes Do We Use? Paradoxical Vocal Cord Movement, Vocal Cord Dysfunction, and Spasmodic Dysphonia

Dee Adams Nikjeh

Perspectives on Voice and Voice Disorders 2012;22 4-5
http://div3perspectives.asha.org/cgi/content/full/22/1/4

The Speech-Language Pathologist's Role in Screening for Head and Neck Cancer

Edie R. Hapner

Perspectives on Voice and Voice Disorders 2012;22 6-13
http://div3perspectives.asha.org/cgi/content/abstract/22/1/6

Multidisciplinary Care of the Head and Neck Cancer Patient

Barbara P. Messing, Keri Ryniak, Jaclyn Shellenberger, Bethany Hieber, Karen Ulmer, Dorothy Gold, Karen Harrer, Melissa Kim, Lisa Valasek, and Jessica Silinonte

Perspectives on Voice and Voice Disorders 2012;22 14-24
http://div3perspectives.asha.org/cgi/content/abstract/22/1/14

Laryngectomy - Concepts and Shifting Paradigms

Jason Xu and Kevin Fung

Perspectives on Voice and Voice Disorders 2012;22 25-32
http://div3perspectives.asha.org/cgi/content/abstract/22/1/25

A Contemporary View of Tracheoesophageal Voice Restoration

Jodi K. Knott and Jan S. Lewin

Perspectives on Voice and Voice Disorders 2012;22 33-44
http://div3perspectives.asha.org/cgi/content/abstract/22/1/33

Seeking to Better Understand Factors That Influence Postlaryngectomy Speech Rehabilitation

Philip C. Doyle

Perspectives on Voice and Voice Disorders 2012;22 45-51
http://div3perspectives.asha.org/cgi/content/abstract/22/1/45

Tuesday, April 3, 2012

Cancer Survivor's Guide to Nutrition - New Take on Spring Salads

Cancer Survivor's Guide to Nutrition: Lecture Series

As cancer treatment continues or comes to an end, you may wonder what foods you should be eating. It may be time to develop new lifestyle behaviors in regard to nutrition and physical activity. Join in for a monthly lecture and discussion on the importance of nutrition and physical activity in cancer recovery and prevention.

Each month, a new topic is discussed. Topics range from choosing whole foods, sugars and sweeteners, understanding food labels and nutrition claims, use of supplements, etc.

Cancer Survivor's Guide to Nutrition
When: April 23rd at 6:30 pm, 2012
Where: Conference Center in Physicians Pavilion East

This month's topic is spring salads. Most people eat the typical salad made of fresh greens and vegetables. This month, I will prepare a recipe containing sweet potato, cabbage, and greens for a different take on the spring salad. I will also prepare an easy homemade dressing and send you home with recipes to try on your own.
Lite fare, refreshments are served
A parking pass is provided.
Open to patients and family members of the Sandra and Malcolm Berman Cancer Institute, Breast Center, and Milton J. Dance Head and Neck Center.
** Please contact Keri Ryniak, RD at
443-849-8186 or kryniak@gbmc.org to reserve a spot.

This is a free patient service open to patients and family members of the Milton J. Dance, Jr. Head and Neck Center and the Sandra and Malcolm Berman Cancer Institute and Breast Center at GBMC. Light fare and refreshments are served and parking is complimentary.