Thursday, August 30, 2012

Scared Soprano

Hello. Thank you for talking the time to answer my question. I have been having constant sore throats and post nasal drip for quite a while. I wake up and can barely speak even after I brush my teeth. There feels like there is constant blockage. I'm a 1st soprano singer, and it's getting so bad that I can't hit some of my high notes without showing raspy or I can't hit the notes at all it at all. I'm sounding more flat or sharp. Help please, singing is my life!

Melissa Kim M.S., CCC-SLP replies... 

There are any number of possibilities as to what could be the cause of your recurring symptoms. See an Ear, Nose, and Throat physician for a thorough evaluation.
Thank you for your question. 

Monday, August 27, 2012

Loss of Singing Voice After Pregnancy

Hello,
Singing has been my lifelong hobby. I used to be able to sing easily in high pitch. Then I got pregnant. Severe acid reflux during pregnancy. My throat used to burn after every meal. I lost my singing voice during pregnancy. I was unable to sing completely. I can now talk in a low voice. People tell me that I sound like a man now - I used to have a sweet voice. I delivered my baby a few days ago. No more acid reflux. But still unable to sing or talk loudly. I really miss my singing voice and wish to correct this. What specialist do I see? Is there hope?

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

Chronic acid reflux affecting the larynx can contribute to any number of vocal fold conditions. Significant vocal fold swelling and inflammation as a result of acid reflux would be the most likely culprit for your lowered and restricted pitch... if this is the case, then symptoms should resolve with time and appropriate treatment. Unfortunately, however, there is no way to know if the answer is as simple as swelling - see an Ear, Nose, and Throat physician for an evaluation.

Best of luck to you.

Loss of Falsetto and Quick Hoarseness

I joined the Marine Corps a few months ago, and prior to that, was an avid karaoke singer. I had gone plenty hoarse at boot camp multiple times, and now when I try to use falsetto, all that comes out is a squeaky whisper. Additionally, I grow hoarse after only a little yelling or singing. Have I permanently damaged my voice? It's been 2 months since boot camp and I've stopped screaming my head off, my speaking voice is mostly back to normal.

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

There could be any number of explanations for your ongoing symptoms, so guessing as to what could be the cause would be unhelpful. The only way to determine the reason for your symptoms is to see an Ear, Nose, and Throat physician for a thorough evaluation.

Good luck to you.

Voice Thicker

I'm 18 years old. Went through puberty very early on, at the age of 12 to be exact. My voice broke, but it still varies in pitch, at times deep and low, and then very feminine sounding.

Is there any way I can change this?  It has caused many problems with regards to my self-esteem and interaction with people.

 Kind regards.

Melissa E. 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.

Wednesday, August 22, 2012

Voice Going Every Week

My voice goes every weekend even when I try to look after it - what could this be?

Melissa Kim M.S., CCC-SLP replies... 

There are any number of possibilities as to what could be the cause of your recurring symptoms. See an Ear, Nose, and Throat physician for a thorough evaluation.

Thank you for your question.

Persistent Nodules

I'm a singer and I've had vocal nodules for about six months now and I've seen no improvement with six months of less talking and singing. My whole life has been adversely affected and its incredibly tiresome. How can you tell if the nodules are soft or hard? Do you recommend surgery? Does vocal nodule surgery scar the voice?

Melissa Kim M.S., CCC-SLP replies... 

Whether vocal fold nodules are acute ("soft") or chronic ("hard") is a determination typically made after visual examination (laryngeal stroboscopy is the gold standard in this case) in addition to the patient's history.  


Voice rest - even for six months - is not typically a recommended treatment for vocal fold nodules... although short-term vocal rest may result in some reduction of the nodules, the functional laryngeal behaviors that contributed to nodular development in the first place will usually result in persistence of the lesions. The primary treatment strategy for vocal fold nodules is voice therapy with a speech pathologist who specializes in the treatment of voice disorders. If your vocal fold nodules do not resolve with vocal conservation and voice therapy, surgical removal is an option. There is always a risk of scarring with any vocal fold surgery, resulting in long-term hoarseness; however, surgery performed by an experienced laryngologist (an Ear, Nose, and Throat physician with specialty training in treatment and surgery for the voice) minimizes this risk.

Good luck to you!

Lack of Vocal Range

I had a cervical fusion two years ago and the surgeon went through the front of my neck to do the fusion. Ever since then I have not been able to sing like I used to be able to. I have lost nearly an octive in the upper range of my singing voice and even speaking loudly can be very difficult for me most times. I later found out that during this type of surgery, the surgeon has to move the vocal chords out of the way to get to the neck to do the fusion but I thought after time my singing voice would come back. I really miss singing while I play my guitar or piano, and have pretty much given up on any hope of ever regaining my range back.  I have even tried exercises to see if I can expand my vocal/singing range, but to not avail

Any advice or help would be MOST appreciated.

Thank you

Melissa Kim M.S., CCC-SLP replies... 
Unfortunately, it is a potential complication of this type of surgery to experience injury to the recurrent or superior laryngeal nerves. If the recurrent laryngeal nerve in injured, one may experience a vocal fold paralysis. Vocal symptoms of a unilateral vocal fold paralysis include weak, breathy voice with an inability to project. Superior laryngeal nerve injury most often results in impaired pitch range and variability. The only way to determine the reason for your particular vocal difficulties and possible treatments is to be evaluated by an Ear, Nose, and Throat physician.

Swallowing difficulties may also be a presenting symptom of both types of injury; this should also be discussed with your ENT.

Good luck!

Voice Loss

On July 23 I had surgery. After 9 days I experienced voice loss after surgery.  The first few days felt like something in the throat and at this time I had only the loss of voice.  I know that with being intubated you run this risk. I'm only curious if anyone experienced long term damage or how long it took for your vocal cords to heal. And what you did to help them along. I am scared and I know I need see an ENT specialist if it isn't better by 7 days post-op. Thanks

Melissa Kim M.S., CCC-SLP replies... 
What type of surgery did you have? It is possible to experience vocal fold injury following certain types of surgery, such as head and neck or cardiac/ thoracic surgery. Vocal fold injury as a result of surgery would have different implications for prognosis and treatment recommendations than would injury secondary to intubation. I would be happy to provide more information if you would like share more details surrounding your situation.

Thank you for your question.

Thursday, August 16, 2012

Voice Change After Surgery

3 months ago I had a surgical procedure that removed the carotid body tumor by a vascular surgeon.  After surgery my voice changed and became hoarse. I can not scream or raise my voice or call any one in another room and my voice is very low and unclear.  The doctor tells me it's just a matter of time and will return as it was.  Is this true or should I review with another doctor?

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

Surgery to remove a carotid body tumor can result in damage to the vagus nerve, which would impact voice and, in some cases, swallowing. Given your symptoms, I would certainly recommend that you see an Ear, Nose, and Throat physician for an evaluation of your larynx. If there is a vocal fold paralysis, which can be a complication of injury to the vagus nerve, short- and long-term options for voice improvement exist.
Best of luck to you.

Recovery from Vocal Nodules

Hello there. I am a singer/actress, as well as a teacher, so, not uncommonly, about six months ago I began experiencing repeated hoarseness, pain, swelling, and visited an ENT doctor who told me that I had developed "small" vocal nodules. He told me it was nothing to get extremely bent out of shape about and prescribed me a steroid Z-pack and Acid reflux medication (though I personally don't believe I suffer from it...). I continued with my teaching and then actually went on to do a three month show. It has been two months now since the show has ended and I am still experiencing symptoms, though I am not hoarse. My vocal chords literally feel like they are banging together, especially in the mid to lower ranges, and my voice tires very easily and begins producing more vocal fry as a result. So, i revisited my doctor today and he told me I need to take a couple months of moderate vocal rest. One thing he could not quite pin down was why I experience CONSISTENT fullness and pressure in my ears (especially the right one), according to my level of vocal use (when I wake up in the morning, they are clear, the more I use my voice over the day, the more ear pressure I experience). Oh, and I do not suffer from allergies. I have a few questions for you: is this ear pressure/fullness a common side effect of vocal nodules? Also, was my extended singing and teaching possibly permanently damaging to my voice and do you think I will recover with two months of relative voice rest?

Melissa Kim M.S., CCC-SLP replies...
Voice rest is not typically a recommended treatment for vocal fold nodules... although short-term vocal rest may result in some reduction of the nodules, the functional laryngeal behaviors that contributed to nodular development in the first place will usually result in persistence of the lesions. The primary treatment strategy for vocal fold nodules is voice therapy with a speech pathologist who specializes in the treatment of voice disorders. If your vocal fold nodules do not resolve with vocal conservation and voice therapy, surgical removal is an option.  

As to your question regarding ear pressure/ fullness, the answer is no, these are not symptoms typically associated with vocal fold nodules. A second opinion regarding these symptoms may be warranted.


Best of luck to you.

Singing Voice Cracking/Jumping Off Notes

Hi. I usually sing for about 4 hours a day, sometimes 5. Two days ago I sang for maybe 10 hours because I wrote a new song. I noticed my throat was getting dry and my voice getting a bit weak but I kept singing because I wanted to get the new song right. Yesterday, during my voice exercises, my voice kept jumping off notes, suddenly shooting higher. Even on relatively low notes. It's like my voice hits a dry patch in my throat and then jumps up. So I rested. Today the same thing happened. So I'm still resting my voice. I don't feel any pain, my voice is not hoarse. My throat doesn't even feel dry, except, like I mentioned, when I sing and the note jumps. Should I be doing anything besides resting my voice? Thanks.

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

You are certainly at risk for certain vocal fold damage from chronic "overuse" of the voice. Continue to exercise vocal rest and hygiene, with a slow return to singing. If symptoms persist for more than one-two weeks, an evaluation by an Ear, Nose, and Throat physician is warranted. For more detailed information regarding vocal health and hygiene, please see our web pages at
http://www.gbmc.org/home_voicecenter.cfm?id=1558 and http://www.gbmc.org/home_voicecenter.cfm?id=1561.

Good luck to you.

Monday, August 13, 2012

Hoarseness

I sing in my local choir for the past few months. I haven't been able to sing like I normally do. My voice gets hoarse and I can feel my glands swell after unrest.  The swelling is gone but when I sing again the hoarseness comes and my voice gets groggy.  What should I do?

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

My recommendation to you is to locate an Otolaryngologist and Voice Clinician/Speech Pathologist in your area and request an evaluation. They should image your larynx/voice box with laryngeal stroboscopy and evaluate your vocal behaviors, vocal health, usage and medical history. From that evaluation you should receive recommendations on how to best treat your vocal problems. 

You may be able to locate an Otolaryngologist or Laryngologist in your area by using out National Referral Database. Go to:
gbmc.org/voice or http://www.gbmc.org/home_voicecenter.cfm?id=1551 to go directly to the National Referral Database list.

Please let me know if I can be of further assistance.

Best wishes,


Barbara

Wednesday, August 8, 2012

Laryngitis Lasting More Than Two Weeks

I have had severe laryngitis for over two weeks with no precipitating cause. Saw an ENT who examined with a soft tube scope of some sort. He prescibed steroid five day pack, and Prilosec for GERD. He also gave me a hand out on acid reduction. I've been doing everything right. It's been a week and there is little improvment. Should I be worried?

Melissa Kim M.S., CCC-SLP replies...
If the primary factor contributing to your chronic laryngitis is acid reflux irritation to the larynx, which is what sounds as though your physician is suspecting, medication to reduce the acid reflux may be very helpful. However, in these cases, anti-reflux therapy can take up to several months of continuous medication before you will experience full resolution of your symptoms.

If after four to six weeks of medication and diet/ lifestyle modifications you have not experienced any improvement at all, or if symptoms worsen in the interim, another visit to your ENT is warranted.

Best of luck to you.

Voice Loss

8 days ago I began to have a sore throat. The soreness was not dull or achy, rather stinging and scratchy. Due to its mildness I thought nothing of it. However, the next morning I woke up with a complete loss of voice. Along with that came a dry cough and an increased amount of soreness in my throat. After several home remedies (cough drops, throat coat, over the counter medicines, and not speaking) I still have no voice even 8 days later. The sore throat has gone away, however the cough, no voice and congestion is still very much present. My question is, what do you think this could be and are prescriptions needed for this?

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

There could be any number of explanations for your ongoing symptoms, so guessing as to what could be the cause would be unhelpful. The only way to determine the reason for your symptoms is to see an Ear, Nose, and Throat physician for a thorough evaluation.

Good luck to you.

Monday, August 6, 2012

Vocal Cords Disorder

I am 79 years old and have had chronic sinusitis since I was 15. I seldom ever have a sinus blockage, but have constant postnasal drip. The chronic sinusitis has been diagnosed and attributed to mild allergies to almost anything and everything to which humans become allergic. About 9 months ago, I had a bout with rhinitis that was confirmed with CT scan as left maxillary, sphenoid and ehtmoid sinus infection. Normally, since I have no success with treatment of these problems, I just live with it and it gets better, with time. But on this occasion it was affecting my vocal chords. For the first time in my life, the post nasal drip was accumulating on my vocal chords, and dramatically affecting my speech. The mucous will build-up to about the size of an almond before I can successfully remove it with several self controlled hard coughing and simultaneous throat clearing exercises. When it comes up, it is extremely thick and light to dark brown in color. I never get complete recovery of my speaking voice after expectoration of the thick, almost hard mucous, but I do get significant improvement. For the last 9 months, when I can speak, I speak either in a very soft (almost whisperlike) voice or a somewhat raspy voice in  a very low register. Although not a professional singer, I have been singing regularly in church choirs for over 50 years.  I have been to a vocal chords specialist and the video of the vocal folds showed it to be inflamed (red in color). The only advice I got from this doctor was to drink lots of water and use Mucinex. I've done both for 3 months with no effect. I am currently seeing a consortium of 3 ENTs in a major medical facility. I spent 6 months taking 5 different antibiotics, with some clearing of the maxillary sinus but no clearing of the ethmoid and sphenoid (confirmed by CT scan with contrast). My consortium is now treating me with steroids for a period of one month. I am now 2 days into 28,21,14,7 (10 mg Prednazone). Of the 3 doctors, 2 specialize in sinus surgery and the other specializes in surgery of the area of the epiglottis / vocal chords (primarily for cancer patients). I had a laryngoscopy for tissue sampling one month ago and both samples were benign. My question to my doctors has been: Why, after 65 years of chronic post nasal drip, am I now experiencing build up of phlegm on my vocal folds? I get no answer. I then ask: Is it not possible to eliminate post nasal drip with sinus surgery? If the post nasal drip was stopped, would not the vocal chords heal? I get a response: "It's not as simple as that. From examination of your latest CT scan of the throat, we think there is more going on in the throat than just post nasal drip."

Where do I go from here? Thank you for your patience from an impatient patient.

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

It certainly sounds as though you've contacted all of the right professionals when it comes to your chronic sinusitis... but keep in mind that Ear, Nose, and Throat physicians, while specialists themselves, do further specialize.  There are ENTs who specialize in nasal and sinus surgery, but also those who specialize specifically in the voice and voice disorders.  I would recommend that you seek out an evaluation with a laryngologist, an Ear, Nose, and Throat physician who has completed fellowship training in the care of the voice.  Even if the "vocal cord specialist" that you saw was a laryngologist, a second opinion would certainly be warranted given that it sounds as though you did not receive a diagnosis or effective treatment recommendations.  To seek out a laryngologist, see the American Academy of Otolaryngology website at

Good luck to you.
http://entnet.org/, which allows you to search for an ENT by subspecialty.

High Pitched Squeaky Voice

My 23 yr old daughter went to bed with a normal voice, woke up with high pitched squeaky voice. She has no sore throat or swollen glands. Tried all kinds of home remedies hot tea honey lemon cough drops spray salt water etc. nothing helped. She doesn't have her tonsils, but did go through hpv/cervical cancer treatment a year ago. Been Cancer free for almost a year. Could the treatment have affected her voice so long after treatment? She has a speech to give at school- could it be nerves?

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

It is unlikely that your daughter's previous cancer treatment is playing a role in her current vocal difficulties... stress or anxiety given her upcoming vocal demands would be a more likely explanation.  The only way to truly determine the cause, however, is to be evaluated by an Ear, Nose, and Throat physician.  If it is determined that the problem is functional, that is, one related to excessive stress or tension of the muscles of the larynx, voice therapy with a speech pathologist can be very helpful; ask your physician for a referral.

Best of luck to you.

Vocal Cord Surgery

My daughter had laser vocal cord surgery to remove nodules, just over 3 weeks ago.  Last night during an argument with her partner - she shouted and then stopped - remembering, and feeling excruciating pain.  What can she do now to minimize damage?

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

In this situation, basic vocal hygiene is called for... vocal rest, excellent hydration, and avoidance of laryngeal irritants (environmental irritants, alcohol/ smoke, acid reflux, etc.).  I would certainly also suggest a visit to her surgeon is in order to determine the source of her discomfort.

Good luck!