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.