Wednesday, October 30, 2013

Neck Damage

Recently I had a chiropractic adjustment to my neck. The next day I knew something was wrong. I had popping sensations at different parts of my neck. Now I am burping all the time. After a big meal it is worse, and I feel pressure in my upper chest. After I have burped all day my throat is mildly sore constantly. What damage do you think was done? Do you think it is permanent? Should I go get it checked? As you can imagine any type of intervention is very scary for me now.

Thanks so much.

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

There could be any number of explanations for your symptoms, so to even guess as to your diagnosis via email is not possible. It would make sense to see a physician, and I would actually suggest that you begin with your family doctor. There are a number of different specialties that might be appropriate for consultation, including otolaryngology, orthopedics, gastroenterology, or speech pathology, and your family doctor can direct you in terms of where to best begin after examining you.

Best of luck to you!


Saturday, October 26, 2013

Thickened Vocal Cords

I have been having trouble singing for the past 3-4 months. (I lead worship service at my church and have been singing for years). I went to a local ENT and he told me that my vocal cords are "thickened".. approximately twice as thick as normal. He did not say what caused this, how to treat it, or if it CAN be treated. He was more interested in chatting with my husband than he was with discussing my condition with me. I, MOST OF THE TIME, can get through one song at church, sometimes two, before I get really hoarse and sometimes lose my voice all together for a few hours. Some days, if we are busy at work and I have to talk a lot, I will go home from work in the same condition. What can I do to get back to being able to sing? *I am 42 years old, do not smoke (NEVER have)! Thanks for your time!

Melissa Kim M.S., CCC-SLP replies... 

In order to determine prognosis and appropriate intervention, the reason for your vocal difficulties and "thickened" vocal folds must be established. If you were not satisfied with the outcome of your evaluation, I would strongly suggest that you seek out a second opinion.

Good luck!

Hoarseness for 2 Consecutive Months

I have been a physical ed. & health ed. teacher for the last 37 years. A few months before the summer, my voice was hoarse. During my summer vacation, my voice was back to normal. The last 2 months of school, my voice is hoarse again. I do NOT scream at my students but use my voice for intervals of 3 hours everyday. A break for 50 minutes. Another 2 hours talking to my students, rest 30 min. another 2 hours with the students. My doctor examined my throat and saw everything was fine. There is NO pain, swelling, etc. I am supposed to see the otolaryngologist in Jan. 2015. I am drinking tea each day to sooth my throat when at rest. Staying away from a lot of caffeine, NON-SMOKER too. When will my voice return back to its normal state? Remember, NO pain, No swelling. Non-Smoker. Use voice everyday.

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

If your larynx was determined to be healthy by an Ear, Nose, and Throat physician, it is very possible that your speaking voice difficulties are secondary to muscle tension dysphonia, a general term to describe excessive and unnecessary tension of laryngeal muscles during voicing. Muscle tension dysphonia is often seen in response to an underlying condition, such as acid reflux, that causes irritation and subsequent compensatory change in vocal technique. Treatment involves intervention for any underlying condition, and voice therapy with a speech pathologist who specializes in the treatment of voice disorders; ask your physician for a referral. 

Good luck!

Friday, October 18, 2013

Tips for Professional Voice Users and Singers

Professional voice users, including both speakers and singers, can follow particular guidelines to promote optimal vocal fold health and function. 
1. Consult an Ear, Nose, and Throat Doctor (ENT). Consult an otolaryngologist, or ENT, to obtain a baseline evaluation of your voice when you are healthy.  Establishing a healthy picture of your larynx serves as a source of comparison if you encounter voice difficulties in the future.  Search for an otolaryngologist by name, location, or subspecialty through the American Academy of Otolaryngology - Head and Neck Surgery at For a listing of voice centers nationwide, please see our   National Voice Center Referral Database.
2. Maintain adequate hydration. Many physicians and clinicians propose that consuming approximately 64 ounces of non-alcoholic fluids per day is necessary to maintain adequate hydration.  Research supports that adequate hydration allows vocal cords to vibrate with less "push" from the lungs, especially at high pitches.  In addition, well-hydrated vocal cords resist injury from voice use more than dry cords, and recover better from existing injury than dry cords.  Increased systemic hydration also has the benefit of thinning thick secretions.  (Titze, 1988; Verdolini-Marston, Druker, & Titze, 1990; Verdolini, Titze, & Fennell, 1994; Verdolini et al., 2002; Titze, 1981; Verdolini-Marston, Sandage, and Titze, 1994).
Individuals who experience external dehydration, such as those individuals living or working in a very dry environment, may benefit from the use of a humidifier or vaporizer.  Dr. Katherine Verdolini of the University of Pittsburgh Voice Center recommends the use of a hot water vaporizer versus a cool-mist device.  The reason is that cool-mist devices vaporize everything in their reservoirs, including any chemicals or germs.  On the other hand, hot water vaporizers create vapor by boiling water, and because water has a lower boiling point than most chemicals, only water is delivered into the air. It is important to check with your doctor before beginning any hydration program.  Drinking large quantities of water can be harmful for some individuals with serious health conditions.
3. Always warm-up and cool-down. Warming-up the voice is important before prolonged speaking or any singing engagements.  A simple, yet effective vocal warm-up is to perform lip-trills while gliding up and down the full extent of one's pitch range.  Additional exercises are discussed on the Vocal Warm-Ups page. Although frequently ignored, vocal cool-downs may also be used to prevent damage to the vocal cords.  The simple practice of gentle and relaxed humming can serve as one excellent, easy form of cooling-down.
4. Know your range.  Avoid singing pieces at the extremes of your vocal range.  To determine your range, perform light glides or lip trills to your highest and lowest notes.  Record these notes by checking them on a piano.  Make sure that pieces in your repertoire fall above the lowest and below the highest extremes of your range. To view average vocal ranges for soprano, mezzo soprano, alto, tenor, baritone, and bass voices, see those put forth by the New Harvard Dictionary of Music at
5. Know the potential side effects of your medications. Many commonly prescribed medications can have significant effects on the voice.  For a listing of medications and potential adverse effects on the voice, see the list compiled by the National Center for Voice and Speech at
6. Screen yourself daily for vocal cord swelling. Screening yourself for potential vocal cord swelling will help you to determine whether you should perform on a particular day, or take a vocal rest.  Tasks for daily screening are found on the   Vocal Screening   page.
7.  When singing with a band, use monitors.  Have some small speakers facing you on stage so you can hear yourself adequately and modify your volume accordingly.
8.  Avoid vocally abusive behaviors.
  • Decrease overall volume.
  • No shouting/ yelling.
  • Don't whisper!  It may actually make your voice worse.
  • Don't talk in the presence of a lot of background noise!  Talk to someone only when they are an arm's length away.
  • Don't try to talk or sing when you have a bad cold or laryngitis.
9.  Avoid behaviors that may exacerbate acid reflux. Certain behaviors and foods may exacerbate acid reflux and yield poor vocal performance.  Please see the page on Reflux Changes to the Larynx for more information and suggestions for modifications to reduce reflux.
10. Consider speaking voice training. There is often a discrepancy between singing voice and speaking voice. Even a trained singer may demonstrate excellent technique during sung performance, but exhibit abusive speaking habits, undermining vocal functioning. To ensure a healthy balance of the entire voice, regardless of whether speaking or singing, singers may benefit from speaking voice training from an acting coach or a speech-language pathologist.   
11.  Don't smoke!  Don't smoke!  Don't smoke!    We can't say it enough.

Monday, October 7, 2013

Lingual Tonsils

What are the lingual tonsils and where are they? My ENT diagnosed me with an infection in June and subsequently prescribed antibiotics. After three rounds I still suffer from the original symptoms of throat tightening and a gagging feeling. Please help me to diagnose what is wrong.

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

The lingual tonsils are masses of lymphatic tissue at the base of the tongue.

If you feel that you have not received an accurate diagnosis, and are continuing to experience symptoms, I would suggest that you seek out a second opinion. There could be any number of possible causes of your symptoms, and a diagnosis cannot be made via email.

Best of luck to you!