Friday, December 12, 2014

Nodules / Polyps / Cysts


I have had 5 surgeries to remove remove polyps from my vocal cords and will have my 6th surgery on Dec 3rd. I have had 3 different doctors during the surgeries. My last surgery was done at UNC in Durham, NC, in June, 2014, and my upcoming surgery will be done at the the same hospital. The 5 previous biopsy have no signs of cancer. My question is should I continue having surgery to remove the polyps if they continue to return?

Melissa Kim, M.S., CCC-SLP writes... 
 
This is a question that would only be able to be answered by your surgeon; I would recommend that seek out a second opinion if you don't feel as though your physicians have thoroughly addressed your concerns.

Good luck to you!

Sunday, December 7, 2014

Son Loses Voice Often

My 11-year-old son loses his voice often. It started about 3 years ago. If he goes to camp, outdoor activities with groups of people, or anything that involves talking a lot or playing loud, he'll lose his voice. I took him to the doctor, who said probably nodules, and to try and keep him from talking when they get inflamed. My question is, if this continues, could this damage his voice for good? Are there any new signs I should watch for? I hate to see what it is going to sound like when he goes through the change.

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

There are no "new" symptoms to look for... symptoms of nodules include hoarse, breathy vocal quality and a tendency to "lose" the voice with excessive use. I would suggest that you ask your physician for a referral to a speech pathologist. Voice therapy can often successfully resolve, or at least reduce, the nodules so that vocal quality and endurance improves.

Thank you for your question.

Friday, November 14, 2014

Hoarse Voice

For the last several years, I have experienced hoarseness in my voice, had the sensation of a lump in the throat (this symptom only after drinking MatTea vocal elixir for 7 days in a row), post-nasal drip, stuffy sinuses, chronic throat clearing, excessive throat mucous and a sore throat. I used to have a great singing voice (not professional, but I do talk for a living) but now I can barely make it through a song and I sound like an 80 year old smoker (and I am neither). I've been to ENT doctors and a speech therapist at Stanford, but nothing seems to help (and acid reflux medication seems to make it worse). I don't have nodules. Please help!

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

There are any number of conditions that can contribute to the symptoms you describe, so to suggest a possible diagnosis would be conjecture. If you've seen general Ear, Nose, and Throat physicians for prior assessments, then I would suggest seeking out a laryngologist, an ENT who specializes in the treatment of voice disorders. Ask your physician for a referral or visit the American Academy of Otolaryngology at www.entnet.org to search by sub-specialty.

Good luck to you!

Monday, October 27, 2014

Hoarse Voice

I had loss of voice beginning of April after a URI, followed by 8 weeks of raspiness, hoarseness before being seen by an ENT doctor and diagnosed with laryngeal reflux. I was put on a PPI, liquid antacid at bedtime diet modification, head of bed elevation,etc. in June.  I am a frequent singer but have not sung since March. I stay well hydrated. My voice is still raspy and rough, gets easily tired though there has been some improvement. How long should I expect these symptoms to continue? Do I need different medicine, a second opinion? Any thoughts would be appreciated.

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

Persistent hoarseness following an upper respiratory infection may indicate a related functional voice disorder. Muscle tension dysphonia, a general term to describe excessive and unnecessary tension of laryngeal muscles during voicing, is often seen following any condition that causes irritation and subsequent compensatory change in vocal technique (e.g., upper respiratory infection, laryngopharyngeal reflux) Treatment involves intervention for any underlying conditions, and voice therapy with a speech pathologist who specializes in the treatment of voice disorders; ask your physician for a referral.

Good luck to you!

Monday, October 20, 2014

Recovery from a paralyzed vocal cord

For the last 6 months I have suffered from a paralyzed right vocal cord as a result of a viral neuropathy. Six months later I am beginning to progress and believe the nerve to be healing. I am able to gain some voice, though it is strained and croaky first thing in the morning. The rest of the time it sounds like a forced whisper with much improved breathing. Would I cause damage by returning to work as a teacher of 9-year-olds, or would it be more advisable to wait a while until my voice has healed properly?

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

You will not cause any further damage by attempting to use your voice for teaching purposes - although you may experience a good deal of vocal fatigue. There are many treatment options available to individuals with a paralyzed vocal fold, however, including both surgical and therapeutic options... discuss available treatment with your physician.

Best of luck to you.

Monday, October 6, 2014

Vocal Cord Nodules Treatment

Hi, I have had acid reflux and asthma for a few years and since the summer have been experiencing chronic bronchitis which has worsened the asthma. I was hospitalized for a week and I have lost my voice since September 15th, 2014. Initially they thought laryngitis but I saw the ENT and had a stroboscopy and they found beginning growths, nodules and callous like growths on my vocals chords along with a lot of swelling and mucous and they could see the blood vessels. My throat and glands are painful and burn at times. They have put me on vocal rest until further testing and encourage me not to whisper. They said depending on what happens and the ENT decides after seeing the results will determine next steps. Is there anything I can do to help?

Melissa Kim, M.S., CCC-SLP writes... 

The treatment of choice for vocal cord nodules that are newly formed is voice therapy with a speech pathologist who specializes in the treatment of voice disorders; I would suggest that you ask your ENT if voice therapy would be indicated, and if so, if they have a referral source. Vocal rest is indicated if the nodules were observed to be particularly traumatic or hemorrhagic, though rest alone won't typically resolve nodules otherwise. In the interim, however, good vocal hygiene would be recommended, including conservative voice use, adequate hydration, and avoidance of irritants such as smoke and alcohol.

Best of luck to you!

Thursday, October 2, 2014

Throat Pain After Singing

I have a concert coming up and so was practicing some complex portions of my song. I think I overdid it a bit and now I am having pain in my throat area (and a little below as well). I do not have any symptoms of a cold, sore throat, etc. I do have slight acid reflux. I am planning to rest my voice for a day or two. What other home-made preparations/therapy could I use to soothe the pain? Could I take any pain killers as well?

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

In general, voice rest and good vocal hygiene are the best guidelines, including increased hydration, avoidance of environmental irritants, and possibly, over-the-counter medications for inflammation. For a more detailed description of vocal hygiene recommendations, please see our webpage on Tips for Professional Voice Users.


Good luck to you.

Tuesday, September 30, 2014

Paradoxical Vocal Cord Motion

A friend of mine has been experiencing voice problems. She went to see a speech therapist and was told that she has "paradoxical vocal cord motion." What does this mean?

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

Vocal cord dysfunction (VCD), also referred to as paradoxical vocal cord motion (PVCM), is a condition in which the vocal folds close (rather than open as they normally should) during inspiration, resulting in any number of symptoms including shortness of breath, wheezing, and/ or cough. The cause of this disorder is often unknown, although in many cases it is thought to be irritant induced, such as chronic laryngeal irritation from acid reflux. Treatment is primarily therapy with a speech pathologist, targeting respiratory techniques to help to manage episodes, in addition to medical treatment of any underlying or contributing disorder.

Thank you for your question.

Thursday, September 4, 2014

Care of Your Voice

You and your larynx... what you need to know

Vocal cordsYour voice reflects many different aspects of your personality. It's what makes you unique. Lifestyle choices and differences in daily vocal use or misuse can affect the health and stability of your vocal cords. We do know that the effects of smoking and drinking alcohol can have detrimental effects on the voice and may lead to cancer of the larynx. Keeping a healthy voice throughout your lifetime.
1.Don't smoke! Don't smoke! Don't smoke! Also, stay away from smoke-filled environments.
2.Hydration matters. Drink at least 8, 8-ounce glasses of water per day (64 ounces); more if you drink caffeine, alcohol, or if you're exercising. Hydration appears to affect voice in at least two ways. First, well-hydrated vocal cords vibrate with less "push" from the lungs. Second, well-hydrated cords resist injury from voice use more than dry cords, and recover better from existing injury than dry vocal 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).
3.Eliminate excessive throat clearing. Chronic throat clearing can result in irritation and swelling of the vocal cords. Try sipping water, humming, or using a "baby" throat clear.
Limit alcohol intake.
4.Alcohol irritates laryngeal epithelium and mucosa, and has been linked to laryngeal cancer risk.
5.Avoid vocally abusive behaviors.
 
  • Decrease overall volume; if you're talking one-on-one in a small room, talk quietly!
  • No shouting/yelling; find another way to let people know that it's dinner time or that they have a phone call!
  • Watch excessive phone talking; you may not realize how loud you're talking while on the phone. Ask your listener!
  • 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.
6.Avoid chronic use of mouthwash. Most mouthwashes have a high alcohol content, which can be irritating to the larynx. If you wish, use mouthwash to rinse your mouth... if you must gargle, switch to a mouthwash without alcohol or use warm salt water.
7.Posture matters. Good posture allows better airflow and reduces tension and strain. Poor posture can be improved with an exercise program designed to strengthen and realign the body for optimal support.
8.Exercise regularly to keep your body, mind, and spirit healthy. Try yoga for the extra benefit of stretch, relaxation, and strengthening, as well as good posture.
9.Get sufficient sleep daily .Early to bed, early to rise makes your voice healthy and wise.
10.Always warm up your voice before or cool down after prolonged speaking or singing. Try quiet lip or tongue trills up and down your range, or softly and quietly hum five-note descending scales in the middle of your range.

Monday, July 14, 2014

Multidisciplinary Comprehensive Rehabilitation Following Laryngectomy 2014

September 12 - 13, 2014

VIEW BROCHURE

About the program:
Although the goal of every clinician is organ preservation, a total laryngectomy is often unavoidable
 in patients with advanced stage laryngeal and hypo pharyngeal cancer or recurrent disease.
Fortunately, the quality of life following a total laryngectomy is very good provided surgical
and rehabilitation efforts are optimal. Over the last several decades considerable progress in voice,
pulmonary and olfaction rehabilitation of the total laryngectomy patient has been made. This
course will share current trends and practices in post-laryngectomy rehabilitation. A cadaver
resection lab offers attendees a unique and powerful learning experience in surgical techniques
for total laryngectomy. Additionally, a hands-on lab with patient volunteers provides attendees
the opportunity to learn techniques of tracheoesophageal prosthesis replacement.

Program Objectives

By attending this program participants will:
  • Describe the surgical techniques of total laryngectomy as learned through the cadaver
    lab component of this course.
  • Describe the latest in surgical techniques for voice restoration following total
    laryngectomy.
  • Differentiate between primary and secondary voice prosthesis placement and identify
    pros and cons of each.
  • Describe the decision making process in selecting the appropriate voice prosthesis.
  • Discuss the benefits of heat moisture exchangers (HMEs) and free hands valves.
Please call Barbara Messing, M.A., CCC-SLP, BCS-S at 443-849-8451 for questions
regarding any of our upcoming conferences. 

Wednesday, June 18, 2014

Neck Dissection - Voice Change

I was diagnosed with squamous cell skin cancer with mets to my throat. I underwent neck dissection with one pos node found at mskcc in NYC. Because of the one node I did chemo and rads. However, after more than three months after treatment ended, I developed a voice about 5 octaves lower than normal with sore throat and extreme hair loss. I was a teacher and am trying to return to work, but at this point, could not talk all day. I had a recent pet scan and all is clear. There is some lymphedema under my chin. Thank you.

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

A change in vocal quality is a common side effect of radiation therapy to the neck, and in many cases there is some degree of permanent change in vocal quality and/ or pitch. However, there are any number of additional reasons as to why you may be experiencing these vocal symptoms, and an evaluation by an Ear, Nose, and Throat physician is certainly warranted.

Best of luck to you!

Thursday, June 12, 2014

10th Annual Voice Conference:

Advanced Topics in the Diagnosis and Treatment of 
Laryngeal Disorders Laryngeal Stroboscopy
in Clinical Practice with Hands-On Instruction
Friday & Saturday June 27 & 28, 2014


About the Program
This is a two-day program designed to educate otolaryngologists and speech-language
pathologists in advanced topics in the diagnosis and treatment of laryngeal disorders.
The conference will cover the fundamentals of laryngeal stroboscopy, including clinical
applications, diagnostic and clinical challenges with case study review in a team
approach. Specialized voice therapy techniques for a variety of vocal pathologies
including therapy for the performing voice. Hands-on instruction in both rigid
and flexible endoscopy will be provided.   

Program Objectives
By attending this program, participants will:
  • Discuss the fundamentals and limitations of the laryngeal stroboscopic examination.
  • Discuss differential diagnoses of laryngeal pathologies.
  • Discuss voice therapy techniques for a variety of vocal pathologies.
  • Discuss therapy interventions for the performing voice.
  • Discuss techniques and protocol performing for rigid and flexible endoscopy.
Please call Barbara Messing, M.A., CCC-SLP, BCS-S at 443-849-8451 for
questions regarding any of our upcoming conferences. 

Thursday, May 29, 2014

Professional Voice User - Acid Reflux

I have acid reflux diagnosed by Stanford University. Prescribed Omeprazole 40 mg 2 x day. Your article recommended other products, and I didn't see this one. Article discussed liquid medication like Maalox, Pepcid and a few others, I didn't see Omeprazole. Which is the better choice? I have an important speaking engagement June 18 and vocal cords are somewhat swollen and irritated due to previously undiagnosed acid reflux. HELP!

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

The information provided on our website mentions over-the-counter products only; prescription medications should be recommended by a physician. Although Omeprazole is now offered over-the-counter (Prilosec OTC), it is still a medication frequently prescribed by physicians to treat acid reflux, and is considered very effective. I would suggest that you follow your doctors recommendations; however, additional over-the-counter medications can be used to address breakthrough symptoms.

Best of luck to you!

Thursday, May 22, 2014

Professional Voice User

For years now, I've struggled with vocal hoarseness after about an hour of singing. Recently, however, after singing, my entire body becomes achy and sore along with my throat hurting. I've seen voice specialists and they say that my scope shows everything's fine. I've worked on my vocal technique with voice teachers, but this issue remains. Lately, I've been searching online for others who experience this body soreness after singing, but haven't found anything similar. I'm a professional commodities trader by day, so I do yell quite a bit in the trading pits, but I never experience any pain or aching. Please advise.

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

It certainly sounds as though you are frustrated by this soreness that occurs only after singing. Although I have not personally evaluated you, some singers can develop muscle tension dysphonia, a condition that occurs when muscles around the larynx become unnecessarily active during vocal function. This can result in pain and discomfort, which is usually intermittent. Likewise, people can develop compensatory muscle tension in other parts of their body. I would be interested to hear what your voice teachers have recommended and if your singing posture has been evaluated. It might be beneficial to have your larynx examined by a laryngologist (an Ear, Nose, and Throat physician who specializes in voice disorders) while you are singing to determine if muscle tension is in fact causing your discomfort. Our medical team would be more than happy to see you; appointments can be made by calling 443-849-2087.

Good luck!

Monday, May 19, 2014

Johns Hopkins and Fender Music Open New Voice Center at GBMC

WMAR-TV

Hopkins, Fender open new voice center at GBMC

The best hospital around is teaming up with a company that made guys like Jimi Hendrix, George Harrison and Stevie Ray Vaughn house-hold names.  The Johns Hopkins and GBMC’s Voice Center got together with Fender Music to create the Fender Music and Voice Studio

http://www.abc2news.com/news/region/baltimore-county/hopkins-fender-open-new-voice-center-at-gbmc?autoplay=true

New Treatment Center At GBMC Mending Broken Voices

WJZ--TV

New Treatment Center At GBMC Mending Broken Voices

Mending broken voices. That’s the specialty of a new treatment center opening at GBMC.
This music studio is only one part of the Johns Hopkins Voice Center at GBMC. There’s also high-tech medicine.  “The idea is showing the patient this is what your vocal chords look like,” said Dr. Chuck Fletcher, Johns Hopkins Voice Center. “Your voice is just this great instrument, but it’s complicated and certainly can go bad in different ways.”

http://baltimore.cbslocal.com/2014/05/07/new-treatment-center-at-gbmc-mending-broken-voices/

GBMC Center Offers Relief for Voice/Swallowing Issues

WBAL--TV

GBMC center offers relief for voice, swallowing issues

Johns Hopkins Voice Center is newest GBMC addition

Elementary school teacher Theresa Wenck is finding her singing voice again inside a brand new studio on the hospital's campus. Over the winter, chronic laryngitis led to a more serious diagnosis for the chorus teacher, who was constantly singing and talking over her students. "I learned that I had a vocal hemorrhage that should have repaired itself with vocal rest, but unfortunately I needed to have surgery," Wenck said.  She went to the Johns Hopkins Voice Center at GBMC, the newest addition to a comprehensive treatment facility that provides a one-stop shop for patients of all ages suffering from voice or swallowing issues. For the musicians, they can come sit in our music room, playing whatever instrument they want while they're singing and show us whatever problem they're having. Same thing for our music teachers," said laryngologist Dr. Kenneth C. Fletcher.


http://www.wbaltv.com/health/gmbc-center-offers-relief-for-voice-swallowing-issues/25856662#ixzz3194g9YcY

Friday, April 11, 2014

Professional Singer/Vocal Teacher Experiencing Intermittent Vocal Loss

I am a professional singer and vocal teacher. I am having vocal problems with separation of tones when singing and it is getting worse. I vocalize students, but I don't sing for any occasion anymore, though I want to. I have had a beautiful soprano voice all my life. I am nearly 68 now and a very young person for my age. I am also a composer with many songs I want to record. I had a scope done years ago when I first started having these loss of tones, but I was singing then a lot and it seemed to clear up and my voice was strong. I am now not using it except to show students how to vocalize has made it weak. I have quite a bit of sinus drainage, which is also a culprit, I am sure. I have had bronchitis and laryngitis many times and afterwards it seems I have many months before I can sing again. I want an ENT who works with these problems and I want to know if the problems can be corrected. I forgot to mention that my vibrato is wobbly at times and then it sounds normal..... I need education from a doctor who has seen these vocal symptoms in patients and can give me the correct advice/ therapy I need and if I should not sing now. I so want to sing again... Thank you. Washington, DC.

Melissa Bidlack, MM, MS, CCC-SLP replies...

I imagine you must be frustrated with these vocal changes. Without having visualized your vocal folds, it is difficult to say what might be causing these changes. As all of us age, our voices change because our vocal folds thin out and do not move as efficiently as when we were young. Also, mucus, as you mentioned, can affect the quality of a person's tone and may sometimes be associated with vocal fold swelling. Furthermore, it is also possible for the laryngeal muscles to develop compensatory habits that change the way people produce voice. The best advice I can give you is to see a laryngologist, an otolaryngologist who specializes in voice disorders, who will visualize your vocal folds in a procedure called "stroboscopy" to determine the cause of your vocal changes. If you are interested in evaluation with a laryngologist at the Johns Hopkins Voice Center at GBMC, you may make an appointment by calling (443) 849-2087. You can also search for a laryngologist at www.entnet.org.

All the best to you!

Voice Loss

I had some sinus drainage which resulted in the complete loss of my voice. My doctor put me on steroids because my vocal chords were inflamed and swollen. It did not help. I went to an ENT. He found no abnormalities or paralysis. It has been 21 days that I've been silent. I'm not a smoker or a screamer. I am however a teacher. Why now? Thank you!

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

There are any number of reasons why someone might experience voice change - or even voice loss - but recommendations for treatment depend on an accurate diagnosis! What did your ENT feel was the cause of your voice difficulties?

Monday, March 31, 2014

10th Annual Voice Conference



Advanced Topics in the Diagnosis and Treatment of
Laryngeal Disorders Laryngeal Stroboscopy
in Clinical Practice with Hands-On Instruction

Friday & Saturday June 27 & 28, 2014

VIEW BROCHURE

Instructional Personnel Disclosures

About the Program

This is a two-day program designed to educate otolaryngologists and speech-language pathologists in advanced topics in the diagnosis and treatment of laryngeal disorders. The conference will cover the fundamentals of laryngeal stroboscopy, including clinical applications, diagnostic and clinical challenges with case study review in a team approach. Specialized voice therapy techniques for a variety of vocal pathologies including therapy for the performing voice. Hands-on instruction in both rigid and flexible endoscopy will be provided.

Program Objectives

By attending this program, participants will:
  • Discuss the fundamentals and limitations of the laryngeal stroboscopic examination.
  • Discuss differential diagnoses of laryngeal pathologies.
  • Discuss voice therapy techniques for a variety of vocal pathologies.
  • Discuss therapy interventions for the performing voice.
  • Discuss techniques and protocol performing for rigid and flexible endoscopy.

Please call Barbara Messing, M.A., CCC-SLP, BCS-S at 443-849-8451 for questions regarding any of our upcoming conferences.

Saturday, March 15, 2014

When to Initiate Voice Therapy?

Hello,

I am a singer and live in Virginia. Since January I've been having problems with my voice including reduced range, tiring easily, and lack of proper sound. Last week my ENT doctor diagnosed acid reflux and prescribed omeprazole for the next three months. I will make a number of lifestyle changes at the same time.

I hope to see a voice therapist who works at Riverside Hospital in Newport News.

How long should I wait before I begin voice therapy?

Thank you.

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

Thank you for posting your question to our question and answer forum. If you are having difficulty with your voice I recommend that you initiate voice therapy now rather than waiting until later since you are experiencing vocal difficulties.

Voice therapy can serve to improve vocal endurance, range and efficiency. The reflux medicine you have been prescribed should reduce the level of acid reaching your voice box to reduce irritation. Combination of voice therapy and pharmacological management of reflux is recommended.

Kind regards,

Barbara

Friday, February 28, 2014

Dymista - Vocal-Fry Effect

I recently visited an ENT doctor over concerns about a vocal-fry effect (moderate rasp) in my lower voice register, a problem that appears when I do public speaking but that is pretty much always with me. The doctor prescribed a month's course of Dymista based on what sounds like a very reasonable diagnosis of "probable effects from environmental allergies." (Some swelling towards the back of my vocal cords and some dimpling at the back of the soft palate seems to have led the doctor to make this diagnosis, plus the fact that I've already tried some measures against acid reflux and still have the voice issue.) My only concern (since I do vocal practice as well and enjoy singing) has to do with any potential for permanent loss of vocal range. My doctor didn't think this was anything to worry about in this regard with the medication I mentioned, so I'm just running this by your excellent site's experts to see if they have any advice on my concern. Thanks in advance!

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

I agree with your physician, I would have no concern for permanent vocal changes as the result of taking this particular medication.

Best of luck to you!

Tuesday, February 11, 2014

Voice Catching - Cutting In and Out - No Control

Hello-
I am a professional singer/songwriter. About two years ago I began to notice that my voice was catching here and there when I was singing. This has grown increasingly worse, to where the "catch" becomes a dipped note, almost a quick strangle sound. I never know when it will occur, and it is wreaking havoc with my self-esteem. Now this even occurs at times when I am simply speaking. My voice cuts in and out.
I do have allergies, and there is a good chance I have GERD. But do these sound like the symptoms of these two things? I have thought at times it was anxiety, but now I am wondering if it isn't physiological, as all the good things I am doing (taking singing lessons again, working with self-hypnosis and going to therapy) don't seem to be helping.HELP! and Thank you.

Melissa Kim M.S., CCC-SLP replies... 

There could be any number of explanations for your symptoms! See a laryngologist (an Ear, Nose, and Throat physician who specializes in voice disorders) for an evaluation and treatment recommendations.

Best of luck to you!

Monday, February 3, 2014

Voice Loss - Electrolarynx

Last Feb. I had surgery to remove my vocal cords due to cancer. I was told one day I could get a device implanted in my throat that would allow me to once again speak. Yesterday I was told that it would not be a good idea. (Due to previous radiation treatments to that area.) I am left with few good options. My electrolarynx is probably my only speech option. I tried it earlier last year but made little progress, with limited home therapy. Is there anything your center could do to help me, or is it just a matter of practice, practice, practice? Thank you.

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

Here at the Milton Dance Head & Neck Center, a tracheoesophageal puncture with prosthesis placement is the standard of care for voice rehabilitation after laryngectomy. Our surgeons typically perform this procedure at the same time as the laryngectomy, though it can be performed secondarily. Many of our patients who are able to produce "voice" in this method have previously had radiation therapy, so although a history of radiation to the head and neck area can present some complications in the rehabilitation course, it certainly does not preclude you from this type of procedure. This is not to say that something specific in your medical history makes your a poor candidate for prosthetic voice rehabilitation, but I would not be able to remark on that without evaluating you personally.

As to competence using an electrolarynx, training/ therapy with a speech pathologist is the best way to improve your skills with this type of device; your head and neck surgeon should be able to provide you with a referral to a speech pathologist who specializes in the treatment of patients with head and neck cancer.

Please feel free to respond with any further questions!

Hoarse Voice

I have been having persistent headaches associated with further body aches and pains. But recently, I have harshness of the voice of about 2 months duration that has refused to go even after taking antibiotics. I regurgitate after every meal since I was a child. Recently, I feel as if a lump is threatening to come from my stomach through my esophagus. I also have persistent stomach ache aside the feel of bloatedness. I feel fatigued most of the time. I'll like to know what is happening to me?

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

I cannot remark on your more generalized symptoms of aches and pains, bloating, and fatigue; those would be best addressed by your primary care physician. From a voice and swallowing standpoint, however, I would suggest that you first consult a laryngologist (an Ear, Nose, and Throat physician who specializes in the larynx). A laryngologist will be able to offer insight as to the nature of your voice complaints, and will be able to suggest the most appropriate diagnostic examination for your swallowing difficulties you mention, likely a modified barium swallow study with esophagram. This x-ray study is done in conjunction with a speech pathologist, who will be able to offer practical suggestions at the time of the examination.

Good luck!

Voice Loss - Stressful Situations

A number of years ago, while on active duty in the Navy, I was having trouble with loosing my voice when in stressful situations. The doctors in San Diego, examined me and told me that I speak with my false vocal cords rather than my true ones. They even took video of my vocal cords as I spoke. Through therapy they taught me how to use my real vocal cords to speak, it was difficult but I was able to speak "normally". But over the years I fell back into the habit of using my false cords to speak but as I get older, I am 63, I am finding that just a little bit of emotion renders me speechless. Any ideas on what I can do to avoid my, as one doctor put it, "hysterical laryngitis". Thank you.

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

To address functional voice loss, I would recommend that you re-visit voice therapy with a speech pathologist. Although you may have already tried to use the techniques that were helpful to you in the past, there is a good chance that a speech pathologist (one who specializes in the treatment of voice disorders) will be able to guide you in techniques specific to your "emotional" voice loss.

Best of luck to you!

Wednesday, January 15, 2014

Cure for Voice Problems?


Is there a cure for voice problems (shaky). Silent reflux has been diagnosed. My throat feels as there is thick mucous there. 

Melissa Kim M.S., CCC-SLP replies... 

Treatment for vocal changes in the setting of laryngopharyngeal reflux (also referred to as "silent" reflux) is most often medication in conjunction with voice therapy with a speech pathologist. This combined approach has been shown in the literature to be the most effective intervention for reflux-related voice disorders.


 Good luck!
 

Hoarseness - Singing Voice and Vocal Range

I've been singing in a rock band for the past 4 years. It's pretty heavy so I have been belting out notes and battle with the loudness. I notice I would always get hoarse after a show but then it goes away. For the past year it never left and I noticed songs that I normally sing became harder to reach the notes also warm ups took for ever. I went to a ent doctor in the summer of last year 2013. She put a camera scope down my throat. She said I had acid reflux. I eat healthy because I am also a fitness competitor. She prescribed meds which I took for a week but stopped because it made my stomach hurt so bad. She prescribed a different one but I was too scared to take it. I figured I would research and do it naturally. So I researched and found out some things that I was doing as far as training played a big part. Such as eating and working out, eating and wearing a corset, eating and singing, and eating then going to bed. I even chew mint gum everyday. I am scared that my vocal range is gone for ever. My band just signed to a independent label. My head voice is still strong just takes a while to warm up. I am having problems with the softer notes. I cant keep them steady. It will come out pretty but then goes off into left field and sometimes I sound like I am singing in front of a fan. I don't know if I am ruined for life. Can I fix this? Do I need the medicine? I just want my voice back? Should I take a break from singing? Should I give up the contract or should I stop working out (fitness competition?) PLEASE HELP!!!

Melissa Kim M.S., CCC-SLP replies... 

Acid reflux that affects the larynx, commonly referred to as laryngopharyngeal reflux, is often blamed for vocal changes in the absence of obvious pathology. This condition is very often treated empirically, meaning that effective treatment confirms the diagnosis. If you would like to pursue a more definitive diagnosis of acid reflux, you might seek out a consultation with a gastroenterologist, or discuss this condition as a potential contributing factor to your vocal difficulties with a laryngologist, an ENT who specializes in the area of voice. My suggestion would be to pursue the latter, as a laryngologist is often able to recommend and/ or perform diagnostic tests, such as pharyngeal pH probe, to determine if acid reflux is impacting the larynx. Additionally, a laryngologist will likely offer alternate possibilities as to the reason for your symptoms. Certainly, it makes sense to pursue further, more specialized evaluation before you abandon any worthwhile endeavors! See the Academy of Otolaryngology site at
www.entnet.org to search by specialty and geographic area.

Best of luck to you!