Wednesday, December 21, 2016

Nodules - Singing Voice

My daughter is a budding singer. She is taking singing lessons and her vocal coach is concerned that she perhaps has nodes. That her chords barely phonate above a B natural in treble clef.  My daughter has to strain to sing in the higher range of her naturally alto voice. We are seeking advice and perhaps an appointment for evaluation.

Thank you

Melissa Bidlack, CCC-SLP replies...

Thank you for contacting us.  
Without knowing your daughter’s vocal history, I would ask how old she is and if this issue has been longstanding or is more recent? Also, has she noticed any changes in her speaking voice? If she has experienced a change in her voice that has persisted for longer than 3 weeks, I would recommend she see a fellowship-trained laryngologist who can examine her vocal folds using videostroboscopy. 
While lesions such as vocal nodules can limit range and increase strain, this can also occur with increased muscle tension.
The only way to be sure is to have her vocal folds visualized by a laryngologist, who would then recommend the appropriate course of treatment.  We would be happy to see your daughter at our center, and appointments can be scheduled by calling 443-849-2087. Please let us know if we can be of further assistance.

All the best to you,

Melissa Bidlack, CCC-SLP


Wednesday, December 7, 2016

Vocal fold paralysis: To Reinnervate Or Not To Reinnervate

JOHNS HOPKINS VOICE CENTER
GREATER BALTIMORE MEDICAL CENTER
PRESENTS
Laryngeal Stroboscopy Grand Rounds
Friday, December 9, 2016
7:30 AM – 8:30 AM
Physician Pavilion East Conference Center

" Vocal fold paralysis: To Reinnervate Or Not To Reinnervate "

Topic Presentation/Discussion:
Julina Ongkasuwan, M.D. 

Monday, November 28, 2016

Head & Neck Grand Rounds

GBMC
HEAD & NECK GRAND ROUNDS

Friday, December 2, 2016

7:30 AM – 8:30 AM

Physician Pavilion East Conference Center
“Principles of Salivary Gland Surgery”

Topic Presentation/Discussion:
James Clark, M.D.

Thursday, November 10, 2016

Singing Voice

Good morning. I had a cold a few months ago, and since then I continue to have small amounts of phlegm. This is especially bothersome when I sing. I cannot take Mucinex because I take an MAOI. Is there anything to be done for this?

In addition, in the past couple of years I have found that, in my lower singing range (starting around "middle" E and below) that my voice sounds hoarse. Any idea why this might be?

Thank you.

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

Persistent hoarseness and increased mucous production are symptoms that should be evaluated by an Ear, Nose, and Throat physician, who will be able to make recommendations based on cause.

Good luck!


Wednesday, November 9, 2016

Laryngeal Stroboscopy Grand Rounds

Johns Hopkins Voice Center
Greater Baltimore Medical Center
presents

Laryngeal Stroboscopy Grand Rounds

Friday, November 11, 2016
7:30 AM – 8:30 AM

Physician Pavilion East Conference Center

 "PVFM: Updates and Case Presentations"

Topic Presentation/Discussion:
Lee Akst, M.D.

Kristine Teets, M.A., CCC-SLP

Monday, October 31, 2016

Dedicated, hardworking and exceptionally talented group of professionals.

Thank you to all the Staff of the Milton J Dance, Jr. Head & Neck Center, Johns Hopkins Head and Neck Surgery, Johns Hopkins Voice center for the heroic work they have done before and after epic go live.  Team work doesn’t begin to capture the sense of what happened here.  In our center, patients and staff will find dedicated, hardworking and an exceptionally talented group of professionals.

Here is what we think of when we think of our team:

Friday, October 21, 2016

Dance Grand Rounds: November 4, 2016

Location:  Civiletti Conference Center
Time:  7:30am
Presenter: James J. Sciubba, DMD, PhD
Title: Overview of Non-neoplastic Oral and Oropharyngeal Mucosal Diseases
Needs Assessment:
Non-neoplastic diseases and conditions affecting the mucosal surface of the oral cavity and oropharynx are often difficult to diagnose and manage, and are often the source of significant morbidity, delayed diagnosis and inefficient management. This brief presentation will highlight five entities ranging from idiopathic to inflammatory and autoimmune. Participants will have an opportunity to witness, by way of clinical images and text material, presentation, etiopathogenesis and management, with a desired format of informality and discussion throughout.
Learning Objectives:
In attending this one hour session, the participant will be exposed to an array of mucosal conditions seen within a community and institutional setting. At the end of the session one expects to have garnered:

  • Appreciation of subtle differences between mucosal lesions with widely different biology and impact as well as management
  • An improved understanding of the common problem of oral aphthous stomatitis and its variants
  • The role of autoimmunity in the pathogenesis of mucosal ulceration and dysfunction
  • Re-acquaintance with the complex of lichenoid lesions, their range of presentation and status of steroid use and alternatives in their management

Monday, October 10, 2016

Updates in the assessment of hyperfunctional voice disorders

Johns Hopkins Voice Center
Greater Baltimore Medical Center

presents

Laryngeal Stroboscopy Grand Rounds

Friday, October 14, 2016
7:30 AM – 8:30 AM

Physician Pavilion East Conference Center


"Updates in the assessment of hyperfunctional voice disorders"

Topic Presentation/Discussion:
Cara Stepp, PhD


Tuesday, October 4, 2016

Thyroid Cancer on the Rise

Thyroid Cancer on the Rise - CLICK HERE to view video.

Dr. Sobel is a surgeon at the Johns Hopkins Head and Neck Center at GBMC. He says thyroid cancer is on the rise.



Friday, September 30, 2016

Hyperfunctional Voice Disorders

JOHNS HOPKINS VOICE CENTER
GREATER BALTIMORE MEDICAL CENTER

PRESENTS
Laryngeal Stroboscopy Grand Rounds
Friday, October 14, 2016
7:30 AM – 8:30 AM
Physician Pavilion East Conference Center

"Updates in the assessment of hyperfunctional voice disorders"

Topic Presentation/Discussion:
Cara Stepp, PhD

Wednesday, September 28, 2016

GBMC Head and Neck Grand Rounds

GBMC
Head & Neck Grand Rounds


Friday, October 7, 2016
7:30 AM – 8:30 AM
Physician Pavilion East Conference Center

“Indolent Lymphomas – A Treatment Update”

Topic Presentation/Discussion:

Mei Tang, M.D.

Monday, September 12, 2016

Meat: what are the best choices?

Tasty Tuesdays: Oncology Nutrition Lecture and Cooking Demonstration
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.

Sessions begin at 12 pm in Physicians Pavilion West,

Third Floor Conference Room

September 13, 2016 Meat: what are the best choices?


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.

To reserve your spot, please call: Keri Ryniak, RD, CSO, CNSD at 443-849-8186.



Thursday, August 25, 2016

GBMC
Head & Neck Grand Rounds
Friday, September 2, 2016
7:30 AM – 8:30 AM

Physician Pavilion East Conference Center


“Topic: NIH Research on Head and Neck Tumor Immunology

Topic Presentation/Discussion:

Clint Allen,MD

Thursday, July 21, 2016

Acid Reflux

I have had acid reflux, on and off, but more so lately and I had unknowingly started to drink 3 cups of coffee a day, along with ignoring the acid reflux at night, as it was not an every night occurrence. Well, I had noticed that when I tried to sing from a hymn book that my voice was starting to crack sometime ago. Then just last week, after "treating" myself to some diet coke at a party, along with all the coffee I had been consuming, my voice began to be very hoarse and even ached when I used it too much. I have not been able to get rid of this, although the acid reflux is gone, as I had also been eating late (my family eats very late due to jobs, etc.) for some time, and I have changed my eating habits after reading so much about this on the internet. I am eating less, stopping 3 hours before going to bed, eating better (little to no chocolate, which I like) and cut out coffee, with the exception of one cup of decaf coffee on two of the last 7 days. So my voice goes fairly hoarse after trying to use it for a short period of time. Sometimes it doesn't bother me much, but still is not normal, and other times there is a kind of mild raw feeling when I use it for 20 or 30 mins. So my question is, will my voice ever improve or have I done permanent damage to the voice box, and will it worsen (even with life changes)? I don't drink wine more than 2 x's a month (one glass limit), don't smoke, but have drank black tea or coffee a lot over many years, as well as indulged in chocolate. So is it possible for my voice to heal itself if I take better care of it? Thank you so much!


Melissa Kim M.S., CCC-SLP writes...
To evaluate any potential damage to the larynx and understand potential for recovery, you would need to be evaluated by an Ear, Nose, and Throat physician.   An ENT will visualize the larynx using a rigid or flexible endoscope to effectively diagnose any issues and make appropriate treatment recommendations.

Good luck!

Thursday, May 5, 2016

Clinical Pathway

What is a clinical pathway?

Your clinical pathway is a way for us to ensure that we keep track of how you are doing during and after your cancer treatments.
Who is involved?
Your team of head and neck surgeons, medical oncologists, radiation oncologists, speech pathologists, registered dietitian, social workers and nurse specialist each have a role in the clinical pathway. You will see one, more or all of these professionals at various times as noted in the clinical pathway schedule. 
Why do I need a clinical pathway? 
National Comprehensive Cancer Network (NCCN) provides guidelines for when you should be seen by your doctor and other professionals so you can have the best quality care (www.nccn.org). Your clinical pathway follows these guidelines. 
The goals are surveillance for recurrent or new tumors, monitor quality of life and function. 
When will I be scheduled for my clinical pathway appointments?
Before, during and after treatment.
After treatment… You will receive a call from our front desk staff to schedule your clinical pathway appointments.



Tuesday, May 3, 2016

Laryngeal Stroboscopy Grand Rounds

JOHNS HOPKINS VOICE CENTER
GREATER BALTIMORE MEDICAL CENTER

PRESENTS
Laryngeal Stroboscopy Grand Rounds
Friday, May 13, 2016
7:30 AM – 8:30 AM
Physician Pavilion East Conference Center

" Management of Age-Related Dysphonia"

Topic Presentation/Discussion:
David Lott, M.D.

Sunday, April 24, 2016

Octave Change

My daughter, now 17, was sick back in Jan 2015. Thought she had the flu but it turned out to be a really bad cold. During this time she had laryngitis for a month. When her voice returned, her volume was low & soft but her pitch was really high. As her normal volume returned her pitch did not. We have been to ENT specialists, Speech Therapists and had many tests done with no answers. She now has been talking like "Minnie Mouse" since her voice returned. She is frustrated because it is very hard for people to understand her...that is how high pitch her voice has become.
Why or what can be causing this? Any suggestions???

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

If your daughter’s larynx was determined to be healthy by an Ear, Nose, and Throat physician, it is very possible that her 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 following an upper respiratory infection, when individuals compensate for hoarseness, sore throat, etc. by unknowingly “misusing” muscles of the larynx. The condition can be successfully treated by a speech pathologist who is a specialist in the area of voice disorders. Your daughter may be best served by seeking out a comprehensive voice center, where a team of specialists treat only problems with the voice.

Good luck to you!

Friday, April 1, 2016

Nutrition

Tasty Tuesdays:  Oncology Nutrition Lecture and Cooking Demonstration

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.

Sessions begin at 12 pm in Physicians Pavilion West,
Third Floor Conference Room

April 12, 2016Are there supplements I should take?
May 10, 2016How to grill safely
September 13, 2016Meat: what are the best choices?
October 11, 2016Sugar and High Fructose Corn Syrup
November 8, 2016Nutrition for Brain Health

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. To reserve your spot, please call:  Keri Ryniak, RD, CSO, CNSD at 443-849-8186.

Friday, March 4, 2016

Dysphagia Research Society




Congratulations to our own Barbara Pisano Messing on her well received and award winning presentation of the Efficacy of Prophylactic Swallow Intervention for Head and Neck Cancer Patients at the Dysphagia Research Society annual meeting in Arizona last week. She was honored with the 2016 American Board of Swallowing and Swallowing Disorders Award and the 2016 CSDRG Logeman Travel Award.

Monday, February 29, 2016

Puberphonia

My son is 18 years old with severe social anxiety. He also has a soft high pitched voice. He has seen an ENT who examined his vocal cords with a scope and said they were very tight. He recommended voice therapy. My son went to about 12 voice sessions but did not respond well because of anxiety about using the deeper voice outside the therapist's office. I've read that thyroplasty can help deepen a man's voice. Is it worth exploring? What are the risks involved? Thanks.

Melissa Kim, M.S., CCC-SLP writes... 

In the absence of anatomic or physiologic abnormality, persistence of abnormally high pitch in young men or women after the onset of puberty is referred to a "puberphonia." Definitive treatment of puberphonia is voice therapy with a speech pathologist who specializes in the treatment of voice disorders. From your question, I take it that your son was able to achieve more normal voicing in therapy, but anxiety is preventing him from maintaining the more normalized pitch; if this is the case, I would suggest evaluation and treatment for anxiety. I believe that he would have difficulty finding a surgeon willing to operate on a young man with a healthy larynx, who is physically able to acheive normal voicing. Best of luck to you both.

Saturday, February 13, 2016

Dr. Ryan Sobel



Dr.  Sobel earned his medical degree from the Drexel University College of Medicine and completed his fellowship at Johns Hopkins Hospital for Advanced Training in Head and Neck Oncologic Surgery. Dr. Sobel specializes in benign and malignant tumors of the head and neck, including thyroid and parathyroid glands, salivary glands, tongue and oral cancers, throat cancer, larynx, neck masses, and advanced skin cancers such as malignant melanoma. Dr. Sobel is fellowship-trained in TransOral Robotic Surgery (TORS) and minimally invasive surgical approaches in head and neck surgery. He is also a published author and frequent presenter on topics involving head and neck surgery and research.

Johns Hopkins Head and Neck Surgery located at
GBMC The Milton J. Dance Jr. Head and Neck Center
Physicians Pavilion West 6569
North Charles Street, Suite 401
Baltimore, MD 21204

Contact Information Office:
443-849-8940
Cell: 516-729-8113
Fax: 443-849-8965
rsobel@gbmc.org

For referrals and appointments, call 443-849-8940. 
www.gbmc.org/mjdancehome

Wednesday, February 3, 2016

Singing Voice

Good afternoon,
I have been a vocalist since I was in high school. Approximately 15 years ago (I am now age 41), I started to notice a weakness in my voice, my voice would crack and "cut out." After several years of trying to adapt to this change and after becoming frustrated with the lack of confidence I had when performing, I sought out a consult from an ENT about 7-8 years ago. My expectation was for him to find nodes, GERD or something relatively treatable. I informed him that while I had no pain, I could "feel" the weakness was coming from the left side of my vocal cords. After a basic exam he noted that my vocal cords were not "aligned" and appeared that I had damage to the nerve that supported the left cord. I was referred to an ENT that had more comprehensive testing. A video strobe was done and confirmed that there was indeed nerve damage and the left cord was not moving in sync with the right. I was asked if I had a hx of previous neck trauma, surgery, a traumatic intubation or head/neck cancer. I had none of these. Perhaps it was from an intubation during routine surgery I had? I also had chicken pox as a young adult when I was in nursing school and it was discussed that possibly the virus may have attacked the nerve.... An MRI of the head and neck was performed to r/o things like a brain tumor that may be causing the nerve compression/damage. This was a normal study. Swallowing study was also done to r/o aspiration because I occasionally experience "coughing fits" when drinking liquids. This was also normal. Essentially I was told that unfortunately there was nothing that could be done to fix the problem. 

So, after several more years, I am seeking out additional information and potentially a second opinion knowing that there may be advancements in this area. I am finding that public singing/vocal performances for weddings, leading worship at our church, giving voice lessons etc is becoming more and more frustrating as I fear issues with my voice. Especially being aware that the dysfunction is present. My throat now seems to tense up even more as I try and "compensate" for the vocal dysfunction. I saw an ad come up on my social media for the Hopkin's Voice Center and watched the video and decided it was worth it to try and contact someone to see what, if any, next steps would be. Thank you.

Melissa Kim, M.S., CCC-SLP writes... 

While it is certainly possible that you experienced some trauma during a routine intubation that resulted in a vocal fold motion impairment, in many cases of motion impairment there is no discernible cause and a viral source is suspected. The most common procedural interventions now offered for individuals with a vocal fold motion impairment are vocal fold injection augmentation or medialization laryngoplasty.

Injection augmentation is done using a filler material to "plump up" the injured vocal fold, moving it closer to midline and improving vocal quality and strength. Filler materials are either temporary, lasting approximately 2 - 3 months, or "durable," in which results last closer to a year. The procedure can be done in the operating room but is now done routinely in the office with great success.

Individuals who have a long-standing paralysis - if that is the diagnosis you've been given - often opt instead for surgical medialization. This involves the placement of an implant to push the vocal fold closer to midline, and is considered a permanent "fix." This procedure is only performed in the operating room.

A laryngologist - an ENT with specialty training in voice disorders - is the professional most experienced in these types of procedures. We would be happy to evaluate you here at the Johns Hopkins Voice Center at GBMC.


Thank you for your question!

Wednesday, January 13, 2016

Pediatric Speech-Swallowing & Voice


Pediatric Speech-Swallowing Services

Our pediatric speech-language pathologists at the Milton J. Dance Jr. Head and Neck Center evaluate and treat children of all ages who have difficulty communicating.

Speech
Children who need help with their speech development may be hard to understand. They may have trouble saying sounds and words correctly or may not be speaking at all. At our Center pediatric speech pathologists specialize in helping children with a variety of speech problems including: articulation difficulty, apraxia of speech, phonological processing disorders, stuttering, voice disorders, and speech-resonance issues associated with cleft lip and palate.

Language
Children who need help with language development may struggle with understanding spoken or written information such as directions, questions, and stories (receptive language). They may have trouble using words or symbols to communicate, using correct grammar, or may not speak at all (expressive language). Children with language disorders or delays may also have trouble with social communication (pragmatics) and have trouble interacting with others, making proper eye contact, or staying on topic. Our pediatric speech-language pathologists specialize in helping children who have language difficulty due to these communication barriers.