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!

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