Treatment of Voice Problems

Our voice is our most important tool for communication. Despite this, most of us take our voices for granted until there is a problem. The proper functioning of the voice requires the interplay of the lungs, the vocal cords, and the air passages of the throat and nose, through which the sound vibrations are developed into our unique tone, or vocal signature. Our job in assessing vocal problems is to determine where the problem lies. Often our patients can tell us what the problem is if they know what to look for. We can then confirm the suspicions thus generated by looking into the nose and throat with special instrumentation as described below.
 
Whether you are an opera singer, a choral performer in church, a coach of a little league team, a lecturer, or just someone who needs to be heard and understood, you need a good clear voice. The degree of perfection required may vary, but the general concepts are similar for all.
 
General good health is important for good voice
Aerobic conditioning helps to improve lung capacity and the strength of the diaphragm and abdominal muscles, which provide the power that supports the voice. Likewise, nasal passages and sinuses that are free of disease will provide a superior cavity for the creation of vocal resonance. Good hearing is necessary to be able to provide the feedback that enables one to modulate the voice as necessary.  Getting adequate sleep is critical; tired vocal cords never sound good. Heartburn – caused by reflux – can be a big problem, as acid can wash onto the vocal cords and cause irritation and swelling.
 
Certain drugs can adversely affect the voice by creating a drying effect:

• Antihistamines
  
• Diuretics
  
• Alcohol
  
• Many antipsychotic medications
  
• Steroid inhalers
  
• Anesthetic sprays (Cepacol®, etc.)
  

Certain foods are tough on the vocal cords:

• Ice cream
  
• Nuts
  
• Chocolate
  
• Fad diets with high quantities of one type of food (Atkins®, etc.)
  

Training is very important. Professional singers know this, but even they may forget that their speaking voice needs training, too. Those with training may need to get a check on their technique; those without training should get it, especially when there are special demands that tax the voice.

Many people are under the impression that getting older necessarily leads to a poorer voice. As in other athletic endeavors, one needs to do more excercizing as one ages just to maintain one’s ability. That being said, if one commits to maintaining good vocal habits and participates in voice strengthening exercizes, a good voice can be maintained throughout one’s life.
 
Good hearing is key to good vocalization. Your ears must be clear of wax. If you are a rock singer, you need a speaker that faces you so you can hear what your own voice is doing, otherwise you will strain just to hear yourself, and hurt your voice.
 
Hydration is a must. Moist vocal cords vibrate cleanly, and water is the only liquid worth drinking (and lots of it). As the saying goes, “Sing wet, pee pale.”
 
After you’ve seen to all of the above, it may still be necessary to see your ENT doctor to get your voice back in shape.
 
At your appointment, we will first listen to you, then take a history of your vocal issues. We will want to know what role your voice plays in your life. We will do a preliminary exam of the vocal cords to make sure there are no tumors.

At a subsequent visit, we will have you return for Video Stroboscopy and laryngeal function studies. First, using the flexible scope that we used at your first visit, we will carefully record the movements of your vocal cords during various speaking, whispering and singing maneuvers. Then, using a telescope placed in the back of your mouth, we will the obtain pictures of your vocal cords in slow motion, looking for the presence of the very smooth waves on the surface of the cords that help to produce good voice. Subtle changes in the way the cords move can be picked up with this technique. The results can help us to plan treatment for you. In addition to prescribing medications or recommending lifestyle changes, we work closely with voice teachers and speech pathologists to make sure you get back to where you need to be.