What to expect at the voice center

If you need a voice check-up, your visit likely will be in three parts: a medical history; examination of the vocal folds; and voice assessment and possible treatment.

At your check-up, it is important to give detailed information on overall health status, medications, allergies, voice use, eating habits, sleep patterns and any concerns you may have. Even subtle clues could be at the root of a voice disorder.

The vocal fold exam: Since vocal folds are hidden in the middle of your neck, your voice team relies on imaging to get a good look. A tiny camera — either placed on a flexible wire and inserted in the nostril or on a rigid rod held at the back of the throat — records pictures of your vocal folds in motion.

Most clients tolerate these procedures very well. However, if a person experiences discomfort or a feeling of gagging, a mild anesthetic will help.

The videostroboscopic instrument is actually quite remarkable and allows your voice team to get a good look inside your larynx.

What's voice therapy?

Teaching people how to correctly use their voices is nothing new. Vocal pedagogy — for actors and singers — originated in the middle ages. Teachers who knew nothing about vocal anatomy advised students based upon what they saw and heard. The result: an emphasis on articulation, pitch, projection and proper breathing techniques.

Modern speech-language pathologists can use those same elements — along with ever-increasing scientific and medical knowledge of the voice - to provide care.

Ideally, the speech-language pathologist focuses on habilitation (optimal usage of the voice under less than ideal circumstances) as well as rehabilitation (repair).

Therapy may be the only treatment needed. A recent study showed voice therapy alone usually reduces the size or eliminates vocal nodules. However, voice therapy is sometimes used in conjunction with medication or surgery.

Phonosurgery

Surgery performed to improve the voice is called phonosurgery. Its success is highly correlated with the experience of the surgeon. Physicians specializing in ear-nose-throat conditions (otolaryngologists), AND sub-specializing in voice surgeries are called laryngologists.

Surgery is appropriate for only some voice patients, usually if:

• visible lesions are diagnosed;
• the lesions don't respond to therapy;
• the post-therapy impairment is unacceptable to the patient;
• the client and voice team believe the surgery can help.

Phonosurgeries are often: laryngeal microsurgery (removal of small lesions); or medialization surgery (moving and/or injecting material to improve closure of the paired vocal folds).

Many phonosurgeries are same-day surgeries, and some procedures do not require general anesthesia. A few days of voice rest often follows surgery.

Acid rain from the stomach

Reaching for antacids a lot lately? Your stomach may not be the only thing that needs to be checked out. Gastroesophageal reflux disease (GERD) can significantly impact your voice.

GERD is increasingly named as a culprit in voice disorders. One study found GERD to be a problem in more than three-quarters (78%) of patients with hoarseness and half of all patients with voice complaints.

The problem arises when stomach acids travel back up through the esophagus and then irritate the tissue in the back of the throat and larynx.

GERD also can indirectly cause voice problems: GERD sufferers sometimes cough or clear the throat frequently, which may harm tissues of the larynx. Others with GERD tend to use excess muscle tension when they speak (in response to the altered feeling in the larynx).

What are GERD's symptoms?

Many people associate GERD with heartburn. In reality, however, only about half of all GERD sufferers have heartburn symptoms.

So, what are GERD's symptoms?

• voice hoarseness;
• sour breath (especially upon awakening);
• frequent throat clearing;
• excessive phlegm or saliva, especially in the back of the throat;
• difficulty swallowing food, liquids or pills, and/or a feeling of a lump in the throat;
• coughing after eating or lying down;
• breathing difficulties (such as asthma-like wheezing) or choking episodes;
• dry cough;
• indigestion.

Gain control of GERD

There are three basic approaches to tackling GERD: diet and lifestyle changes; medication; or surgery.

Self-management tips:

• Don't eat or drink anything but water within three hours of bedtime;
• Don't overeat;
• Don't recline after meals;
• Eat a low-fat diet;
• Avoid fried foods, coffee, tea, chocolate, mints and soda;
• Elevate the head of your bed 4-6 inches or sleep on a wedge-shaped pillow;
• Don't wear tight-fitting clothes or belts;
• Stop smoking.

Everyday illnesses

Colds and sore throats: It is the rare, lucky teacher who avoids catching at least one nasty cold or virus per year. The close proximity and questionable hygiene of young people besieged with viruses place the teacher at great risk of contamination.

Caused by viruses, colds easily travel in a closed atmosphere such as a classroom. They typically last 4-6 days and can cause a sore throat, hoarseness, laryngitis or respiratory infection.

The best way to prevent a cold is to build a healthy body: exercise, eat right and rest well.

If you catch a cold, take it easy. Relax, eat lightly, and blow your nose gently to prevent further sinus or middle ear problems.

You may feel it's impossible to skip a day, but bed rest is the best medicine for a cold. Let your body heal itself, and don't spread the infection to your co-workers or students.

Allergies and other damp conditions

For teachers with allergies, management is key — and protecting your voice is a high priority.

An allergy is the hyper-sensitive response to something in your environment. The allergen usually produces swelling of the mucous membranes in the nose and mouth, which may interfere with vocalization.

Once you know the offender, you can try to avoid it. Barring that, medications can help.

If allergies are more than a mild annoyance, you would benefit by working one-on-one with a physician with specialized training in these conditions (an allergist).

Beware of the dual-edge of antihistamines: While antihistamines dry up mucous secretions (and make you feel better), they dehydrate voice tissues. If you use them, sip water throughout the day.