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Treatment of Voice Disorders
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Treatment
of Voice Disorders Treatment of a voice disorder should start
with an evaluation from a voice care specialty
team. This may require a series of
referrals. Types of Treatment Surgical
Treatment using precision laser and
microscopic techniques. Functional
Voice Therapy for re-teaching the
mechanism to function properly through
exercises. At the Lions Voice Clinic, a voice evaluation is
done with Dr. Goding and either Dr. Michael or Mr.
Ramanathan. We discuss the problem thoroughly with
the patient, gathering information about the
history of the problem, and the complaints and
needs of the patient. Dr. Goding does a thorough
examination of the ear, nose, and throat of the
patient. A view of the larynx is obtained, which
may be done in a number of ways. During the routine
examination, Dr. Goding may use a mirror to see the
larynx. Often, it is desirable to videotape the
examination of the larynx, in order to have a
document of the results. Also, it may be desirable
to have the patient view his or her own larynx in
action, in order to better understand the voice
disorder. In both of these cases, the examination
is done in the Stroboscopy Lab, which is the heart
of the Lions Voice Clinic. Either Dr. Goding, Dr.
Michael, or Mr. Ramanathan may perform the actual
examination of the larynx, but review of the videotape and discussion with the
patient is always done with Dr. Goding and either Dr. Michael
or Mr. Ramanathan together. The examination may be done with either flexible
or rigid endoscopy, or both. The flexible endoscope
is passed through the nose and into the throat,
allowing a full view of the larynx in action. The rigid endoscope is inserted into the mouth
and straight back, functioning like a submarine
periscope to view the vocal folds. The rigid
endoscope is larger, offering a larger, brighter
view of the larynx. However, the flexible
endoscope, being passed through the nose, allows
the patient to talk and sing during the procedure.
This is vital in assessing the function of the
vocal mechanism. An endoscope consists of a lens at the end of
fiberoptic cables that carry light to the dark
insides of the human body. The image is viewed
through an eyepiece. In the Lions Voice Clinic, the
endoscope is attached to a video camera. This
allows the image to be projected onto a video
monitor during the exam, and videotaped for replay.
The video is often dubbed for the patient, or
copies of single frames of video are made. An additional feature of the endoscopic exam is
called stroboscopy. In this case, the light carried
through the fiberoptic cables is a strobe light,
which shines intermittently on the vibrating vocal
folds (also called vocal cords; see the explanation
of this terminology). The vocal folds vibrate
anywhere from 80 to 1500 times per second; the
faster the vibration, the higher the pitch of the
voice (see Vocal Fold
Vibration and Pitch in our page About
the Voice). These vibrations are so fast, they
can only be seen as a blur. But when the strobe
light shines intermittently on the vibrating vocal
folds, they look as if they're vibrating in slow
motion. This allows an evaluation of the nature of
the vibration, which is crucial to understanding
many abnormalities of the vocal sound. In the Lions
Voice Clinic, we use state of the art stroboscopy
equipment to assess voice disorders. Treatment using medicines is one of the
components of treatment for voice disorders. In
many cases Dr. Goding will prescribe a medication
to make the larynx more healthy. Dr. Goding, Dr.
Michael, and Mr. Ramanathan may suggest
over-the-counter medications for certain vocal
conditions. There are few drugs specifically used to treat
voice disorders. More commonly, the medications
fall into several classes that have a secondary
effect on the voice: 1. Medications to treat
sinus drainage 2. Medications to treat
acid reflux 3. Medications to
reduce inflammation of the vocal
folds 4. Medications to thin
secretions 5. Over-the-counter
medications Certain voice disorders are best treated with
surgical intervention. Some lesions (growths) need
to be surgically removed. In the case of vocal fold
paralysis, there are several surgical options that
provide a better voice. Dr. Goding is known
nationwide for his skills as a surgeon. At the
Lions Voice Clinic, surgery is almost always
accompanied by at least one session of functional
voice therapy, to teach the individual about
postoperative voice care, and to teach vocal
techniques to optimize the surgical result.
Surgical treatments for each voice disorder are
described on the Voice
Disorders page. At the Lions Voice Clinic, functional therapy is
done with Dr. Michael or Mr. Ramanathan. After the
voice evaluation, a treatment plan is discussed
with the patient, and therapy sessions are
scheduled. The plan for therapy varies from patient
to patient, but in general, sessions occur weekly
for one hour at first, then become gradually more
spaced apart as the patient learns more advanced
techniques and needs more time to practice them and
incorporate them into day to day speech. The first few sessions generally include a
thorough discussion of the patient's vocal
lifestyle: voice needs, activities, and habits.
Education is given about how to keep the voice
healthy regardless of the level of voice activity.
The patient learns pertinent information about how
the voice works, in order to understand the
therapeutic process better. Then, exercises are
taught to keep the upper body relaxed while using
the voice, and to ensure that breathing technique
is optimal. Then, specific voice exercises are
taught. Certain sounds ensure that the muscles are
used correctly; once the sounds are mastered, they
are advanced to words, sentences, and finally
conversational speech. Finally, exercises are done
to train the patient for specific vocal needs, such
as singing, loud talking, prolonged talking, phone
use, etc. In the Lions Voice Clinic, exercises are
tailored to each individual patient, according to
his or her strengths, weaknesses, and needs. The
exercises are recorded during the session so
the patient can practice at home with the tape or CD.
This ensures optimal practice.
Most voice disorders are not life
threatening. It is generally up to the
individual whether to seek treatment for a voice
disorder, depending on the extent of voice
impairment or discomfort. However, though you
will not die from non-treatment of a voice
disorder, it is still considered medically
necessary to seek treatment. A normal sounding
voice, free from discomfort or fatigue, is
considered a normal function. If it is
disordered, restoring it is medically necessary.
Sometimes insurance companies will argue that
point, but if they challenge it, your voice care
professional will help you negotiate with them.
Medical
Treatment involving prescription and
nonprescription drugs.
Decongestants, antihistamines, or
steroid nasal sprays may be prescribed if
the individual is bothered by congestion or
sinus drainage that may irritate the tissues in
the larynx, or thicken secretions, making it
hard for the vocal folds to vibrate
Gastroesophageal reflux is a common
disorder that can cause acid from the stomach to
reflux up the esophagus (the food pipe) and then
spill over onto the larynx (see About the
Voice). The acid is irritating to the larynx and
may cause swelling or inflammation of the vocal
folds. Medications such as Zantac or Prilosec
may be prescribed by Dr. Goding to treat this
condition, in order to improve the health of the
larynx (see Related Disorders).
On some occasions, vocal fold swelling
warrants a prescription of oral steroids to
reduce the inflammation. These are not used on a
long-term basis.
Some individuals are helped by guaifenesin, a
mucolytic/expectorant that thins secretions and
may help reduce throat-clearing or the sense of
congestion. This is available over the counter.
Conservative remedies are important at
the Lions Voice Clinic. Maintaining good
hydration of the mucosal tissues is extremely
important to vocal health (see Singers,
etc.). Drs. Goding and Michael often
recommend such strategies as saline nasal irrigation,
personal steamers, and sucking on hard candies.
Also, over-the-counter medications such as
saline nasal sprays or guaifenesin (as in
Robitussin expectorants) are helpful in keeping
drainage minimal and secretions thinned.
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Date Last Modified: 8/23/07 |