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Professional Voice

If you rely on your voice for your profession, even a mild voice disorder can create daily challenges. Professional voice users require significant voice use for their professions and are at an increased risk of developing voice problems due to the nature of their employment. These include singers, actors, teachers or professors, attorneys, physicians, clergy, telemarketers, customer service representatives, salespeople, and many more.  For professional voice users, voice injuries or disorders can result in temporary loss of income, loss of employment, and increased emotional stress and anxiety. 

At the Voice and Swallowing Institute, our highly trained staff includes Dr. Michael Pitman, a highly regarded laryngologist, along with two voice therapists/singing voice specialists, who have a unique ability to understand the urgency of your problem. Our goal is to help you through your vocal recovery as efficiently and effectively as possible so you can go back to work.

Common Voice Injuries

  • Vocal Fold Nodules
  • Vocal Fold Hemorrhage
  • Vocal Fold Polyp
  • Vocal Fold Scarring
  • Muscle tension

When To See an Otolaryngologist

If you are experiencing hoarseness lasting over 2 weeks, seek out an evaluation with a multidisciplinary team in a specialty voice clinic.  However, if you rely on your voice for your employment or main source of income, seek out an evaluation with a voice team within two days if you experience sudden changes in any of the following areas:

  • Increased throat pain
  • Sudden onset of hoarseness
  • Abrupt changes to voice sound quality (breathy, raspy, pitch breaks or cracks)
  • Changes to vocal range
  • Straining or increased effort when talking or singing

What to Expect From Your Appointment

Diagnosis

We will take a detailed history of the problem as well as your voice use profile.  Start thinking about when the problem began and what you noticed.  How did your voice change?  What became difficult for you? Describe the sound quality.  What was going on in your life at the time, voice-related or otherwise?  What treatment have you tried thus far, with other doctors or on your own?  How do you use your voice on a daily/weekly/monthly basis?  What do you need your voice for now and in the future?  What are your career or professional aspirations?

We may conduct some tests, including:

  • Videostroboscopy: This test uses a camera called an endoscope that can visualize your larynx. There are two types of endoscopes: flexible endoscope and rigid endoscope. A flexible endoscope is a small flexible camera that looks up through your nose and hangs over the back of your throat to view your larynx. It does not hurt and only takes one or two minutes to perform the test. A rigid endoscope is a slightly larger, but still small, firm camera that enters your mouth, just to the back of your tongue, and looks at your larynx via the mouth. It does not go down your throat and also does not hurt. Both endoscopes use light sources called strobe lights that allow the physicians to view the vocal folds vibrating in slow motion.
  • Imaging tests: X-rays, CT scans, and MRI can show growths or other tissue problems in the throat. If your physician feels this test is necessary for your voice complaint, he/she may send you for one following the videostroboscopic examination.

Treatment

  • Education: We may teach you about the anatomy and physiology of voice, general voice care guidelines, voice conservation techniques, and encourage you to develop an increased self-awareness of your own voice habits.
  • Behavioral therapy: You may be referred for voice therapy with one of our speech-language pathologists/voice therapists.  “Behavioral” means that we will teach you exercises to help rehabilitate your voice or work with you to make some changes to your vocal behaviors.
  • Environmental modifications: We can brainstorm together to develop environmental modifications personalized to your needs.  These are designed to help you not only recover your voice but ensure that your voice remains healthy for the duration of your career. Some examples are modifying your schedule to allow for voice “breaks” throughout the day, using non-verbal communication techniques whenever possible, avoiding loud environments, and others.
  • Medications: Some voice disorders are caused by problems that can be treated with medication. For example, antacid medication may be used for GERD, prednisone may be used for severe acute inflammation or nasal sprays may be used for allergies.
  • Surgery or In-office Procedures: Some voice disorders may not respond to behavioral rehabilitation attempts, or may be so severe that they require intervention.  In the course of treatment, your doctor may discuss the injection of a substance into the larynx or into the vocal cords themselves or in-office laser treatment.  Your doctor may also discuss surgery to remove vocal fold lesions and restore optimal laryngeal function.

Tips for Care of the Professional Voice

Baseline Exam

Most individuals seek out medical care when they experience a problem with their voice.  It is our recommendation that if you rely on your voice for your profession you should come in to see us when your voice is healthy.  We can perform a videostroboscopic exam of your voice at baseline.  This enables the voice care team to examine your voice at its stable, healthy level of functioning.  This also allows us to identify the normal appearance and function of your vocal folds.  Everyone’s are a little different.  Then, if you experience a voice change or injury in the future, we can determine precisely what changes have occurred regarding your anatomy, function, and voice quality.  This allows for better diagnosis and more effective treatment.

Allergy Management

Allergies can result in post-nasal drip or other irritation to the throat and the voice.  This can cause inflammation, chronic coughing or throat clearing, or changes to voice sound quality. Suggested management approaches include:

  • Nasal steroid sprays (Flonase, Rhinocort, Nasonex, etc)
  • Nasal saline sprays
  • Nasal saline irrigation or Neti pot
  • Inhale steam for 2-3 minutes, multiple times throughout the day
  • Glycerin throat lozenges (Pine Bros Softish Throat Drops, Lakerol pastilles, Fontus Green Apple lozenges, etc)

Allergy treatments to avoid, as these have a drying effect which can place you at increased risk of voice injury include:

  • Antihistamine allergy medications (Claritin, Allegra, Zyrtec, etc)
  • Menthol or eucalyptus cough drops

Naturopathic Options For General Vocal Health

Following are suggestions for care and maintenance of healthy voices. Many of these remedies have not been scientifically tested, but we offer them as naturopathic alternatives that may be helpful. These methods can help promote hydration, reduce irritation or inflammation, and reduce acid reflux symptoms. However, if you are experiencing voice changes or think you sustained a voice injury, please seek out care with a multidisciplinary treatment team. These are not suggested as alternative care for voice injury or voice disorders but can supplement the program you develop with your voice team.

  • Glutagenics for mild reflux and gastric discomfort: This is a powder of aloe, DGL, and glutamine.  What we actually know: Aloe has anti-inflammatory and anti-bacterial properties, DGL decreases aspirin induced gastric ulcers, glutamine can aid in the repair of the gut and protect the esophagus during radiation.
  • Gould’s gargle for throat pain or irritation:  1 cup water, .5 tsp kosher salt, 5 tsp baking soda, 5 tsp light corn syrup or maple syrup.  What we actually know: This mixture is hydrating as it is saline, and clinically soothing to a sore throat.
  • Aloe manuka honey slurry for throat pain or irritation: 2 oz aloe vera juice with manuka honey mixed in.  Gargle and swallow with this several times per day. What we actually know: Aloe has anti-inflammatory and anti-bacterial properties. Manuka honey also has anti-inflammatory and anti-bacterial properties. Both may be helpful in wound healing.
  • Arnica: For vocal fold hemorrhage and inflammation (this should be diagnosed by a physician).
  • 30C potency tablets: Place 4 beneath the tongue 2 times per day.  What we actually know: Plastic surgery literature and research shows that this may help to decrease and speed the recovery of bruising in facelifts and nasal surgery.  There is some controversy as to whether this is accurate.  There is no research on its effect on vocal fold hemorrhages but there is minimal risk with possible benefit.
  • Apple cider vinegar: Most likely this is very bad for reflux and throat. We do not recommend its use for any ailment. We work hard to decrease the acid in our diet for our reflux, yet some believe apple cider vinegar is good for this. What we actually know: Apple cider vinegar is acid and has the same pH as hydrochloric acid.  Apple cider has been moderately studied. While it does decrease cholesterol and diabetes in rats, it has not been shown to be helpful in reflux and digestion.
  • Diet: Maintain a healthy, well-rounded diet of mostly vegetables and some meat or fish.  Avoid processed foods when possible.  Avoid eating within 2-3 hours of bedtime.
  • Rest: Be sure to get 7-8 hours of sleep per night and take rest breaks if feeling fatigued throughout your day.
  • Exercise: Maintain good health through regular exercise to keep body in shape, to maintain proper alignment for breathing and voice use, and to reduce stress levels
  • Relaxation: Meditation, gentle stretching or Yoga, progressive relaxation, and mindfulness techniques can also help reduce stress and tension in the body and calm the mind.

You are a vocal athlete and your whole body needs to be rested and cared for, not just your voice.