Transcription:
The Importance of Voice Care

Melanie Cole (Host): Many people have experienced losing their voice at some point, we all have. But if you have a voice change that lasts for a while; you may need to consider seeing a specialist that can help you and see if there’s a voice disorder present. My guest today is Dr. Lauren Tracy. She is a board-certified otolaryngologist, fellowship-trained laryngologist and she specializes in voice care at Boston Medical Center. Dr. Tracy since you are new to Boston Medical Center, tell us a little bit about yourself and how you came to BMC.

Lauren Tracy, MD (Guest): Thank you for having me today. I did my residency training down in Chapel Hill, North Carolina and then I did my fellowship at Massachusetts General Hospital last year in laryngeal surgery. And while I was there, I was looking for jobs within the Boston area in part because my husband is also a head and neck cancer surgeon and Boston Medical Center really attracted me because it has an incredibly rich history of laryngology. Many say that laryngology maybe within the US really started or it took off at Boston Medical Center. This is the place where we first started using lasers within the larynx to help store laryngeal cancer. So, that was really attractive to me obviously to be part of that institution.

Host: Well, I certainly would agree with you. Boston Medical Center is an amazing place and we do so many great podcasts for them. So, welcome. I’m so glad that you are here on with us today. So, let’s talk about our voices. What is a voice disorder? Are there different types? What goes on with our vocal cords?

Dr. Tracy: Oh, so there are many different types of voice disorders. It does not just have to what we think as being hoarse. Any problem that you are experiencing when you are trying to speak, and that includes having your throat just feeling raw or achy or strained when you are trying to speak or sing. Or if you have increased effort while speaking, even if the clarity of the voice remains the same. If you are repeatedly clearing your throat or if your voice just sounds deeper or abnormal; those are all signs of a voice disorder. And a voice disorder usually just that belies that there is something going on within the vocal cords which is just as varied as the problems that I just reviewed.

Host: Well as someone who talks for a living; what are some of the most common professions that are more likely to encounter voice issues? Who is at risk for voice disorders?

Dr. Tracy: Well, frankly anyone is at risk for a voice disorder. So, every time we speak, men, their vocal cords hit around 140 times a second and women, their vocal cords hit around 240 times a second and how loud you are is how hard they hit together. So, anyone who uses their voice any day is potentially at risk but going with that so those people who are what we call professional voice users are at a higher risk of encountering a voice disorder. But that doesn’t necessarily mean just singers or radio people, it also – that includes lawyers, teachers, coaches at the gym, anyone who uses their voice every day, sales people. So, basically anyone is at risk is the take home message.

Host: Do we know what’s causing this? If somebody is a constant talker or a singer or as you say a lawyer or a teacher. What is the cause of a vocal cord disorder?

Dr. Tracy: Well, so, again, one of the most common things that I see that causes hoarseness is actually vocal overuse or vocal misuse. So, that can happen just from poor diaphragmatic support, pushing air too forcefully, poor posturing or poor utilization of the neck muscles that help the vocal cords move. But sometimes it can just be bad luck. There are thousands of performers out there using their vocal cords to their extreme every day and who don’t encounter difficulties with their voice.

Host: Then how is something diagnosed? You and I spoke a little bit off the air about diagnosis, so, if someone has this hoarseness or tightness or they are clearing their throat, all these symptoms that you have described; what is the diagnosis like and are you looking for nodules? What are you looking for when you diagnose somebody with a vocal cord disorder?

Dr. Tracy: So, our academy recommends that if anyone has had a voice problem for more than four weeks, that they should have a laryngologist, or an otolaryngologist evaluate their vocal cords. Most patients come to me just when they have a change in voice, they want to know if they have cancer or not. And so, I am able to either reassure them that they don’t or help guide them to the appropriate care that they need. The way that I look at your vocal cords is actually with a camera called a flexible laryngoscope and that is basically a skinny camera about the size of a thick piece of spaghetti that I put through the nose and I’m able to bypass the gag reflex and directly visualize your vocal cords and how they move together and how they vibrate and we are fortunate at Boston Medical Center to have screens where for those interested patients, they can also take a look at their vocal cords and it really helps to point out all of the anatomy and help patients see what’s going on. And that helps them better understand the care that we are able to provide them.

Host: I’m definitely one of those people that likes to see it on the screen and see what you are doing in real time which is absolutely very cool. So, what is treatment like? Pick one of the disorders you see most commonly Dr. Tracy and speak about treatment. People right away go oh I don’t want to have surgery. But there’s actually kind of vocal cord physical therapy in a way isn’t there?

Dr. Tracy: Oh, there is and it’s incredible. So, one of the more common things that I see again, from coming for the vocal overuse and vocal misuse would be vocal cord nodules. And those are essentially calluses that occur on the vocal cords. And in order for the vocal cords to function well, they need to be soft and slippery and vibrate together, but when they get these rough calluses, you can hear that essentially in someone’s rough voice. But the mainstay of most of our vocal cord problems is actually what we call voice therapy. And we again, are fortunate at Boston Medical Center to work with a number of incredibly talented speech and language pathologists. Some who specialize in voice care, some who specialize in signing voice, some who specialize in breathing and swallowing. So, for the majority of my patients, I need to see them in order to confirm or see that there is or not a malignant process going on. But many of them are able to be just achieve much better voices by working with our voice therapists.

Host: What’s that like? What is vocal therapy like?

Dr. Tracy: So, I’m not a voice therapist so I think they would be the best people to explain, but some techniques they do is they do a lot of neck massage to help relieve some of the tension and tightness in the neck that a lot of people experience as they are trying to compensate for the roughness of their vocal cords. But they teach them how to use better breath support, how to have better posture while they are speaking and how to project and basically use their voice efficiently. It’s really very similar to a running coach if you are running a marathon.

Host: Well, I’m trying all those things right now Dr. Tracy as you are saying that. Now what about medical intervention? Can voice issues be caused by things like reflux or even COPD or any of these other things? Can they affect your voice?

Dr. Tracy: They certainly all can. Reflux can cause a lot of swelling in the back of the airway and cause you to kind of start to misuse your vocal cords. And with COPD, you actually have decreased breath support, so you are not able to push all of the air through the vocal cords to have a loud robust voice. And again, COPD is commonly caused by smoking. All smoking creates a risk of their developing cancer on the vocal cords as well as other precancerous lesions on the vocal cords.

Host: That’s pretty scary to have something like that and so Dr. Tracy speak about what you would do. I mean is there medication or do you ever discuss surgery? What does that look like?

Dr. Tracy: In terms of vocal cord cancer, so obviously the word cancer is an incredibly scary word. The kind of good news is that vocal cord cancer while it’s rare; it’s only one to two percent of cancers within the United States and there’s only about 10,000 new diagnoses each year; because it often presents with a hoarse voice; we are able to catch it relatively quickly and when we do catch it quickly, it has very good survival outcomes, in the 90-95 percentile. And there are a number of options that are available. We have again, I mentioned at Boston Medical Center, we invented using the laser in the larynx, so we have different lasers, carbon dioxide laser as well as a KTP laser that we can use to remove cancer off the vocal cords and then there is radiation therapy that’s available as well for certain types of cancers. So, there are treatment options available and it’s a relatively good outcome with these and the main thing is to be vigilant and get the diagnosis early.

Host: Then wrap it up for us with your best advice about when it’s time to see an otolaryngologist or a laryngologist, when you feel that the symptoms are enough that you need to go see somebody and what you want people to know about really keeping a healthy voice and taking care if they have been told that they have nodules. Just wrap it all up for us and give your best advice.

Dr. Tracy: So, my best advice is to – if you are experiencing voice problems for greater than four weeks; you should come see a laryngologist or if you are someone who relies heavily on their voice and you are experiencing any voice concerns for any period of time; we are more than happy to see you and help you because we understand if you rely on your voice then you need that to be functioning. And in terms of keeping your voice healthy, the main thing is to not abuse your voice. Try to avoid yelling or speaking loudly in noisy areas and if that is something that you have to do; consider using amplification and especially in this wintertime when people are prone to upper respiratory infections, try and spare your voice as much as you can. And certainly, in this dry winter – we either have dry cold or dry heat; consider using a humidifier and try and stay hydrated to optimize your overall vocal health.

Host: That’s absolutely wonderful information and thank you so much Dr. Tracy for coming on with us today and really clearing that up, explaining it all so well and sharing your expertise. For people like me, this is such great information. So, thank you again. Welcome to Boston Medical Center and it was such a pleasure to have you with us. This is Boston MedTalks with Boston Medical Center. For more information you can go to www.bmc.org, that’s www.bmc.org. This is Melanie Cole. Thanks so much for listening.