While you may hear about voice problems encountered by singers, people in a variety of fields who use their voices extensively can encounter ear, nose and throat problems.
Learn more – including what you can do to protect your voice – from Dr. James Daniero, a UVA expert in voice conditions.
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Protecting Your Voice
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James J Daniero, MD
Dr. James Daniero is a otolaryngologist whose specialties include ear, nose and throat problems in people who use their voices extensively, such as singers, coaches and teachers.Learn more about Dr. James Daniero
Learn more about UVA Otolaryngology
Transcription:
Protecting Your Voice
Melanie Cole (Host): While you may hear about voice problems encountered by singers and people in a variety of fields who use their voices extensively, they can also encounter ear, nose and throat problems and many other people can, as well. My guest today is Dr. James Daniero. He's an otolaryngologist whose specialties include ear, nose, throat problems in people who use their voices extensively, such as singers, coaches, and teachers at UVA Health System. Welcome to the show, Dr. Daniero. So, tell us a little bit about some of the common voice conditions you encounter at the UVA Voice and Swallowing Clinic.
Dr. James Daniero (Guest): Sure, first of all, thank you for having me on the show, Melanie. Some of the voice disorders that we encounter at the University of Virginia, most commonly is just a persistent hoarse voice. That can be broken down into several categories, the most common of which is just a sort of misalignment in the way we produce our voice and then other things that can be associated, such as benign lesions that grow on the vocal cords.
Melanie: So, what are some symptoms? What are some things that people would notice if you're somebody in a profession--you're a singer, or you talk for a living--what might you notice besides hoarseness that would send you to see you?
Dr. Daniero: Sure. Obviously, the number one thing is the change in the voice, which most people characterize as a "hoarse voice", but also neck pain or soreness that develops in the front of the throat, typically throughout the day as the more their voice is used and that's associated with a "vocal fatigue", as I call it. Patients will notice that their voice starts out strong and, in the middle of the day, it starts to fade. By the end of the day, they feel like they're really straining and just having exhaustion from voice use. And then, there's also pain with swallowing or pain with voice use that can be associated symptoms.
Melanie: What do you do to test somebody for issues that you think that they might be experiencing?
Dr. Daniero: In our clinic, we run a multi-disciplinary clinic, and that is a speech-language pathologist as well as myself, the physician and surgeon, is present for the initial interview with the patient. We ask a lot of detailed questions about how they use their voice and what their behaviors are in regards to taking care of their voice. If they have any consideration of how to care for their voice at that point, and then, we also will look at their vocal cords, not only at the structure and looking at them with a very detailed, high-definition camera, but also the way it functions. So, we'll videotape the voice being produced in the various configurations. That videotape can then be slowed down to get a very detailed analysis of how the vocal cords are vibrating to produce the voice which can often identify the problem.
Melanie: Wow. So then, I'm an exercise physiologist, Dr. Daniero, so I know that exercise helps various ailments and things. Are there exercises you'd recommend people to do to protect their voice and possibly prevent some of these problems?
Dr. Daniero: Absolutely. Certainly, for people that are professional voice-users, and that's not limited to just singers, but anybody that uses their voice for their profession. There are a number of different exercises that, when trained by a voice specialized speech-language pathologist, patients can learn to care for their voice and also rehab their voice through these exercises. They usually have to be performed or taught through a speech-language pathologist that has some knowledge of specifically how to do the exercises.
Melanie: So, people can do these exercises and make their voices stronger? Do you advise people that are in these kinds of professions to either use their voice more limited or softer? People yell at their kids and they yell out on the streets. Is that really damaging our voices?
Dr. Daniero: Well, I think everything in moderation is the key there. There are some people that have a tendency to use their voices more forcefully, loudly, and are loud, frequent talkers and they, if they're professional voice users, might need to have some consideration of the amount and volume of voice use that they're using throughout the day, to limit it in certain situations. Then, there's others that are generally voice conservationists. They don't really speak out loudly. They speak softly and they're more introverted personalities and tend not to have issues with voice conservation.
Melanie: So, now what about some of the benign lesions and things that you might find? What do you do about them? Is there surgical intervention necessary? Do they go away on their own?
Dr. Daniero: Well, it depends on the type of growth or lesion that's on the vocal cord. A good portion of them will go away on their own if they have proper intervention such as vocal exercises and what we call "vocal hygiene" and behavioral modifications to prevent or limit the trauma on their vocal cords. A good portion of them will avoid surgery if those measures are instituted. Then there's a much smaller portion that does require surgery eventually. That's the type of micro-surgery that I do in the operating room.
Melanie: So, if you're doing microsurgery on somebody, what is that like? What is the recovery like? Is somebody then prohibited from speaking for quite a while? Tell us just a little bit about that.
Dr. Daniero: Sure. The surgery is generally an outpatient surgery. They go home the same day. Typically, it's around an hour, maybe an 1 1/2 hour of surgery but the key to the recovery is actually what happens after that. So, we typically will have patients that have anywhere between three to seven days of absolute voice rest. That means no noise coming from the vocal cords in coughing, throat-clearing, humming or voice use. During that time period, we're trying to get an area of surgery, the incision, to heal up well without the vibration irritating that area from producing the voice. Then, after that time period, we'll generally have them begin a rehab treatment. Similar to the way, if you had an orthopedic surgery for a shoulder or a knee, you would begin physical therapy after that, we do the same for the voice. We do a physical therapy for the voice that begins with the speech-language pathologist retraining the patient to use their voice in a much more efficient and less traumatic fashion.
Melanie: Dr. Daniero, are there other conditions, co-conditions, that can contribute to vocal problems? Reflux, sinus conditions? Do any of these contribute?
Dr. Daniero: Absolutely. Often, when we initially perform an assessment, those are things that I inquire about in detail; those are symptoms of acid reflux or even risk factors for acid reflux. We know there's a group of patients that may not have any symptoms of acid reflux but might have the findings. Some of that could be throat clearing or frequent belching but not the classic heartburn symptoms that you would associate with acid reflux. Then, allergies and sinus complaints often will produce thick mucus that drains down onto the vocal cords and that could, again, create an issue of chronic inflammation and hoarse voice, as well.
Melanie: In just the last few minutes, first, tell the listeners your best advice for people to protect their voice with voice hygiene, as you called it, and what they can do.
Dr. Daniero: Sure. The simplest thing is to make sure that we're well-hydrated. The classic recommendation is 8-10 glasses of water per day and very few of us actually reach that if we keep track throughout our day how much water we're drinking. The other thing is the amount of caffeine that we consume. Our vocal cords are just a few inches away from our mouths and we all know if we're drinking a lot of caffeine, we'll tend to get a dried-out mouth. So, when we're using our voice with these dried out vocal cords, we're causing a little bit more trauma. So, hydration can just eliminate a lot of the trauma that we're seeing there just by sort of lubricating the system. Other things in hygiene that are involved are managing our mucus, as we discussed, acid reflux and allergy symptoms, but then, also limited the trauma of our voice use in general--not calling across the house to our children that may be in a different room and actually walking over there to speak with them; simple behavioral interventions.
Melanie: Always great advice. And why should people with voice conditions come to UVA Otolaryngology for their care?
Dr. Daniero: We have a multi-disciplinary approach with the speech-language pathologist and the physicians creating a consensus that we can understand the problem from both the behavioral as well as the medical and surgical perspective. Also, we just understand the plight of a patient that has a voice problem. This is what we specialize in and we can help them.
Melanie: Thank you so much for being with us today, Dr. Daniero. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.
Protecting Your Voice
Melanie Cole (Host): While you may hear about voice problems encountered by singers and people in a variety of fields who use their voices extensively, they can also encounter ear, nose and throat problems and many other people can, as well. My guest today is Dr. James Daniero. He's an otolaryngologist whose specialties include ear, nose, throat problems in people who use their voices extensively, such as singers, coaches, and teachers at UVA Health System. Welcome to the show, Dr. Daniero. So, tell us a little bit about some of the common voice conditions you encounter at the UVA Voice and Swallowing Clinic.
Dr. James Daniero (Guest): Sure, first of all, thank you for having me on the show, Melanie. Some of the voice disorders that we encounter at the University of Virginia, most commonly is just a persistent hoarse voice. That can be broken down into several categories, the most common of which is just a sort of misalignment in the way we produce our voice and then other things that can be associated, such as benign lesions that grow on the vocal cords.
Melanie: So, what are some symptoms? What are some things that people would notice if you're somebody in a profession--you're a singer, or you talk for a living--what might you notice besides hoarseness that would send you to see you?
Dr. Daniero: Sure. Obviously, the number one thing is the change in the voice, which most people characterize as a "hoarse voice", but also neck pain or soreness that develops in the front of the throat, typically throughout the day as the more their voice is used and that's associated with a "vocal fatigue", as I call it. Patients will notice that their voice starts out strong and, in the middle of the day, it starts to fade. By the end of the day, they feel like they're really straining and just having exhaustion from voice use. And then, there's also pain with swallowing or pain with voice use that can be associated symptoms.
Melanie: What do you do to test somebody for issues that you think that they might be experiencing?
Dr. Daniero: In our clinic, we run a multi-disciplinary clinic, and that is a speech-language pathologist as well as myself, the physician and surgeon, is present for the initial interview with the patient. We ask a lot of detailed questions about how they use their voice and what their behaviors are in regards to taking care of their voice. If they have any consideration of how to care for their voice at that point, and then, we also will look at their vocal cords, not only at the structure and looking at them with a very detailed, high-definition camera, but also the way it functions. So, we'll videotape the voice being produced in the various configurations. That videotape can then be slowed down to get a very detailed analysis of how the vocal cords are vibrating to produce the voice which can often identify the problem.
Melanie: Wow. So then, I'm an exercise physiologist, Dr. Daniero, so I know that exercise helps various ailments and things. Are there exercises you'd recommend people to do to protect their voice and possibly prevent some of these problems?
Dr. Daniero: Absolutely. Certainly, for people that are professional voice-users, and that's not limited to just singers, but anybody that uses their voice for their profession. There are a number of different exercises that, when trained by a voice specialized speech-language pathologist, patients can learn to care for their voice and also rehab their voice through these exercises. They usually have to be performed or taught through a speech-language pathologist that has some knowledge of specifically how to do the exercises.
Melanie: So, people can do these exercises and make their voices stronger? Do you advise people that are in these kinds of professions to either use their voice more limited or softer? People yell at their kids and they yell out on the streets. Is that really damaging our voices?
Dr. Daniero: Well, I think everything in moderation is the key there. There are some people that have a tendency to use their voices more forcefully, loudly, and are loud, frequent talkers and they, if they're professional voice users, might need to have some consideration of the amount and volume of voice use that they're using throughout the day, to limit it in certain situations. Then, there's others that are generally voice conservationists. They don't really speak out loudly. They speak softly and they're more introverted personalities and tend not to have issues with voice conservation.
Melanie: So, now what about some of the benign lesions and things that you might find? What do you do about them? Is there surgical intervention necessary? Do they go away on their own?
Dr. Daniero: Well, it depends on the type of growth or lesion that's on the vocal cord. A good portion of them will go away on their own if they have proper intervention such as vocal exercises and what we call "vocal hygiene" and behavioral modifications to prevent or limit the trauma on their vocal cords. A good portion of them will avoid surgery if those measures are instituted. Then there's a much smaller portion that does require surgery eventually. That's the type of micro-surgery that I do in the operating room.
Melanie: So, if you're doing microsurgery on somebody, what is that like? What is the recovery like? Is somebody then prohibited from speaking for quite a while? Tell us just a little bit about that.
Dr. Daniero: Sure. The surgery is generally an outpatient surgery. They go home the same day. Typically, it's around an hour, maybe an 1 1/2 hour of surgery but the key to the recovery is actually what happens after that. So, we typically will have patients that have anywhere between three to seven days of absolute voice rest. That means no noise coming from the vocal cords in coughing, throat-clearing, humming or voice use. During that time period, we're trying to get an area of surgery, the incision, to heal up well without the vibration irritating that area from producing the voice. Then, after that time period, we'll generally have them begin a rehab treatment. Similar to the way, if you had an orthopedic surgery for a shoulder or a knee, you would begin physical therapy after that, we do the same for the voice. We do a physical therapy for the voice that begins with the speech-language pathologist retraining the patient to use their voice in a much more efficient and less traumatic fashion.
Melanie: Dr. Daniero, are there other conditions, co-conditions, that can contribute to vocal problems? Reflux, sinus conditions? Do any of these contribute?
Dr. Daniero: Absolutely. Often, when we initially perform an assessment, those are things that I inquire about in detail; those are symptoms of acid reflux or even risk factors for acid reflux. We know there's a group of patients that may not have any symptoms of acid reflux but might have the findings. Some of that could be throat clearing or frequent belching but not the classic heartburn symptoms that you would associate with acid reflux. Then, allergies and sinus complaints often will produce thick mucus that drains down onto the vocal cords and that could, again, create an issue of chronic inflammation and hoarse voice, as well.
Melanie: In just the last few minutes, first, tell the listeners your best advice for people to protect their voice with voice hygiene, as you called it, and what they can do.
Dr. Daniero: Sure. The simplest thing is to make sure that we're well-hydrated. The classic recommendation is 8-10 glasses of water per day and very few of us actually reach that if we keep track throughout our day how much water we're drinking. The other thing is the amount of caffeine that we consume. Our vocal cords are just a few inches away from our mouths and we all know if we're drinking a lot of caffeine, we'll tend to get a dried-out mouth. So, when we're using our voice with these dried out vocal cords, we're causing a little bit more trauma. So, hydration can just eliminate a lot of the trauma that we're seeing there just by sort of lubricating the system. Other things in hygiene that are involved are managing our mucus, as we discussed, acid reflux and allergy symptoms, but then, also limited the trauma of our voice use in general--not calling across the house to our children that may be in a different room and actually walking over there to speak with them; simple behavioral interventions.
Melanie: Always great advice. And why should people with voice conditions come to UVA Otolaryngology for their care?
Dr. Daniero: We have a multi-disciplinary approach with the speech-language pathologist and the physicians creating a consensus that we can understand the problem from both the behavioral as well as the medical and surgical perspective. Also, we just understand the plight of a patient that has a voice problem. This is what we specialize in and we can help them.
Melanie: Thank you so much for being with us today, Dr. Daniero. You're listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That's UVAHealth.com. This is Melanie Cole. Thanks so much for listening.