Transcription:
Vocal Therapy for Voice Disorders

Melanie Cole (Host): Many people have experienced losing their voice at some point. It may be from a cold or a respiratory illness, however, it might be caused from one of the many disorders of the vocal cords. If you have a voice change that lasts for a few weeks, you may need to consider seeing a specialist that can help you with your voice disorder. Joining the show today to discuss voice disorders and treatment options available, is Marissa Yoes. She is a speech and language pathologist with Meritus Health. Welcome to the show Marissa. So, what is a voice disorder and are there different types?

Marissa Yoes, MS CCC-SLP (Guest): Thank you so much for having me. Well, you know I’m never more conscious about my voice than when I’m working with one of my voice therapy patients. I notice my own voice dips down as I get later in the day and that’s one of those voice disorders. People can have tired voice, more back focused, but it is really anything that is noticed with pitch, loudness, or quality in someone’s voice. So, it can range from anything from mild hoarseness to complete loss of voice. It can be related to injuries from shouting, overuse, improper breathing, Parkinson’s disease, strokes, or other medical and physical conditions. And we also actually treat transgender voice.

Melanie: Wow, so I mean we have all had laryngitis as I said in the intro when we are sick or something, but when you notice that hoarseness, when something somehow seems different, when is it that you go see somebody? How long do you wait?

Marissa: You know I would say anything that lasts longer than a month. It really shouldn’t go on for that long and the first person you should see is an ear, nose and throat doctor, otolaryngologist and they would be the ones that would make the referral for speech therapy.

Melanie: Who is at risk for vocal cord disorders? Is it just people think of opera singers and such like that but really that’s not all there is.

Marissa: Definitely. About 28 million workers in the US experience daily voice problems and about 4-6 children out of every 100 have a voice disorder. So, anybody can really be at risk, but especially those people who use their voice for a living.

Melanie: Certainly that is true, and we are all keenly aware of that. Are there any steps that we can take before we talk about treatment options and what an evaluation might be like? Are there steps that you like to tell people to prevent voice disorders in the first place?

Marissa: Hydration is the most important thing you can do. So, you want to try to get about 60 ounces of water a day. Hydration plays an important role in the internal hydration of vocal fold tissue and actually the external surface layer of the vocal fold tissue. People can reduce their caffeine intake. Caffeine unfortunately is very drying, which affects the hydration. Getting acid reflux under control is an important thing to do. So, symptoms of acid reflux, we are all familiar with that heartburn sensation, but there is another kind of reflux that is more known as silent reflux and it feels like a bitter taste in the back of your mouth, something kind of stuck in your throat, feeling difficulty swallowing, post nasal drip, and that is actually the silent reflux that can eventually cause a hoarse voice. People need to manage allergies, post nasal drip, having excess mucus on your vocal cords and in your throat, makes you cough which irritates your vocal cords. They swell up. You feel like something is there. You cough. And it is this cycle about – that will eventually swell everything up and give you a voice disorder. It’s important to try not to clear your throat or cough. Try to take water instead and reducing talk time. So, professional voice users like singers, teachers, religious leaders, people who are on the phone all day need to make sure that they are taking about ten minutes every hour to rest their voice so that they are not overusing or misusing their voice.

Melanie: And certainly moms who scream at their kids are at risk as well, right. Because that’s something that certainly does happen. Now what’s a voice evaluation like?

Marissa: So, it works – we ask you some questions about your history, what you do with your voice during the day. Then we measure some different aspects of your voice quality like loudness or pitch and then we try some different therapeutic techniques to see if any of them would be more effective than others. Some speech pathologists have the capability to view your vocal cords in the office. At Meritus, we recommend that you visit your ear, nose and throat doctor and they will do the visualization.

Melanie: So, what happens if you determine that someone has one of these issues whether it is from silent reflux or if it’s nodules or whatever the reason, what is vocal cord therapy like?

Marissa: We try to coordinate your care with your regular doctor and your ear, nose and throat doctor. Most of my patients come for visits about once a week or once every other week for thirty-minute appointments, six to eight weeks and we work on different exercises, demonstrate them for you in the office and then send you home to practice because thirty minutes a week isn’t going to be enough to make major changes. You have to do a lot of the work on your own at home.

Melanie: Marissa, are speech therapy and voice therapy the same?

Marissa: They are both provided by speech language pathologists. Speech therapy works more on sounds, and those kinds of things and voice therapy is all about breathing, bringing your vocal cords together more gently and modifying pitch, loudness and clarity of your voice.

Melanie: So, when someone is in voice therapy, give a us a little example, because people want to know what this therapy is going to entail and what its like. When you mention the words pitch and such like that, what are you doing with people? Are you giving them exercises? What does that sound like?

Marissa: There are a couple different exercises. The one that I use most often is called semi-obstructed vocal tract exercises and it kind of looks like you can put a straw in your mouth and kind of sing through the straw; so doing pitch glides, going from a low tone up to a high tone, and that puts your vocal folds in actually their optimum position and is a really great warm up before you are going to go talk to someone or be using your voice for a while. We do lots of what feels uncomfortable during therapy initially, but I get to know my patients pretty well and we can be silly together.

Melanie: Those are really good. Give us one more usable tip. Something that you do in therapy that people can do at home to work on their voice.

Marissa: Easy onsets. So, visualizing bringing your vocal folds together very gently and easily instead of harsh attacks so saying the phrase we eat eggs every Easter; your vocal folds come together pretty hard when you say that phrase. Visualizing bring them together softly we – eat – eggs – every - Easter changes that and can be a way to lessen the impact of bringing the vocal cords together.

Melanie: If somebody comes to see you and they have been doing therapy and their symptoms are still there, they are still hoarse, or they still have these issues when do you tell them it is time to go see their ENT again to consider some medical treatments?
Marissa: That’s a good question. We try to work with ENT so if I am ever questioning it, I pick up the phone and call them. But probably after that initial six to eight weeks; would be a good time to go back and see the doctor.

Melanie: Is one of those kinds of treatments and you mentioned the silent reflux, is it getting your reflux under control? Does that help?

Marissa: It is so important yes to get reflux under control.

Melanie: And how would you know if it is a silent reflux, would your voice then go back to how it used to be? How would you know?

Marissa: I think that lump in the throat sensation starts to go away. Your voice should improve and with visualization, they would be able to tell too that it’s not as red, it’s not as irritated; those kinds of things.

Melanie: So Marissa, what lifestyle changes would you like to in summary, would you really like people to know about to protect their vocal cords and their voice and to notice any changes and what changes they should look for.

Marissa: The most important lifestyle change is drinking enough water. Second most important would be getting your reflux under control, whether that is done with medication or diet changes. Allergies would be the third most important thing and the red flags would be any other voice problem that you are noticing that goes for longer than a month. And I’d just like to add, people can be really nervous about coming to voice therapy and they really have nothing to be worried about. None of the exercises are painful. We have a lot of fun in therapy and it can make a huge impact on the way that people live their lives.

Melanie: Thank you so much Marissa, for such great information. And I hope the listeners will try some of the great tips that you told us about today. You’re listening to Your Health Matters with Meritus Health. For more information, please visit www.meritushealth.com . That’s www.meritushealth.com . I’m Melanie Cole. Thanks so much for listening.