By: Carleen F. Ozley, MS, CCC-SLP
Voice and Swallowing Therapist and Endoscopist
If you break a bone an Orthopedic is the physician you are looking for to help you. If you have joint aches and pain, a Rheumatologist is the one you need to see. Vision problems – ophthalmologist; headaches – neurologist; heart problems: cardiologist. But who do you see if you have a voice disorder? An Ear, Nose and Throat (ENT) physician and Voice Specialist is the medical team that can best diagnosis and provide a voice plan of care for you. Today’s advanced technology in visualization of the larynx (voice box) through a quick and simple nasal or oral endoscopy examination provides the complete picture for the Voice Team to accurately assess your problems. The endoscopy exam along with a complete voice evaluation and perceptual and acoustical analysis of your voice provides the needed information for intervention and correction of the voice problem.
What is a Voice Disorder?
Most people give very little thought to how they produce their voice and even less attention to the health of their voice on a daily basis until their voice interferes with communication in their day to day lives. Voice problems have a direct effect upon occupation and personal and work relationships. Voice disorders may be accompanied by pain or discomfort in the throat area, and may have an effect upon swallowing and/or breathing. In addition to these physical and functional limitations there are also emotional constraints that voice disordered people experience. Isolation, aggravation and overall frustration may also be experienced as one attempts to communicate with a less than efficient vocal production. As a general rule, any change in voice (hoarseness/ reduced pitch range/ change in ability to raise or lower volume) or discomfort in the throat that lasts for more than two weeks should be evaluated by a team of voice care professionals.
What Causes Voice Disorders?
There are many causes of voice problems and most often the cause is multifactorial. Listed are a few of the possible causes of voice disorders:
*upper respiratory infection
*inappropriate pitch- too high or too low
*speaking too loud
*speaking for extensive periods of time
*improper breathing techniques
*chronic throat clearing and /or coughing
*excessive dryness due to poor hydration or side effects from certain medications
*Gastroesophageal reflux disease
*Laryngoesophageal reflux disease
*other more serious neurological problems or medical conditions
What Are Some Signs of a Voice Disorder?
*Hoarseness, roughness or rapines
*Chronic throat clearing or coughing
*Vocal arrests – voice cuts off
*Inability to control vocal volume – too loud, too soft
*Feeling of lump in throat
* Pitch changes
*Decreased vocal range- can not reach higher or lower pitches
*Increased effort to talk – voice gets tired as you use it
*Throat pain or discomfort after speaking or singing
Who has a Voice Disorder?
Anyone at any age may have a voice disorder. Occupational voice users (teachers, pastors, singers, speakers, etc.) are at a higher risk of developing voice disorders because of their extensive daily vocal use and their increased perception and awareness of vocal variations that may negatively affect their ability to perform their jobs. According to Ingo R. Titze, Ph.D., at the National Center for Voice and Speech, he reported a study which comprised 123,060,000 U. S. worker evaluated for voice disorders. Interestingly, the occupation with the highest percentage of voice disorders (factory workers at 14.53%) comprised only 5.6% of clinic case load. Teachers with a prevalence of 4.2% for voice disorders comprised 19.6% of clinic case load for vocal treatment intervention. Additional occupations reported the following percentages of voice disorders: Salespeople: 12.97%;Clerical workers: 10.57% and Teachers: 4.2%.
What is the Prevalence of Voice Disorders?
There is some variation in study results but it is generally reported that as age increases there is an increase in voice disorders. Ages 45-70 years old report a 6.5% incidence (Leeks, 1982 and Marge, et al. 1985). Often mild hoarseness or intermittent vocal changes or throat discomfort goes untreated for several years until a more persistent voice problem develops. Approximately 28million workers in the U.S. experience daily voice problems(Verdolini, K., & Ramig, L.O. (2001) Review: Occupational Risks for Voice Problems. Logopedics, Phonetics, Vocology, 26 (1):37-46. A second study estimates that 5% to 10% of the U.S. workforce would be classified as heavy occupational voice users. (Roy, N., Weinrich, B., Gray, S. D., et al. (2003,June).
Take this simple and quick quiz and find out!
*(Adapted from several validate questionnaires use in voice clinics: See Voice Handicap Index (VHI), Jacobson et al.; Voice-Related Quality of Life (V-RQOL), Hogikan & Sethuraman; Laryngo-pharygneal Reflux Symptom Index (RSI),Belafsky et al.
Answer YES or NO to the following questions based on symptoms within the last month (other than times when you’ve had a cold:
1. I have trouble talking loudly or being heard in noisy situations.
2. I feel a lump in my throat, like extra phlegm or something sticking there.
3. I have trouble doing my job or practicing my profession because of my voice.
4. Talking or singing takes effort/makes me tired.
5. I have to repeat myself to be understood in normal conversation.
6. My throat feels sore or achy even though I’m not sick.
7. My voice sounds higher, lower, or less flexible in pitch these days; I’m losing notes at the top.
8. I feel anxious or frustrated because of changes in my voice.
9. I have trouble being heard/understood on the telephone.
10. I have to strain, change now I use my voice, or compromise my vocal technique in order to sound the way I should.
IF YOU ANSWER YES TO 5 OR MORE- FIND THE VOICE DOCTOR AND VOICE SPECIALIST TEAM AS SOON AS YOU CAN!
IF YOU ANSWER YES TO 4 OR MORE QUESTIONS – TAKE BETTER CARE OF YOUR VOICE AND IF SYMPTOMS DON’T IMPROVE IN 2-3 WEEKS, FIND THE VOICE TEAM.
IF YOU ANSWER NO TO NEARLY EVERY QUESTION, CONTRULATIONS! YOU ARE IN GOOD VOCAL HEALTH. KEEP TAKING GOOD CARE OF YOUR VOICE!
Take care of your voice….TODAY!
Carleen F. Ozley, MS, CCC-SLP
Voice and Swallowing Therapist and Endoscopist
ExcelENT of Alabama