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What to Expect at Your Voice Center Visit
Dr. Ingo Titze
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Voices12/1/2005

Editor's Note: Presented by Dr. Ingo Titze, The National Center for Voice and Speech, a Division of The Denver Center for the Performing Arts and a Center at The University of Iowa

Advisory Note: Patient education materials presented here do not substitute for medical consultation or examination, nor is the material intended to provide advice on medical treatment appropriate to any specific circumstance.
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Care of the Professional Voice
It is a good idea for all performers to have baseline voice evaluations, even if they have never experienced vocal problems. This includes a complete medical history, endoscopic evaluation of the vocal folds under stroboscopic light, and assessment of the speaking and/or singing voice when the voice is healthy.

The laryngeal exam is captured either on video or digitally and provides a legal documentation of vocal health. This information becomes particularly useful if an injury is ever sustained during a professional contract (worker’s compensation). It is also wise to know the health of one’s vocal folds (including voice use/technique) if using the voice, whether for professional purposes or as an avocation.

If you are experiencing voice difficulties, this evaluation is imperative to your vocal career.
Voice Center Personnel
At many voice centers, a team of professionals will work cooperatively to care for your voice.
An otolaryngologist is a medical physician who specializes in the care of the ear, nose, and throat. An otolaryngologist who has expertise in the care of the voice is called a laryngologist.
A speech-language pathologist is a state-licensed practitioner who has earned a master’s degree and is experienced in treating communication disorders.
Speech-language pathologists may serve general populations, or they may choose to specialize. Those with special training in the care of the voice are called vocologists.
A voice educator also may join the otolaryngologist and speech-language pathologist. As the name implies, voice educators are instrumental in teaching patients about singing and speaking skills and healthful voice production.

Medical History
Any time you see a laryngologist or voice specialist, he/she will ask many questions about:
  • Medical health, daily habits
  • Medications you take (including herbal supplements and over-the-counter)
  • Allergies
  • Voice use
  • Eating habits
  • Sleep patterns or disturbances
  • Upcoming performances
  • Voice concerns
  • Vocal hygiene (water, caffeine, alcohol, tobacco use)
  • Phonotraumatic behaviors (throat clearing, coughing, yelling, prolonged loud talking, etc), voice training, stress issues, etc.

  • It is crucial that the otolaryngologist obtains an accurate understanding of the singer’s overall health. Many systems in the body can have a negative effect on the voice, and the otolaryngologist needs to make sure nothing subtle is affecting the voice. An example of this is gastroesophageal reflux. Many performers have voice difficulties from stomach acid coming up the esophagus and burning the tissue in the back of the throat and larynx

    What is Videostroboscopy?

    Videostroboscopy is a method of examining the vocal folds under two types of light; halogen (a bright, static light) and xenon (strobe light). The halogen light is most useful to see the true color of the vocal fold and surrounding tissues. Redness of these tissues may indicate irritation due to a viral or bacterial infection, gastroesophageal reflux, or tissue fatigue. The strobe light allows an averaging of the vocal fold cycles so the naked eye can visualize vibration and tissue health.

    A comprehensive examination includes two different endoscopes, a flexible fiberoptic laryngoscope and a rigid telescopic laryngoscope. The flexible scope is inserted into the nose and allows visualization of the vocal folds from above without any restriction of voice use or articulation. This scope gives the clinician information about vocal fold function in a dynamic sense; he/she can watch you whistle, speak, and sing. The rigid scope is placed in your mouth (about to the back of your tongue) and has a light source and considerable magnification to allow greater detail of the vocal fold tissue health. Most clients tolerate these procedures very well. However, if a person experiences discomfort or a feeling of gagging, a mild anesthetic — similar to those used for dental work — may be sprayed in the nostril and back of the throat.

    Voice Assessment and Treatment

    A comprehensive assessment of the voice includes another case history, an oral mechanism exam, objective voice measures, and assessment of vocal technique for speech and singing.

    If there is a change in the laryngeal mechanism from an illness, reflux, or an injury, often compensatory behaviors develop that get in the way of easy, relaxed, and optimally healthy phonation. Voice therapy from a speech pathologist specializing in the care of the professional voice is helpful in addressing any kind of laryngeal pathology, weakness, excessive muscle tension, or general technical issues that may interfere with optimal voice use.

    In some cases, surgery to improve the voice — or phonosurgery — may be recommended. Many phonosurgeries can be completed on an outpatient basis and are usually accompanied by sessions of voice therapy.

    The success of treatment depends on a number of factors, including the motivation of the client. Generally, singers are eager to do what they can to ensure long and healthy careers.

    Also relevant is the type and extent of a voice disorder. Quite simply, some disorders respond better to current treatment methods than others. The overall health of the singer also may be important.

    Finally, the skill of the clinicians treating the singer is critical. Not all speech-language pathologists and otolaryngologists are experienced in working with the singing voice. It is well worth a singer’s time and energy to obtain referrals, interview prospective care-givers, and perhaps travel some distance to work with a skilled voice team.

    Written by:
    Kate Emerich, BM, MS, CCC-SLP, speech pathologist and research associate at the Denver location; and Julie Ostrem, BS, MBA, educational program director at the Iowa center.

    National Center for Voice and Speech
    www.ncvs.org

    The National Center for Voice and Speech (NCVS), conceived as a “center without walls,” was formally organized in 1990. The NCVS was organized on the premise that a consortium of institutions is better able to acquire and maintain resources to fulfill the global mission of the sponsors than a single organization. NCVS members, although geographically separate, are linked by a common desire to fully understand the characteristics, limitations, and enhancement of human voice and speech. They maintain cohesiveness by exploiting contemporary communications technology, inter-site training responsibilities, periodic conferences, and shared resources. Visit the Center’s Web site at www.ncvs.org to find information on The Voice Academy, Summer Vocology Institue, and other tutorials.
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