The Real Truth

Vocal abuse is defined as behavior that strains or injures the vocal folds (vocal cords).  Vocal misuse is improper voice usage, such as speaking too loudly, or at an abnormally high or low pitch.  Frequent voice abuse or misuse can cause serious problems to the vocal cords, even permanently damaging them.

frequently asked questions regarding the voice.....

  1. Who may be at risk for a disorder of vocal abuse or misuse?

    Simply put, anyone can be at risk for such disorders. If a person uses his or her voice excessively, then they are at risk of developing some type of voice problem.  However, the most common occurences are withing the following professions: singers, auctioneers, lawyers, teachers, cheerleaders, clergy, and actors.  These activities, or careers, usually demand more from the vocal cords than other jobs.  Professional voice users must take extra precaution to use the voice properly, so as not to damage it.  Visit my vocal tips page for the dos and don'ts of professional use.
     
  2. Where are the vocal cords located?  How do they work to produce sound?

    The vocal folds are located in your throat above your trachea or windpipe. First, the folds come together in a firm but relaxed way. Once the folds are closed, air from the lungs passes through them, causing vibration and thus making sound. The sound from this vibration then travels through the throat, nose, and mouth (resonating cavities). The size and shape of these cavities, along with the size and shape of the vocal folds, help to determine voice quality.
     
  3. What's the difference between the vocal cords and the vocal folds?

    These two terms refer to the exact same part of the body performing the exact same functions. The term "vocal cords" is less technically correct but more often used among singers and laypersons.
     
  4. How do I know if I have a voice problem?

    Voice problems occur with a change in the voice, often described as hoarseness, roughness, or a raspy quality. People with voice problems often complain about or notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. Other voice problems may accompany a change in singing ability that is most notable in the upper singing range.



  5. What are some of the most common disorders of vocal abuse and misuse?

    The most common disorders are laryngitis, vocal nodules, vocal polyps, and contact ulcers.  Health professionals who have training in voice and voice disorders often refer to these conditions as "hyperfunctional voice disorders."    Visit my vocal problems page for complete information and treatment options for such disorders.
     
  6. Are voice disorders easy to identify?

    Yes and No.  Any type of growth or lesion on the vocal cord can usually be seen very easily with a laryngoscopy.  If your problem is related to the movement of the vocal cords, then it may be more difficult to identify.  You wil usually need a videostroboscopy, so that your doctor can obtain a more accurate look at your vocal cords as they vibrate to produce sound.  These problems related to vocal fold movement may include glottal insufficiency, poor closure, paralysis, or other problems.  There are a few problems that do not have a known cause.  But even if the cause of your problem cannot be identified, there are usually treatment options available that will improve your symptoms.
     
  7. How are disorders of vocal abuse and misuse treated?

    Treatment options vary depending on the problem.  For some people, complete vocal rest for a few days will rectify simple problems.  For many, a period of voice therapy proves to be very successful.  The goal of such therapy is to identify harmful habits that strain or injure the vocal cords.  Then the person can learn better techniques for voice use and breathing.  Another option that is being used with good results is surgery.  But even after surgery, speech therarpy is helpful in order to prevent the problem from recurring.
     
  8. Where should I go for treatment?

    Perhaps the best place to start is a local otolaryngologist.  Many problems are easily discovered with a laryngoscopy (scope performed in the office).  If this does not turn up any discovery of your problem, then you may try making an appointment with an laryngologist, who specializes in identifying problems in the larynx.  Sometimes a videostroboscopy is useful in helping your doctor to observe in slow motion the movement of the vocal cords.  Visit my procedures page for more information on how the vocal cords are examined.  Also, you can reference my specialists page, as it lists the best vocal/speech treatment centers in the United States.  For most people, they will resolve their problem long before having to fly to another city across the country.  But for professional voice users, sometimes traveling to one of these centers becomes necessary.

     
  9. How much does it cost to have my vocal cords examined by a otolaryngologist?

    In my experience, a basic laryngoscopy has always been between $275.00 and $325.00.  The videostroboscopy costs about $810.00.  Most insurance covers about 80% or more of this procedure.
     
  10. When should I seek treatment?

    Anyone who experiences vocal change or hoarseness for more than 2 weeks should be examined by a physician, preferably an otolaryngologist.
     
  11. I've recently seen a voice doctor but he said my vocal cords looks normal.  But I'm still experiencing voice problems?  What should I do?

    First, it's vital that you understand what a difficult job a voice doctor has.  Only then can you be prepared to provide exactly what your doctor will need in order to understand the problems that you are experiencing. 

    Be aware that a laryngologist sees hundreds of patients that are experiencing voice problems.  Every person's voice sounds different.  Your physician has likely never heard your voice before.  Therefore, he/she cannot compare your present problematic voice to what you know as normal.  Also, there are many different problems that can occur with the voice.  Sometimes the words we use to describe our problem may not be the right term for what we are experiencing.  Additionally, some voice problems vary from day to day.  It may be that the particular day that we come in for an examination, your voice sounds almost normal.  That still doesn't change the fact that you have a problem.  But your voice doctor is not a psychic.  He can only diagnose a problem if he can see or hear it.  What can you do?

    One tip that is very important, especially important for professional voice users is to make regular recordings of your voice (at least one updated recording every year).  Then if a problem occurs with your voice, you have something to point to saying "This is my normal voice".  It's very important that this recording be very clear and audible, and with minimal background noise.  Place your recorder on a thick towel to eliminate the hum sound of the tape recorder.  Just a few minutes of your normal voice is sufficient.  Record your voice as you use it professionally (singing, auctioneering, etc..).  Also make a recording of yourself doing several other things, such as reading out loud from a book and a short conversation with another person.  All of these examples can be on the same tape and can be as short as 5 minutes or less for everything combined. 

    If your problem varies from day to day, or you have some days that seem normal, you will need to make a recording of your voice when you are experiencing problems.  Try your best to do whatever makes your voice experience problems and then record that.  If there is something that you can do that makes your problem sound worse or more severe, make sure you get it on tape.  Your physician will need to hear this to diagnose your problem.  Make your recordings brief, but long enough to clearly identify what your voice sounds like when the symptoms are occurring.  An experienced laryngologist doesn't usually need to listen to a 20 minute tape.  If your problem is clearly documented on the tape, he/she will likely know right away what is occurring and how to proceed with treatment.

    ** The above paragraphs suggest a tape recording.  This is for simplicity, assuming that everyone has a tape recorder somewhere in the house.  What works even better though is a video recording.  If you don't have one, borrow one from a friend.  Set up a simple tripod and get it aimed and focused, and make your recording.  Even if your problem is in no way related to something that you can see, the video adds a whole new dimension to your recording.  Not only can your physician hear your problem, but he can watch in color as it occurs.  I personally had good results from using the video method.  It is very important before you show up at the clinic to call your doctor and ask what media viewing equipment they have on hand to view a video.  VHS or DVD?  If it's DVD, then you will need to convert your video recording to a DVD format.  If you don't know how to do this, you can visit my contact page and send me a message.  I have the equipment and have done it many times.  I can give you some tips on how to do it, or I can do it for you for a small fee.
     
  12. Where can I find a voice doctor who performs botox injections for Spasmodic Dysphonia?

    Laryngologists are the specialists who perform botox injections.  They specialize in treating problems of the larynx.  Basically, this includes voice problems and swallowing problems.  Alternatively, some head and neck surgeons also perform this procedure.  If you would like to see a nation-wide list of different laryngologists that is organized by state, you can visit the website of Dr. James Thomas.
     
  13. How are Botox injections performed?

    Botox injections are performed right in the office.  It's a simple procedure and only takes 10-15 minutes for the complete procedure.  Usually, this injection is done by a laryngologist, or in some cases a head and neck surgeon.  A nurse will also usually help perform this procedure.

    You physician will likely spray some local anesthesia spray into the back of your throat.  He will then place two sticky electrodes on the side of your neck, which are used to identify muscle waves.  After these are placed, he will feel with his fingers around the bottom part of your throat to locate the correct area to insert the needle.  The needle is then inserted right through your throat and directed upwards towards your vocal cords.  The placement of the needle into the vocal cord is verified by him listening to the sounds of the machine that is connected to the electrodes placed on your throat.  When the needle is in the proper place, the machine will make a distinct sound, and the botox is injected into the vocal fold. If both vocal cords are being injected, your physician will angle the needle towards the other vocal fold, find the proper spot and make the second injection. 

    During this procedure, you will likely feel pressure around your throat.  The needle insertion through your skin is not usually painful.  When the needle touches and/or inserts into the actual vocal cord, you will likely have a strong sensation to swallow and/or cough.  I've had this procedure performed several times, and I usually describe it not as painful but as very uncomfortable.  It sounds much scarier than it really is.  I find it helps a lot to make sure your doctor sprays your throat with the local anesthetic.  Occasionally, your physician may have a little difficulty finding the right spot to inject.  This only means that it may take an extra minute or so as he fishes around with the needle.  He may also ask you to say certain sounds or perhaps lean your head back further for a better angle.  If you still have active botox in your vocal folds, it is definitely a little harder to locate the right spot.
     
  14. How much do Botox injections cost?

    In my experience, botox injections into the vocal folds usually cost around $600 per visit.  Your insurance company may deny payment on this claim at first, since botox injections are generally for cosmetic purposes.  In this event, your doctor can provide a letter saying it is medically necessary for your condition.
     
  15. Will I experience side effects after my Botox injection?

    Botox has been in use for well over 15 years.  Most of the common side effects include hoarseness, breathiness and roughness in the voice.  This is because the botox partially paralyzes the vocal cord(s).  Thus for a few days the vocal folds are weak and possibly not able to close completely.  These symptoms are very common, sometimes lasting for 1-2 weeks.  Every person reacts different to botox, so your physician will customize your dose based on how you respond.  If you experience no side effects at first, he may increase your dosage until you do, thereby extending the number or weeks that you benefit from each injection.  The effects of botox are always temporary, so these initial side effects will quickly wear off.  After 3-4 months all of the botox will wear off, thus causing your voice to return to its previous state.  Smaller injections produce fewer or no initial side effects, but the improvement of your voice doesn't last as long.  Larger injections cause more initial hoarseness,  but they also improve your voice for longer periods.  A person who uses his/her voice extensively will likely want smaller doses, so that they aren't off work for days at a time after each injection.  Conversely, for an older person that lives alone and doesn't talk much, larger doses may be preferable because it will take fewer injections each year.  Your laryngologist will make suggestions as to what you should do, but he/she will also adjust your injection amount according to your wishes. 

    Another side effect includes difficulty swallowing thin liquids.  If this occurs with you, then you know that your dose was too large.  Be sure and keep a record of this and tell your doctor so that your next injection can be adjusted to a smaller dose.  This side effect usually disappears much quicker than the hoarseness of the voice.

    Other side effects include an allergic reaction to botox.  Your physician will be happy to discuss this with you while you are in the office. 

    Additionally, a small percentage of people develop a resistance to botox, so that the injections stop working or become less effective.  

     
  16. Could medications be affecting my voice?

    Some medications including prescription, over-the-counter, and herbal supplements can affect the function of your voice.  Most medications affect the voice by drying out the protective mucosal layer covering the vocal cords. Vocal cords must be well-lubricated to operate properly; if the mucosa becomes dry, speech will be more difficult. This is why hydration is an important component of vocal health. 

    Medications can also affect the voice by thinning blood in the body, which makes bruising or hemorrhaging of the vocal cord more likely if trauma occurs, and by causing fluid retention (edema), which enlarges the vocal cords. Medications from the following groups can adversely affect the voice: antidepressants, muscle relaxants, diuretics, antihypertensives (blood pressure medication), antihistamines, anticholinergics (asthma medications), high-dose Vitamin C (greater than five grams per day).
     
  17. What about surgery of the vocal cords?  How successful is it?

    There are many types of surgical procedures used to improve vocal function.  Your laryngologist can discuss in more detail with you the risks and expectations.  But generally speaking, most people have good results with surgery.  Some procedures require more healing time than others.  One doctor described the results of surgery this way: "Many people get excellent results, most people get good results, some people get little or no results, and a few people get poor results."
     
  18. How is vocal cord surgery performed?

    There are two ways of performing surgery on the vocal cords: the open surgery approach  and endoscopic approach.  The open surgery approach involves making an incision in the neck and performing the surgery through the opening.  This approach is often performed after trauma or fracture of the larynx (upper front of neck) has occurred. 

    The endoscopic approach requires a tube to be inserted through the mouth into the throat.  This approach seems to be more successful in restoring normal voice sound.  The endoscopic approach also has the advantage of allowing extremely close observation of the vocal cords, therefore resulting in a precise and accurate cut or removal of tissue.
     
  19. Where can I find more infomation about Cymetra?

    Cymetra is one the common substances used in vocal fold injection, which increases the bulk of the folds, thus helping to produce better closure.  It is manufactured by Lifecell, and the makers of it provide the basic infomration about it's makeup and structure.  Read more at lifecell.com.
     
  20. Is the purpose of the larynx (voice box) only to produce sound?

    Actually No.  In fact the main function of the larynx has nothing to do with speech.  The larynx protects your lungs from food and water.  Your vocal folds (cords) form a valve that closes tightly to protect the airway.  When you swallow, the vocal folds adduct tightly (close together).  Also, the epiglottis folds over the glottis, and the larynx rises up while the esophagus opens to let the food/water enter.  Have you ever been drinking something and "gotten water down the wrong pipe"?  That's because the water went down too fast for the glottis and epiglottis to protect the airway. When the water hit the vocal folds, they went into a cough reflex to expel the water and keep it out of the lungs.