- The Washington Times - Monday, July 5, 2004

Judith A. Lese’s voice was stressed from more than 30 years of teaching. When she had chemotherapy in 2003 for breast cancer, fatigue caused the strain on her voice to come to the forefront.

An examination at Washington Hospital Center in Northwest revealed the Silver Spring woman had swelling, irritation and nodules on her vocal cords.

But now she has a renewed voice thanks to vocal therapy. Mrs. Lese, 56, continues her job as a teacher at Cannon Road Elementary School in Silver Spring.

“I use my voice in my profession,” she says. “It was important to bring myself back to a healthier state, if possible. … I had to be prepared to talk. My voice is stronger than it was two months ago. I’m still very protective of it. I don’t yell at rallies.”

Vocal health often is overlooked by many people until it’s gone. If hoarseness does arise, vocal therapy often can significantly help or reverse the problem. In extreme cases, surgery may be beneficial.

Videostroboscopy is the best way to diagnose exactly what is wrong with the vocal cords, says Allana Sullivan, speech language pathologist at Washington Hospital Center.

She has been working with Mrs. Lese in voice therapy, in which she underwent videostroboscopy to track her progress. A scope is put through the patient’s nose or mouth and shows the exact condition of the vocal folds, even when the patient is talking or singing.

“By looking at the video, you can tell if you use excessive effort to talk,” Mrs. Sullivan says. “You notice extra effort and muscle tension.”

Hoarseness, which is the main reason people undergo a videostroboscopy, can arise from many causes, says Dr. Thomas Troost, partner at Washington ENT Group, an ear, nose and throat practice in Northwest and Bethesda. If people suffer from hoarseness for about four weeks, they should see a physician.

Oftentimes, the vocal cords swell and don’t vibrate properly due to an upper respiratory infection, a viral infection, heartburn or acid reflux. Sometimes, the air being breathed is dry, cold, dusty or smoky. Smoking can damage vocal cords and asthma inhalers also can irritate the area.

Other problems can include masses or lesions on the vocal cords, such as polyps, nodules and warts. A hemorrhage, due to a ruptured blood vessel, can bruise the area. Also, a cancerous growth on the vocal cords can prevent them from vibrating properly.

Further, the vocal cords can become completely or partially paralyzed for a number of reasons, including a tumor or stroke affecting the nerves.

In about 2 percent of cases of thyroid surgery, the vocal cords are damaged. Or damage can be caused in a car accident if the driver’s throat hits the steering wheel.

“The vast majority of things can be improved so it’s a minimal problem, or the problem is completely resolved with voice therapy,” Dr. Troost says. “Then, you basically have surgical options.”

With vocal cord paralysis, sometimes an implant can be used to push the vocal folds together and restore the normal voice.

In the case of spasmodic dysphonia, a neurological voice disorder that causes the voice to break or to have a tight, strained or strangled quality, regular injections of botulinum toxin, also known as Botox, can improve the voice. Diane Rehm, radio talk show host of “The Diane Rehm Show” on WAMU 88.5 FM, receives the treatment every four months. She also participates in voice therapy.

“I do voice exercises before I go on the air, usually on my way to work in the car by myself,” she says. “I do weird sounds. Then I sing, and then I hum. … It has mostly to do with making sure I can count on my vocal cords working.”

Singing or humming in the shower every morning is a good way to warm up the voice, says Susan Miller, speech pathologist at the Voice Treatment Center in Northwest. She also is an assistant professor of otolaryngology and director of the Center for the Voice at the Georgetown University Hospital in Northwest.

Along with Susan Berkley, a voice expert in Englewood Cliffs, N.J., Ms. Miller created a compact disc of exercises to energize and enhance the speaking voice. She suggests slowly reciting a poem, tongue twister, prayer or story aloud every morning. Even people without vocal problems can do these warm-ups to prevent complications.

When people need therapy, Ms. Miller recommends exercises that are specific to their problems. Although singers and actors usually seek her services, she also sees a wide range of people in everyday professions who constantly use their voice, such as pastors, coaches and secretaries.

She usually places patients on a vocal hygiene regiment, which includes drinking at least eight glasses of water a day. Patients always should drink water before their morning coffee, and add an extra glass for each alcoholic and caffeinated beverage consumed. Good posture should be used, as well as breathing from deep in the small of the back, making sure not to speak with too many words in one breath.

Aspirin products also should be avoided because they thin the blood and predispose a person to vocal fold hemorrhage. Ms. Miller recommends gargling with mouthwashes that do not contain alcohol, stopping smoking and avoiding excessive alcohol consumption. Yelling or talking loudly at parties should be eliminated, she says.

It is beneficial to stop eating late at night to prevent heartburn, especially items such mints, fatty foods, nuts, chocolate and spicy or high-acid foods, she says. Also, avoid dairy products that thicken mucus and cause throat clearing.

“My goal is that people like the sound of their voice and communicate effectively,” she says. “When you’re 60, there’s no reason you shouldn’t have a healthy voice.”

Rosalind Brannigan, 61, of Arlington, who is a patient of Ms. Miller, experienced hoarseness due to a virus in her vocal cords. She had lost about one-quarter of her ability to speak. As vice president of Drug Strategies in Northwest, she makes presentations throughout the world regularly. However, she was having trouble completing hourlong speeches.

“The voice is a real tool for communication, which I must say I never really thought about,” she says. “I was able to have voice lessons… and I learned what the power of the voice is.”

Most of all, sometimes the voice needs rest, says Melanie Reynolds, speech language pathologist at Inova Mount Vernon Hospital. Excessive talking should be limited whenever hoarseness arises.

“We hope by educating people that a lot of voice disorders could be prevented,” she says. “Muscles surround the throat. Too much tension can cause a voice problem. Breathe with the diaphragm. Relax in general.”

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