Academic journal article Journal of Singing

Consulting a Voice Doctor: When?

Academic journal article Journal of Singing

Consulting a Voice Doctor: When?

Article excerpt

Modified from: Heman-Ackah, Y.D., Sataloff, R.T., Hawkshaw, M.J., Divi, V.D. "Protecting The Vocal Instrument," in press.

INITIALLY, THE ANSWER TO THE QUESTION "When should I see a voice doctor?" would seem obvious: When you are sick. However, the correct answer is more complex than that. Singing teachers should be familiar with the value of consultation with an expert laryngologist not only during illnesses and crises, but also prior to training, for evaluation, establishing an individual's "normal" baseline, and for education and advice regarding preventive voice care. Finding the right voice doctor is the subject of another article in Journal of Singing, but this article is to help singing teachers understand better when a laryngologist (voice specialist) should be consulted, and especially when one should be consulted urgently.


Anyone who relies on one's voice for his or her profession should have a baseline laryngeal function and videostroboscopic examination with a laryngologist when the voice is functioning optimally and without difficulty. This examination will help to diagnose any potential areas of concern that may contribute, in the long term, to the development of debilitating voice difficulties. Entities such as asymptomatic reflux, mild asymmetries in vocal fold motion, mild allergy, tonsil enlargement, nasal septal deviation, nasal congestion, nasal polyps, and others that may not be causing any symptoms or difficulties presently, but that may contribute to the development of unhealthy behaviors or voice problems can be identified and recommendations can be made by the laryngologist and voice team on how to prevent these entities from becoming problematic. Additionally, asymptomatic benign lesions such as polyps, cysts, pseudocysts (localized swelling in the vocal fold), areas of stiffness, sulcus vocalis (benign indentations in the vocal fold), and others can be identified. Knowing that these lesions exist when the voice is functioning normally can prevent a misdiagnosis and misguided treatment that otherwise may focus on these lesions as the cause of a voice problem that develops in the future. Because everyone is at risk for infection, trauma, and the need for nonvoice surgery that may require general anesthesia, everyone is at risk for the development of voice problems regardless of one's level of training, technical prowess, or use of proper voice technique.


Probably the most pressing reason to see a voice clinician is to evaluate acute voice disorders that may worsen if left untreated. These usually are characterized by the sudden onset of hoarseness and can be precipitated by myriad events, including trauma, voice overuse or misuse, and infection.

The sudden onset of hoarseness during or immediately after intense vocal use implies injury to the vocal fold. This may be in the form of hemorrhage (Figure 1), tear (Figure 2), or edema (Figure 3). Hemorrhage occurs when there is trauma to one of the blood vessels within the vocal fold and it begins to bleed. Usually the bleeding is beneath the surface of the vocal fold mucosa and the only symptom of the bleeding is the occurrence of hoarseness and occasionally soreness or pain in the throat.1 A vocal fold tear occurs when there is disruption of the mucous membrane of the vocal fold, usually from intense yelling, screaming, or forceful singing.2 Edema is swelling in response to vocal fold trauma or infection. Vocal fold tears can also occur during episodes of laryngitis or other upper respiratory tract or gastrointestinal infections, usually as a result of coughing forcefully or from the dry heaves associated with vomiting. The placement of an endotracheal (breathing) tube by an anesthesiologist for surgery can also result in vocal fold tears, and whenever possible the smallest (5.0mm to 6.0mm inner diameter) plastic endotracheal tube that will allow adequate ventilation (artificial breathing) during the general anesthesia is recommended for professional voice users undergoing nonvoice surgery. …

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