Academic journal article Journal of Singing

What to Expect during a Visit with a Voice Doctor. Part I: The History

Academic journal article Journal of Singing

What to Expect during a Visit with a Voice Doctor. Part I: The History

Article excerpt

UNTIL THE 1980s, MOST PHYSICIANS caring for patients with voice disorders asked only a few basic questions, such as: "How long have you been hoarse?", "Do you smoke?" etc. The physician's ear was the sole "instrument" used routinely to assess voice quality and function. Visualization of the vocal folds was limited to looking with a mirror placed inside the mouth using regular light, or to direct laryngoscopy (looking directly at the vocal folds through a metal pipe or endoscope) under anesthesia in the operating room. Treatment was generally limited to medicines for infection or inflammation, surgery for bumps or masses, and no treatment if the vocal folds looked "normal." Occasionally "voice therapy" was recommended, but the specific nature of therapy was not well controlled, and results were often disappointing. Since the early 1980s, the standard of care has changed dramatically. Singing teachers and their students should be familiar with current standards of practice in voice care. These are covered in much greater detail in other sources,1 but this two part article is written to provide an introduction and overview of what a singer reasonably should expect from his/her laryngologist.

What kinds of questions are expected from one's doctor?

Correct medical diagnosis in all fields often hinges on asking the right questions, and listening carefully to the answers. This process is known as "taking a history," and is usually the first step of the initial office visit encounter. The history may be taken directly by the physician or by a nurse or medical assistant, who then relates the history to the physician. Recently, medical care for voice problems has utilized a markedly expanded comprehensive history that recognizes that there is more to the voice than simply the vocal folds. Virtually any body system may be responsible for voice complaints. In fact, problems outside the larynx often cause voice dysfunction in people whose vocal folds appear fairly normal, and these issues need to be relayed to the physician and/or medical staff at the time of the history. Regardless of whether or not the patient feels that portions of his or her medical or surgical history, including the use of medications, herbal remedies, or vitamin supplements are relevant to the voice problem, it is extremely important that the voice doctor and the voice team are aware of everything that currently affects or has in the past affected the function of the entire body.

1. Describe your hoarseness.

The first question in the office encounter normally asks the individual to describe in detail the difficulties that he/she is having with his/her voice. Most people with voice problems complain of "hoarseness" or "laryngitis." A more accurate description of the problem often is helpful in identifying the cause, and the laryngologist usually will ask several questions to help him/her better understand the voice problem and its possible causes.

Hoarseness can be described as raspiness, which is a coarse, scratchy sound caused most commonly by abnormalities on the vibratory margin of the vocal fold. These may include swelling, roughness from inflammation, growths, scarring, or anything that interferes with vocal fold vibration. Such abnormalities produce turbulence at the level of the glottis, which we perceive as raspiness.

Breathiness is caused by lesions (abnormalities) that keep the vocal folds from closing completely, including paresis (partial weakness), paralysis (complete weakness), cricoarytenoid joint injury or arthritis, vocal fold masses, scarring, or atrophy of the vocal fold tissues. These abnormalities permit air escape when the vocal folds are supposed to be tightly closed. We hear this air leak as breathiness.

Fatigue of the voice is the inability to continue to phonate for extended periods without change in vocal quality. The voice may fatigue by becoming hoarse, losing range, changing timbre, breaking into different registers, or by other uncontrolled behavior. …

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