Diagnosis of the cause of vocal change is paramount before any intervention.
Our evaluations include a voice-directed history and a complete history and physical examination of the head and neck. (Evaluation of the support structures of the neck and chest are important with professional voice users.) Hearing may be tested, as trying to “over speak” because of hearing loss can lead to abuse and hoarseness. A complete nasal and sinus evaluation is important as nasal congestion and sinusitis often will adversely affect one’s voice. Persistent coughing is problematic as well, for it bangs the vocal cords together, traumatizing the larynx. Video documentation of laryngeal findings, discussions with a performer’s vocal coach when indicated, and additional evaluations by our speech therapist may also be recommended.
There are several factors we find specific to voice evaluation:
Vocal Use and Abuse
Understanding the specific vocal needs and vocal use patterns of each individual is essential to attaining vocal health. Vocal stresses and requirements vary significantly among individuals. Both smoking and excessive alcohol consumption can be detrimental to the voice and are factors causing most head and neck cancers.
For performers, indeed for all patients, it is important to evaluate the patient’s specific environment. Problems varying from allergy to environmental sensitivities are important to understand prior to voice treatment; nasal and sinus disease can adversely affect the voice and are addressed as necessary. Performers may be faced with specific issues, which include working in smoky environments and speaking or singing with background noise or poor acoustics. We have found that older theaters may be prone to mold infestations that can adversely affect many individuals. We work with many patients to help with noise protection and proper placement of speakers, monitors, and noise bafflers. Appropriate sound attenuation may be prescribed.
Gastric Reflux Disease
Gastric reflux is the passage of stomach acid up the esophagus from its normal location in the stomach. Often we find that this acid can come up as high as the larynx (voice box) and is a significant contributing cause of hoarseness in many individuals. Voice evaluation includes evaluation for reflux and treatment as necessary. Specific findings from the exam can help diagnose early reflux disease and allow treatment even before vocal quality has been significantly affected. Performers are especially prone to reflux because of their need for vocal projection, diet, and patterns of working and eating late in the day.