Voice & Swallowing Center
At the Voice and Swallowing Center, we understand the importance of your voice, especially if you rely on your voice for your career and livelihood. The voice can be a person's most defining characteristics and it helps us express ourselves on a daily basis. Swallowing aids us in tasting and consuming our food, similarly important for quality of life and good health.
Our doctors are specially trained to handle a wide range of voice and swallowing disorders, and strive to offer patients the most advanced, minimally invasive treatments. These treatments are geared towards restoring the patient's voice and swallowing abilities, and allowing them to once again enjoy activities such as eating, speaking and singing.
The Voice and Swallowing Center is headed by Dr. Reena Gupta, one of our most esteemed physicians, who is experienced and knowledgeable about voice and swallowing disorders, having completed special training in this arena.
What is Laryngology?
Laryngology is the study of the human voice, which originates in the larynx, or “voice box.” Because the larynx is involved in breathing, voicing, and swallowing, laryngologists can care for disorders of any of these functions. Dr. Gupta has chosen to focus her practice on the evaluation, treatment, and management of the professional voice user. Professional voice includes:
Do I need a laryngologist (voice doctor)?
If you rely on your voice for your career, you do. A laryngologist becomes part of a voice user’s team, overseeing the maintenance of the voice, preventing vocal abuse, and helping preserve career longevity.
As part of your team, the laryngologist becomes more than someone you see when something is wrong. The relationship develops into a customized program, with periodic evaluations to keep you on track. Dr. Gupta strongly believes in preventative voice care, which means having an evaluation when you feel normal. This is important for two reasons:
Serious professional voice users may elect to have the Elite Vocal Evaluation. This will include:
Preventative Voice Care
Every professional voice user needs a laryngologist to provide preventative voice care. Your voice is your instrument and you need to keep it as finely tuned as if you were a pianist getting her piano tuned. This is the only way to ensure the longevity of your career.
What is preventative voice care and why do you need it?
Preventative care accomplishes exactly that: prevention. Vocal folds are delicate structures and even the slightest injury can have serious consequences for your voice. By examining you before your performances, it is easier to anticipate any potential problems. This anticipation can result in advice that can prevent injury, whether it means using your voice cautiously or, at the extreme, cancelling a performance. In the long run, we believe that the best performers are those who understand that you may have to cancel one or two performances to get an extra few years of performing.
This process is made significantly easier if you and Dr. Gupta already have a relationship. This means seeing her regularly, early in your career. By getting to know you, she will be able to help you see any problems in your technique.
Often, singers and actors have amazing voices that carry them through their performances. However, they often have habits when speaking that predispose them to injury. Poor speaking habits are often missed and unrecognized as the true culprit in voice disorders. Are you one of these people? By meeting you for your evaluation, Dr. Gupta can show you if you are and help teach you techniques that will improve your speaking voice. You obviously spend a lot more time speaking than performing. Dr. Gupta’s mission is to ensure those hours are spent without any risk of injury to your instrument.
What can affect your voice?
Understanding the anatomy of your voice is the best way to understand problems and injuries. Most singers know many of the things that affect their voices. Most of this information, then, may not be new to you. But having it at hand will help you to review some of the major culprits in voice problems, helping you identify which factors play a role for you.
Muscle tension is the overuse of neck and throat muscles while singing. There are few singers and speakers for whom muscle tension is not a factor. Dr. Gupta will spend some time discussing this with you during both your initial evaluation and your follow up visits, to ensure you are comfortable with these ideas.
Tongue tension (Don’t swallow your tongue)
Your tongue is far larger than you might realize. When you stick out your tongue, you are actually only seeing half of your tongue. The back half is attached to the deeper structures in your neck and throat. Many singers, over the course of a competitive career, start to slowly pull their tongue back, using it to amplify their sound.
Over time, this becomes habit so that you may use tongue tension regularly. Other muscles can also begin to engage, including your neck musculature. Tongue and neck tension may result in slightly painful singing over time.
Jaw tension (Don’t clench)
Another familiar arena for singers is jaw tension. This is another difficult area to combat because tightening your jaw gives you a feeling of control. Relaxing your jaw will create more room in the back of your throat and thus, give your sound a larger chamber through which it can resonate.
Laryngopharyngeal reflux (LPR, acid reflux)
Normally, when you swallow, food goes one way, from the mouth, through the esophagus, into the stomach. In patients with LPR, stomach contents travel back up and out of the esophagus. The acidic contents coats and damages the larynx, causing the signs and symptoms of LPR.
Singers and other professional voice users are particularly prone to LPR. The constant pressure in the abdomen from supporting your sound increases the likelihood of refluxing. This can result in changes in the pitch of your voice and predispose you to injury. Also, reflux causes you to clear you throat chronically, which can injure the delicate lining of the vocal folds.
There are several things you can do to treat LPR. Lifestyle modifications can minimize the creation and reflux of acid. Dietary modifications also can significantly improve LPR. Other means of controlling your reflux can be discussed during your visit.
Vocal fold masses are often called nodules. The term “singer’s nodules” is a misused term. In reality, the vast majority of vocal masses are not singer’s nodules. This misdiagnosis often result in inappropriate treatment or surgery. Vocal masses may include:
Glottic Insufficiency (a space between your vocal folds)
Any space between your vocal folds (i.e., if they don’t meet in the middle) can result in a change in your voice. This space between your vocal folds is termed " glottic insufficiency" and is often the first reason that singers present for evaluation.
Glottic insufficiency can also be a normal consequence of aging. Atrophy, or thinning, of vocal muscles results in the vocal folds being lax, causing a gap between them. This results in a fluttering voice quality. Pitch becomes difficult to control and vocal quality suffers.
Regardless of the cause, injection of the vocal folds often results in significant improvement in voice quality. When you come for evaluation, we can determine if you are a candidate for this.
Vocal fold weakness
A weakness may affect your voice mildly or severely depending on the degree of weakness. Symptoms may be subtle and therefore ignored by other physicians. However, voice symptoms should never be taken lightly. A laryngologist will be able to determine if you have a vocal fold weakness.
Medical or Surgical?
Certain vocal conditions respond better to medical interventions. Others require surgery. A thorough exam of your voice is required to determine which group you fall in to.
Rest assured that every effort will be made to avoid surgery. If surgery is required, all precautions will be taken to ensure the best possible outcome.
The “Voice Lift”
The weak, wobbly voice associated with aging occurs because of vocal fold atrophy, or thinning. Research shows that by correcting this thinning of the vocal folds, strength and quality can be returned to your voice, giving it a more youthful vitality. Please inquire if you are interested in being evaluated for this quick and painless procedure.
Good performance relies on having a team of professionals upon whom you can rely. As a performer, you require a reliable team who knows you and can coach you through any challenges you face.
This includes a laryngologist, a speech pathologist and a voice coach. With reliable, pre-tour care, you will have someone who can advocate for you while you are on tour. It is critical to have a series of pre-injury examinations so that if you do get injured on tour, these exams can be used to understand the true nature of your problem. This way, even if you do have to see someone else in a distant city, your laryngologist can communicate with that person and show them videos of your vocal folds to help them treat you.
As a professional voice user, your voice is your livelihood. So what can we do to protect it?
Regular Voice Evaluations
The best way to protect your voice is to know when you are at risk for injury. This requires a close relationship with your laryngologist and speech therapist.
Knowing your voice enables us to recognize pathology. Some incredible performers work with a small mass on a vocal fold or a small gap between their vocal folds. This same performer might get a minor injury and present to another physician. That physician, not knowing the patient and their history, may see the mass as the source of the problem and suggest its removal. This may lead to devastating consequences.
That is why it is so important to have a laryngologist see you when you are healthy and meeting your vocal demands.
Just as important as having your vocal folds evaluated regularly is having a check-up before touring and performances. Inevitably, in the weeks before tours and shows, the vocal demands of a performer have increased considerably. Rehearsals increase in duration and frequency, which alone can be responsible for increased vocal swelling and strain. Added to that are the frequent press engagements, phone negotiations, communication to support staff including back-up singers, choreographers, and countless other individuals.
A small injury at the beginning of your tour, gone unrecognized, can increase dramatically in severity over the course of a multi-city tour or while doing several shows a week.
Also, critically for female performers, a pre-performance clearance evaluation will pay particular attention to details of the blood vessels in your vocal folds. At various stages in the hormonal cycle, blood vessels can become more fragile and likely to rupture, causing hemorrhage. While unable to predict with total certainty if this will occur, your evaluation will identify any at-risk vessels.
Speaking and Singing Therapy
Every performer needs a well-trained speech pathologist on their vocal health team. A speech pathologist is very different from a voice coach, though both are essential to a successful career.
Speech therapy focuses on the use of the speaking voice. Many singers have excellent singing technique but, when it comes time to resume regular speaking, degrade to a poor technique. This includes poor postural support, inadequate breath, and an increased rate of speech. These technical issues worsen when speaking over volume, such as at restaurants and bars. Your singing voice is being put at risk throughout the day as you are going about your daily activities.
However, reality requires that you do and we need to ensure that your speaking technique minimizes the risk of injury. It is an element of pre-performance that can be the difference between an effortful and effortless performance.
Interestingly, other professional voice users, such as public speakers, preachers, politicians and lawyers, often benefit from singing voice therapy. Singing therapy teaches excellent techniques for breath control, abdominal support, and use of upper airway resonators. This helps projection and timbre, elements that are critical for powerful public speaking.
Not all speech pathologists are of the same caliber. You want to work with someone who has narrowed their focus solely to voice as this person is more likely to have learned about the newest and most effective vocal techniques. The advantage of such a person is also that they will be able to fine tune their therapy to suit you as an individual. The danger of a general speech pathologist who does not have the depth of experience in voice is that they will use the same “formula” in all patients. Just as different patients respond to different medications, each patient needs individualized vocal techniques to maximize their vocal abilities.
At the Center for Vocal Health, we have worked with vocal scientists and performers to study the effects of various compounds on the voice. We have formulated a soothing elixir that contains several compounds known to have soothing and healing effects on vocal lining. Additionally, there are lubricating compounds that facilitate smooth vocal fold gliding and vibration.
Please inquire about this product if you are interested.
If you are interested in learning more about the services offered at the Voice and Swallowing Center at OHNI, please call us today to schedule an appointment.