What About a "Voice-Lift" with your Facelift?

I was informed about this interesting concept on ABC news...

With many aging baby boomers tapping into cosmetic surgery in order to look younger, some are taking it a step further to "sound" younger as well with a "voice lift".

For some, it's not right to look 10-20 years younger after a facelift but still sound like 70 years old.

A hoarse voice with aging is not unusual, but a surgical "voice-lift" is not necessarily the first step that should be taken.

First things first...

• Make sure the hoarseness is not due to something bad like vocal cord cancer. As a person ages, risk of cancer does increase especially if tobacco and alcohol use is present.

• Make sure there are no physical problems with the vocal cords like paralysis, polyp, cysts, reflux, etc.

Beyond that, vocal limitations often seen with the aging voice should first be addressed with voice therapy. Bowed vocal cords as well as compensatory muscle tension dysphonia are conditions often seen in this patient population causing a significant raspy voice and often respond quite well to voice therapy. Should voice therapy fail to resolve the vocal disquality, than surgical options can be considered.

What are the surgical options?

Just like a facial wrinkle may require a collagen injection to plump it up or a chin implant to address a receding chin, the vocal cord can also undergo collagen injections or receive an implant to plump it up and give it volume lost to aging which can lead to vocal problems.

Click here to read more about this procedure.

Click here to read the ABC new report.

Read More

The Vocal Problems of Professional Singers

The Washington Post on May 20, 2011 published a great article on the travails of opera singers regarding their vocal cords and the stresses placed on them (the singers and their vocal cords).

The opera singer (as well as any other professional singer) are the Olympic athletes of the voice.  As such, peak performance is mandatory in order to sustain a successful career. Just as an Olympic sprinter measures their success in milliseconds... the professional singer is judged by the most minute inflections, variances, irregularities of their voice. Never mind the back-biting and gossip.

99.9% is not good enough in this cut-throat world when anything less than 100% perfection is considered failure.

As such, the demands placed on the vocal cords are tremendous and rather than pulled hamstrings of a world-class sprinter, vocal cord swelling let alone nodules or muscle tension dysphonia can cut a career short.

Push the voice too hard... and they can get damaged, especially when vocal technique gets sacrificed to perform pieces beyond appropriate range (and even ability). Even professional opera singers have vocal instructors and coaches... a point I regularly make with amateur singers with injured vocal cords when they argue against the necessity of voice therapy and singing lessons ("I already know how to sing!").

Read the Washington Post story here.

I did want to point out that there was one error in the story...

Near the end of the story, it is stated that Giuseppe Filanoti had thyroid surgery. Although this can affect the voice, it is NOT vocal cord surgery as reported.

Read More

Is Whispering Bad for Your Vocal Cords???

For most people, the answer is yes according to research publicized in a New York Times article on Feb 7, 2011.

In the mentioned study, out of a group of 100 patients, 69% exhibited increased supraglottic hyperfunction with whispered voice (ie, it was bad for the voice). 18% had no change and 13% had less severe hyperfunction.

As such, though whispering is not bad for everybody, it is for most people and as such, the safest thing to do if the vocal cords are damaged whether by infection or trauma is to rest your voice. If you have to talk, do not whisper, but rather talk in a soft voice.

The best way to think about injured vocal cords is to talk in an analogy. Laryngitis is like a badly sprained ankle. In this scenario, talking is like walking and screaming is like running. So just like you would rest the sprained ankle and not walk on it in order for it to recover as quickly as possible, you should refrain from talking in order for the laryngitis to recover as quickly as possible. Where does whispering fall in this analogy? Probably equivalent to running on a sprained ankle.

Read the NYT article here.

Read more about voice problems here.

Reference:
Laryngeal hyperfunction during whispering: reality or myth? J Voice. 2006 Mar;20(1):121-7.

Read More

“The Who" Roger Daltrey Underwent Vocal Cord Surgery

A story was published in December 2010 about Roger Daltrey's experience with losing his voice and requiring vocal cord surgery literally 6 weeks before he was to sing at the Superbowl February 2010.

Fortunately, under the expert care of Dr. Zeitels at Massachusetts General Voice Center, he was successfully treated and recovered his voice in time to sing during the 2010 Superbowl half-time show in Miami.

Read the story here.

Read More

Simple Rubber Device Mimics Complex Birdsongs & Implications for Human Voice

A team of US researchers at Harvard has developed a simple rubber device composed of two pieces of rubber replicating the 'vocal tract' and a motor that replicates the action of a contracting muscle. With this device, the researchers have been able to EXACTLY mimic the birdsong of a variety of species including the bengalese finches and vireos.

Given complex birdsongs have been faithfully reproduced with such a rudimentary device as shown here, it does suggest that complex neurologically processes are NOT required. In reality, physics is all that is needed with just a little brain power.

You can listen to samples of birdsongs produced by the device here (halfway down the page).

If birdsongs can be replicated with such a simple device, just maybe, better vocal cord devices can be created for humans who have lost the ability to produce a clear voice.

Humans can lose the ability to talk/sing clearly due to cancer, papillomas, scarring, paralysis, etc. Although research on vocal cords is active, I'm not aware of any projects pursuing complete replacement with a biological equivalent of the rubber band. In fact... I'm not aware of any research project being pursued to create the biologic rubber band in the first place.

If you read any textbooks describing the vocal cords, it does seem mind-numbingly complex which perhaps explains why researchers have been discouraged from pursuing this line of inquiry.

But, if it can be done for birdsongs whose vocal cords are anatomically similar to humans, than theoretically, a simple rubber band device can also be created mimic-ing the human voice. This does sound like a fun high school science project the more I think about it.

Once that has been achieved, the physical characteristics of this rubber band can be broken down and than replicated by biochemists to create a biologic equivalent (or biologically inert) rubber band which can than be transplanted into a human with a damaged vocal cord.

Even to just more faithfully replicate a human voice would be a boom for those whose voiceboxes have been completely removed due to cancer (laryngectomy). Current replacement talking devices sound like a robot using state-of-the-art electrolarynx. Watch video below:



Just a thought that I am sure is easier said than done.

Read the full article in the BBC here. Research paper on this topic to be published in near future.

Read More

Distributed Botox Injection for Spasmodic Dysphonia (Rather than Single Injection)

For many patients with spasmodic dysphonia, botox injections to the vocal cords are a regular right of passage every few months towards a clearer voice. Spasmodic dysphonia characterized by spastic or breathy voice breaks while talking causes much problems socially as well as misunderstandings.

For many physicians who perform botox injections for spasmodic dysphonia, a single injection is performed to either one or both vocal cords.

However a few and perhaps growing number of physicians are now using a more sophisticated method of injection where not only one, but multiple "mini"- injections are performed to the vocal cord during an injection.

Why would multiple injections be performed when one will do?

For that, I would like to take the reader to the world of cosmetic botox injections for facial wrinkles.

For the millions more sufferers of facial wrinkles, patients know that from the point of injection, there is a limited region of affect... typically no more than a dime to nickle area in size depending on the volume used. SO... in order to get rid of forehead wrinkles, 5 or more injections are required as shown here by the "x" marks.

The point is... in order for a great outcome in forehead wrinkles... multiple injections are performed. Not one single injection.

The same holds true for the vocal cord muscles. Rather than a single large injection to one spot in the vocal cord muscle, there is a growing belief that multiple "mini"-injections should be performed throughout the vocal cord muscle in order to produce a better outcome... a distributed injection. No specific research to prove this, but rather anecdotal.

Here is a video of botox being injected in a patient with spasmodic dysphonia.

Read More

What is Vocal Cord Stroboscopy?

Stroboscopy of the vocal cords is a special exam whereby a scope is introduced down into the throat where the vocal cords can be directly visualized. Using a special light, the vibration of the vocal cords can be examined and allows identification of subtle pathology that can contribute to a raspy voice.

The exam is recorded and can be played back at any speed to allow for careful analysis.

Here is a YouTube video our office has made showing how this exam is performed!

Read More

NCIS Character Tony DiNozzo Gets Acute Laryngitis

On October 19, 2010, there was a CBS episode of NCIS (Naval Criminal Investigative Service) called "Cracked" in which Special Agent Tony DiNozzo developed acute laryngitis.

The show's chief medical examiner, Dr. Ducky Mallard, examined Special Agent Tony DiNozzo and instructed him on strict voice rest for 24 hours which Tony ignored.

If I was on the show, I would have performed a much more thorough examination that would include fiberoptic laryngoscopy (and/or stroboscopy) in which the vocal cords could be directly examined as shown in this video:

Based on his hoarseness, lack of productive cough, and acute onset, I suspect Tony developed acute VIRAL laryngitis. Here's an example of what I suspect I would have seen on laryngoscopy if one was done (video is actually stroboscopy, a much more intensive examination than laryngoscopy):

This exam is different than acute BACTERIAL laryngitis in which pus on the voicebox would be seen as shown in this video (also stroboscopy):

Overall, treatment for acute viral laryngitis is strict voice rest as the esteemed Dr. Mallard recommended, though 24 hours is a bit optimistic. I probably would have prescribed a course of steroids to help with the swelling as well as hydration.

Should Tony keep on talking in setting of acute laryngitis, he runs the risk of developing muscle tension dysphonia.

Read More

NPR on Muscle Tension Dysphonia aka (Hyper-)Functional Dysphonia

NPR reported on July 12, 2010 one woman's travail overcoming a raspy voice due to laryngeal hyperfunction (also known as muscle tension dysphonia). Voice therapy provided a cure for her condition.

I should state that muscle tension dysphonia (MTD) is NOT the same as spasmodic dysphonia and the two disorders are often confused with each other... and treated completely differently from each other.

MTD is when the muscles of the voicebox are too tight causing a raspy voice. This very commonly occurs after a viral laryngitis/cold. My (unsupported) hypothesis is that the brain tries to achieve a normal sounding voice in a setting of laryngitis where the voicebox is inflamed and swollen. This attempt at normalcy usually results in hyperfunction of the muscles composing the voicebox.

Unfortunately, once the laryngitis resolves, the patient is still locked into a mode of hyperfunctional voice use, even though there's no more need to do so. In essence, it has become muscle memory or a bad habit.

Voice therapy in its purest form tries to get the brain to revert back to a more normal muscle pattern while talking by essentially teaching the patient to break this bad habit. Whether that includes laryngeal massage as in the article or via specific vocal exercises, it depends on the patient. There is not one specific treatment that will work on everyone with this condition.

Spasmodic dysphonia is when specific muscles of the voicebox goes into spasm, much like people with eye twitches. It is involuntary and occurs at random without warning. Treatment for spasmodic dysphonia is botox injections. Voice therapy does play a limited role in allowing for a longer duration of botox effectiveness which typically wears off in about 3 months before repeat injection is required.

Read the NPR story here.

Read more about muscle tension dysphonia here.

Read more about spasmodic dysphonia here.

Of note, our clinic specializes in these disorders.

Read More

April 16 is World Voice Day

The American Academy of Otolaryngology-Head & Neck Surgery has designated April 16 to be "World Voice Day."

First started in 2002, it is observed every year on April 16.

Click here for more info.

For extensive information on how the voice works in both health as well as in disease, click here.

Read More

Dr. Chang Invited as a Guest for Online Radio Talk Show

Dr. Chris Chang has been invited to participate as a guest in an hour long online radio show hosted by Trish Causey of Musical Theatre Talk. The radio show with Dr. Chang will be aired on January 10, 2010 at 5PM.

Two other members of the voice team that Dr. Chang works with will also be participating including Sarah Maines (singing voice therapist) and Melissa Mainville (functional voice therapist).

More details to come.

Read More