Dr. Michael Pitman is the director of the Voice and Swallowing Institute at the New York Eye and Ear Infirmary of Mount Sinai. He specializes in treating patients for problems with their airways.
THE SPECIALIST
As the Director of the Voice and Swallowing Institute at the New York Eye and Ear Infirmary of Mount Sinai, Dr. Michael Pitman specializes in treating patients for problems with their airways. May is Better Hearing and Speech Month.
WHO’S AT RISK
It isn’t just professional crooners like Sam Smith or Adele whose voices give out on them. “As much as 38% of the population will have a significant voice problem in their lifetime,” says Pitman. “Vocal dysfunction can develop as the result vocal overuse or abuse, or as the result of many different medical issues, including vocal fold paralysis, allergies, acid reflux, and vocal fold cancer.”
Vocal disorders can take many different forms. “If you’re a lawyer doing a trial, your voice may become raspy and uncomfortable as the day goes — or a teacher’s voice may deteriorate over the course of the week, and cause pain by Friday,” says Pitman. “For singers, the voice can break or become breathy in the upper registers.”
One of the concerns with vocal disorders are the toll they take on other parts of your life. “Vocal dysfunction can cause professional problems for some patients, and social problems for others,” says Pitman. “You want to have the strength and quality of voice to be heard without discomfort. Studies find that people pay more attention to a smooth clear voice than a raspy one — the sound of your voice affects how you are perceived.”
The risk factors associated with vocal disorders depend on the underlying medical problem. “Anything that irritates the throat can affect the voice — so smoking, drinking, acid reflux, and allergies,” says Pitman. “Your job can also put you at risk if you have to talk for hours a day — teachers, lawyers, people who work at call centers, and anyone who is a professional voice user has a higher risk of developing vocal dysfunction.”
Women carry a higher risk than men. “Women tend to have voice problems more often than men do, which we think is due to the anatomy of the vocal fold,” says Pitman. “There’s a protective jelly in the vocal fold, and women have a little less than men. Their vocal folds also vibrate closer to 200 times a second as opposed to 100 times a second.”
Age is also a factor. “As you get older, around 60, 65, the vocal folds tend to atrophy and thin out — one of the things that makes your voice loud is how quickly and completely the vocal folds close and block the air from your lungs,” says Pitman. “With age a gap may develop between the vocal folds, and the voice gets weaker and thinner as the air leaks between them. That’s why you can tell on the phone or radio that someone is older from their voice.”
SIGNS AND SYMPTOMS
The warning signs of vocal dysfunction are fairly easy to recognize. “One early symptom are is losing your voice after overextending it,” says Pitman. “First you bounce back the next day; the next time, it takes a few days to bounce back. Eventually, your voice gets tired, weak, and breathy by the end of the day.” Hoarseness and a raspy voice are other red flags.
Almost everyone loses their voice from time to time — so what is the sign that something more serious is wrong? “The real key is to look out for any change that lasts longer than two weeks,” says Pitman. “At that point, you need to get the problem checked out.”
TRADITIONAL TREATMENT
The first step is getting a proper diagnosis. “There are tons of things that can lead to the same hoarseness, so when a patient comes in, we have to look at the whole medical history, when the voice issue started, and what the vocal demand is,” says Pitman. “Then we look at the vocal folds with a video stroboscope that allows us to see their vibration in slow motion. Abnormal vibration is what causes the voice changes so this evaluation is essential.”
Anything from sinusitis, to cancer to acid reflux could be causing the vocal dysfunction. “Usually conservative management is enough to fix the problem,” says Pitman. “That can include behavioral therapy to learn to use your voice more efficiently, or even small fixes like having a microphone in class if you are a teacher. Most people don’t need surgery, especially if you identify the problem early.” Medications and changes in diet can also be enough to correct the problem.
For patients who require active intervention, there are now many minimally invasive procedures and surgeries. “If you have blood vessels in the vocal folds that bleed again and again, we have lasers we can use in the seal them off,” says Pitman. “And we can now do many of the procedures in the doctor’s office, as opposed to the operation room.”
There are also many surgical options. “At this point, we can reconstruct the larynx, we can do microsurgery to remove lesions, and we can put implants in the vocal folds to bulk them up,” says Pitman. “These surgeries are extremely successful in restoring the voice. Vocal disorders are a quality of life issue, one with many effective treatment options.”
RESEARCH BREAKTHROUGHS
New technological advances bear tremendous potential for treating vocal dysfunction. “We’re working on implantable electronic stimulators and the possibility of implanting grafts into the vocal fold to help your own body regenerate,” says Pitman. “We’re on the cusp of a lot of new things.”
If you’re a lawyer doing a trial, your voice may become raspy and uncomfortable as the day goes — or a teacher’s voice may deteriorate over the course of the week, and cause pain by Friday.
QUESTIONS FOR YOUR DOCTOR
If you’re having a vocal problem, ask your primary care physician, “Can you refer me to someone who specializes in voice disorders?” Don’t be shy about asking a voice specialist, “What percentage of your practice is devoted to voice disorders?” and “Do you work closely with a voice therapist you can refer me to?” Most patients can be treated conservatively, so ask, “What can I do to strengthen my voice?” And don’t assume there’s nothing to be done. “We all take our voice for granted until it’s not there — and then, it’s difficult to communicate with family and friends, to perform at work, and it’s very scary,” says Pitman. “But thanks to the technological revolutions, we can restore the voice in most cases, especially if we catch the problem early.”
WHAT YOU CAN DO
Get informed.
For medically-sound information on the web, check the American Academy of Otolaryngology-Head and Neck Surgery (ent.net.org) and the Voice and Swallowing Institute at Eye and Ear Infirmary of Mount Sinai (vocalhealth.org).
See an expert.
Get a referral for someone who specializes in voice disorders, usually an ear, nose and throat doctor or a laryngologist who subspecializes in vocal disorders.
Drink tons of water.
Being well-hydrated allows your body to create the necessary mucus for the airway, which acts in a similar way to lubrication in a car.
Protect your voice.
“Take voice breaks throughout the day, moderate the voice, and try not push through things,” says Pitman. “Avoid menthol and eucalyptus lozenges, which may feel good but are actually irritating to the airway.”
Don’t clear your throat.
Clearing the throat actually bangs the vocal cords together. Instead, when you want to clear something expel the air like a heavy breath, or “like someone’s hitting you in the stomach,” says Pitman.
…..
By the numbers: (from the doctor)
— 38% of people have a significant voice problem in their lifetime
— 58% for teachers who report having vocal disorders
— 50% of vocal dysfunction caused by overuse can be treated conservatively
This entry passed through the Full-Text RSS service – if this is your content and you’re reading it on someone else’s site, please read the FAQ at fivefilters.org/content-only/faq.php#publishers.
Health – NY Daily News