Many people don’t know that unexplained or perplexing changes in the voice can be corrected or significantly improved, often with therapy alone, or in some cases with minimally invasive procedures.
Serving the Dallas/Fort Worth area and beyond, the Clinical Center for Voice Care is a unique resource where all aspects of your voice can be assessed and treated in one location by a highly specialized, multidisciplinary team.
UTSW Voice Center expanding to Fort Worth
The Voice Center team will now be able to increase its capacity to care for even more in the North Texas area and beyond, thanks to the opening of the UT Southwestern Monty & Tex Moncrief Medical Center at Fort Worth. There, fellowship-trained laryngologist Kathleen Tibbetts, M.D., and speech-language pathologists Janis Deane, CCC-SLP and Se-in Kim, CCC-SLP, have begun providing the same high-level, collaborative patient care as the team in Dallas.
Who We Treat
Come see us if you notice any voice changes, including:
- Age-related changes
- Decreased loudness
- Loss of pitch range
- Pain or fatigue when speaking or singing
Our team also provides well-visits for singers and performers at an affordable price. These visits include a perceptual and objective evaluation of the speaking and singing voice, as well as a videostroboscopy to examine the vocal folds.
Our Voice Care Team
Our team consists of fellowship-trained laryngologists, speech-language pathologists with expertise in voice disorders, and singing-voice specialists. In addition to treating patients, our staff also conducts research in the field of laryngology and voice care.
Education and outreach are also part of our mission. We can provide presentations about vocal health to your choir, department, or organization.
We are passionate about what we do, and we are here to help you rediscover your voice.
Good morning and welcome to the program.
For people on the radio like myself and my coworkers, our voice is our so-called money maker. Of course some people make more money than others. But because our voices are so important to our jobs, we take great pains to protect our voices, especially during the spring allergy season because the allergies can cause us to lose our voices.
Now for singers like Adele, Justin Timberlake, Steven Tyler of Aerosmith, John Mayer, and Rod Stewart, their singing voices truly are their moneymakers. For all of those singers I just mentioned, their voices were put in jeopardy because of vocal nodules, or vocal hemmorhages.
April 16th is World Voice Day, a day set aside to highlight the importance of the voice in our daily lives, as a tool of communication and so much more. Joining me in studio right now to talk about vocal health is Dr. Lesley Childs. Dr. Childs is a voice care specialist with UT Southwestern Medical Center. Also in studio is Janis Deane, a vocal therapist. Dr. Childs, Janis, thank you for being here this morning.
Janis: Thank you for having us.
Most people, Dr. Childs, don’t give their voices a second thought, until they lose their voice. What are some common mistakes that people make when it comes to harming their vocal cords?
Dr. Childs: You’re absolutely right that most people take their voices for granted. Some of the more common things that people will do, include overusing the voice, misusing the voice, abusing the voice, and within that category we include chronic coughing and chronic throat clearing; those behaviors can also be quite traumatic to the vocal folds.
A lot of the times when we injure the vocal folds, it’s as a result of wear and tear.
And when you say misusing the vocal cords, what exactly do you mean?
Dr. Childs: So an example of misuse would be glottlefry for example, which would is a type of speaking mannerism that involves very little air support and decreased engagement of the vocal folds, for a lack of a better way to explain it. It’s become very popular.
Ms. Deane: It’s pushing the voice, rather than breathing with the voice.
Dr. Childs: To some degree – that’s a good way to explain it, yeah. It’s not involving airflow and it's not speaking on the airflow if that makes sense.
How would you describe it, Janis, as a vocal therapist?
Ms. Deane: Well, what we hear most often is that people don’t use breath support to support their voice, and so instead of having a clear tone like a – clear tone sound – you have more like a – unclear tone sound – and you hear this a lot with people on tv and even in radio sometimes. But mostly on tv, and there are a lot of starlets who use glottlefry as a manner of speaking. And teenagers and 20 something in our environments pick up on that and imitate it. So instead of saying, "one, two, three, four, five," you might hear – unclear – "one, two, three, four, five."
And it’s just about using your diaphragm in your breath. I was a theater major in college, but I started in speech and drama early on my freshman year in high school, and I remember some of the first things we learned were vocal exercises and breathing exercises, and Dr. Childs, I know that you come from a singing background; you were in choir and you learned that as well.
Dr. Childs: Absolutely. We always recommend warming up the voice. We like to think of singing and speaking voice use as an athletic event. You wouldn’t run a marathon without stretching and warming up and practicing on a daily basis, so we recommend those things for all of voice users, both speaking and singing voice users.
I touched upon taking our voices for granted and I’m guessing parents once their child learns to speak they don’t tell them you’re speaking incorrectly, you’re not using your vocal cords right. That is something that parents don’t do. What as a vocal therapist, Janis, do you think parents should be on the lookout for with their young children as far as vocal health goes?
Ms. Deane: Well, a lot of children are engaged in a lot of athletic activities, where they are yelling to their peers on the field. They are also involved in cheering, and other activities and singing in choir. And you’re right; the parents don’t tell the kids how to use their voice, but neither do any of the singing teachers or coaches so we really need to emphasize to all people – children and adults – that voice is something that has to be used properly or you do risk some consequences. So what we try to do is start with vocal hygiene, just telling the children to drink water to have some lubrication in the voice, and also not to drink so much caffeine. For adults maybe not to drink as much alcohol, or if they do have caffeine or alcohol, have a little bit more water.
Dr. Childs, what do you say to someone who says this advice is for someone who truly relys on their voice like a singer or tv/ radio personality; this really doesn’t have anything to do with me?
Dr. Childs: You know, that’s a great question because you know as we said earlier we take our voices for granted. So even if you don’t consider yourself a professional voice user or a professional singer, we do use our voices to communicate day in and day out. Whether we make money from our voice use, its something that we absolutely have to cherish and protect. We get one set of vocal folds. We can’t trade them in, we can’t upgrade them, and hopefully we wont have to intervene surgically.
There’s so much that we can do to protect our voices through vocal hygiene efforts, as Janis was describing, and also through voice therapy intervention, which involves optimizing both singing and speaking voice production. So hopefully we can prevent folks from needing to enter the operating room to have vocal surgery by really prioritizing health, hygiene, and vocal-pacing efforts, things like that.
Baseball season just started. Of course, Mavericks season is still underway. A lot of people lose their voices when they go to sporting events, and they’re yelling at their favorite players jumping on the field. That is considered to be misuse and overuse as well. For someone who this happens to quite often cause they’re really true fans of the Texas Rangers or the Mavericks, what advice do you have for them?
Ms. Deane: Well, from a yelling perspective, we would ask them not to yell if they can do that. However, if you cannot inhibit emotions/cheering, warming up the voice or knowing how to yell diaphramatically rather than screaming from the throat itself can help. Also if you do have a period of yelling and screaming for your team, actually take about 30 minutes following that to just zip it, to just let your voice rest, and then for a day after that really. Just let the voice rest and recover rather than continuing to use it. Unfortunately after ball games and screaming and yelling, people like go out and drink and end up in a loud environment and talk over noise, and that kind of compounds the problem.
I’m sure there were a lot of spouses and significant others that I’m sure when you said zip it for a good while they were going, "YES, finally I can tell them you need to quiet to protect your voice." My guests, once again, this morning for this segment of the program Dr. Lesley Childs, a voice care specialist with the UT Southwestern Medical Center in Dallas, and Janis Deane; Janis is a vocal therapist. April 16th is World Voice Day, a day set aside to highlight the importance of the voice in our daily lives as a tool of communication and so much more. I mentioned Adele at the beginning of the program, Dr. Childs, and she had to have surgery on her vocal cords a couple of years ago because she had a vocal hemmorhage. This also happened to Rod Stewart, Steven Tyler. What are ways singers can protect their vocal cords.
Dr. Childs: So vocal hemmorhage basically means a bleeding episode into the actual vocal fold itself. It’s one of those rare vocal emergencies in my world. So when one develops a hemmorhage in the vocal fold, usually it’s associated with immediate onset of hoarseness or voice change. The best thing to do with immediate hoarseness, especially in a professional voice user or singer, is go to a laryngologist to get a vocal cord exam, to see what’s going on. And if a hemmorhage is diagnosed, more than likely the prescription will involve a weak, 7 days or so, of strict voice rest, not using the voice at all. So your question was how to prevent a vocal fold hemmorhage. As we mentioned earlier, warming up the voice, pacing the voice, trying not to overuse, misuse, or abuse are some of the best things we can do.
I hear of some artists like Celine Dion and Mariah Carey who prior to a performance won’t speak at all that day ahead of a performance because they’re resting up their vocal cords because they know they will probably overuse them in the evening.
Dr. Childs: Yes, there’s an analogy that a lot of us use in the voice care world: If you think of yourself having a dollar’s worth of voice use a day, if you’re going to spend 80 cents of it performing, that means you only have 20 cents for the rest of your day. So I think that it makes a lot of sense. Singers usually don’t think about how much their speaking voice affects their singing voice.
What about vocal cord polyps? I know Rod Stewart had vocal cord polyps. What causes that?
Dr. Childs: All of these are under the umbrella of phonotraumatic lesions, which means wear and tear injuries on the vocal folds. The management of a polyp is different than that of a vocal hemmorhage. More often than not, we will start with voice therapy. That’s where Janis and the rest of our fabulous voice therapy team really gets to work hard with our patient population to work on strategies to optimize and thoughts about pacing and exercising to decrease the amount of trauma that is caused by the way that they are producing their sound. Polyps sometimes will need surgical intervention, as was the case with some of the examples you provided. Surgical intervention involves a procedure called the microflap excision. It’s done in the operating room under a general anesthetic. Everything is performed through the mouth, so there is no incision on the neck. We use a microscope; it’s a very delicate, beautiful procedure that people by and large heal from fabulously. But, it does involve some voice rest both before the surgery and definitely after the surgery, so there is some recovery time that needs to be considered for the population that depends on using their voice for a living.
Janis is a vocal therapist. When should someone be concerned about their vocal health? They feel hoarse; they remain hoarse for several days, it doesn’t seem to be going away, when should they become concerned?
Ms. Deane: Well, one rule of thumb is that if you have persistent hoarseness for greater than two weeks, for an average person, that’s probably when you should probably start questioning because a lot of us we yell at a sporting event and we’re hoarse for a couple of days and we recover, but when you don’t have that recovery, that’s when you really need to start asking. For a singer, I don’t think I would wait quite two weeks. I think if I had persistent hoarseness for about a week I would probably start asking some questions.
I mentioned the misuse, the overuse, but there’s also contaminence in the air, allergens that can affect the vocal cord health. What can someone do, if it’s allergy related that you lose your voice, Dr. Childs?
Dr. Childs: Great question. Usually we recommend if you’re sick, if you’re ill, if you’re under the weather for any reason, even if it’s from an allergic sort of inflammation, don’t stress the voice, don’t use the voice if you can help it. A lot of over-the-counter remedies are available now for allergy treatment, including saline flushes for the nose that are just fabulous, over-the-counter antihistamines can be used, even over-the-counter nasal sprays can be used like a steroid nasal spray. So those things can be very helpful when allergies strike.
I know that also contaminance in the air because of ozone action day or air pollution or if you’re in a smokey environment that can also affect your voice. And of course, the common treatments are to gargle with warm salt water, or with Listerine or Scope, or sometimes I gargle with Jack Daniels cause it numbs my throat. But some people will over use certain medications that are over-the-counters like Chloriseptic. It numbs the throat and then they continue to misuse their voice. What advice do you have to for someone to have to proper use of over-the-counter medication?
Dr. Childs: You’re absolutely right. I’m so glad you brought that up. So menthol, for example, is one example of an irritant. Things like that can dry and irritate the tissues in the throat. One remedy that we pretty much across the board love to suggest is steam. Steam inhalation is absolutely wonderful for the vocal folds.
So a facial, and its good for your vocal health -- there you go; two in one! As a therapist that deals with people that deal with vocal cord issue, what sort of exercises, Janis, you talked about the singing vocal exercises, other exercises that people can do at home, in the privacy of their bathroom or their car?
Ms. Deane: We really like to train people on these exercises. They can be done incorrectly, however. For singers, we teach them proper warm-up techniques, which may involve first just breathing, and then some techniques to open up the throat and relax the muscle in the throat that they would be using for singing. And then we gently warm up the vocal folds doing humming. There are some exercises called semiecluded vocal track exercises that are very popular. Some of them involve lip trills, tongue trills – inaudible tongue noise – that you probably learned in school. And then we teach them strategic exercises that tone the muscles involved in voice production, and also to increase flexibility – just like you would in any other muscle system in your body for any kind of athletic event. So I usually tell my patients that singing in particular is like a gymnastic event. You don’t just see a gymnast walk into a gym and jump on the apparatus. They walk properly, then they engage in the activity, then they cool down and that’s exactly what we do with our patients.
If you want more information about vocal health, you can go to the UT Southwestern website utswmedicine.org and then click on the link for Conditions & Specialties. From there, scroll down to Voice Care. Dr. Childs, what is the most important message you want to get across to people about vocal health, as we get ready for World Voice Day, this Saturday, April 16th?
Dr. Childs: World Voice Day is a wonderful day where we celebrate the human voice, and it gives us the opportunity to increase our awareness of vocal health. And in our world, everyday is World Voice Day. But we hope for all of you that are listening that especially on April 16th, you’ll remember your voice and hopefully know where to go if you run into trouble. We’d love to take care of you at UT Southwestern's Voice Center.
And what about you, Janis?
Ms. Deane: One thing I'd like to emphasize is that just as Dr. Childs has specialized in laryngology, not all ear, nose, and throat doctors are equal in terms of care for the voice, and I would encourage people to see an ear, nose, and throat doctor. But if the first option is surgery, to get a second opinion because at the Voice Center, surgery is usually not the first option. Likewise, speech language pathologists also subspecialize in voice, and we’re not all created equal either, so it’s important to seek out a professional if you're having problems, who is specialized in the care of the voice.
Dr. Childs, Janis Deane, thank you so much for being on the program.
Dr. Childs/Janis Dean: Thank you.
Request an Appointment
If you experience any change in your voice that is impacting your livelihood, we can help. To schedule an appointment with one of our laryngologists, or for more information about our services, call 214-645-8300.