A person’s voice serves as their vocal signature. In many social situations, it defines our interactions with the people around us. When our voice fails to work for us, it can result in unintended social isolation and poor performance. Studies have shown that up to 30% of Americans suffer from a voice problem at some point in their lives. Up to 28 million Americans are affected daily in their work activities. It is for this reason that voice problems should not be ignored, especially those that persist for greater than two weeks.
Voice & Swallowing Treatments at SFENTA
The first step in managing a voice problem is a formal evaluation by an otolaryngologist (ENT). A laryngologist — a sub-specialist otolaryngologist — is a physician who is specially trained to deal with voice and airway issues. The evaluation consists of a routine head and neck exam and a special video exam of the vocal cords known as a “videostroboscopy”. The video exam takes very close images of the vocal cords and allows the physician to see their function in slow motion. South Florida ENT is fortunate to have the only fully high definition videostroboscopy system in South Florida, which allows for the most detailed and comprehensive examination of the voicebox. The video strobe can help identify very subtle changes in the vocal cords that may adversely impact a patient’s voice.
- Vocal cord and voice examination
- Swallowing therapy
- Speech therapy
- Acid reflux testing
- Complicated voice disorders
Vocal Cord and Voice Examination
Before treatment can begin, your provider will need to examine your voice and vocal cords. To examine the vocal cords, your provider will use a laryngoscope, a videostrobolaryngoscopy, or in some cases, a mirror. This will allow them to look for any abnormalities and provide treatment recommendations.
For certain patients, swallowing can be difficult or painful. This can occur at any stage of the swallowing process and may be due to an underlying condition. At SFENTA, our specialists can help patients improve their swallowing abilities to make this everyday action easier and more manageable through a tailor-made treatment plan. This may include medication, exercises, or other forms of treatment.
A licensed speech-language pathologist can help patients who have difficulties with speech or langue. This includes difficulty speaking, forming words, stuttering, or responding to others. Our speech therapists will work with you and create a customized program to improve your abilities. Patients will meet with the therapist once or twice a week to work on vocal exercises and activities to increase their skills.
Acid Reflux Testing
Acid reflux is a digestive condition in which stomach acid or bile moves into the food pipe and begins to irritate the throat and the food pipe’s lining. This can cause symptoms such as burning pain in the chest, regurgitation, stomach pain, and making eating challenging. Our staff provides acid reflux testing to help determine if you have acid reflux or other gastrointestinal conditions. After testing, our providers can help you find a treatment that works well for you and provides long-term relief.
Complicated Voice Disorders
SFENTA specializes in diagnosing and treating vocal disorders. Some disorders may be easy to treat, while others are complex. This includes laryngitis, vocal paresis, vocal paralysis, spasmodic dysphonia, muscle tension dysphonia, and more. We offer treatment methods including medication, surgery, speech therapy, or a combination of therapies to address your vocal disorder.
What Causes Vocal Disorders?
Voice problems vary widely in their cause. At times, it may be related to compensatory behavior to changes following a cold or the effect of laryngopharyngeal reflux (LPR or “silent reflux”). These reasons can often be treated with medicine or voice therapy. More insidious causes such as nodules, polyps, or even certain laryngeal cancers may require surgery. A laryngologist is skilled in performing minimally invasive surgery to remove only the disease while preserving the normal vocal cord for the best vocal outcome. Some procedures, such as vocal fold injections, can be performed in the office to avoid lost time at work or with friends.
Voice therapy performed by a licensed speech-language pathologist (SLP) may be used as an additional treatment following surgery to encourage the best vocal habits and prevent recurrence of the underlying problem. Many patients do well and are able to regain their previous vocal functions. By working with a laryngologist and a voice therapist, many patients find their voice is better than when they started — and they are excited to engage both socially and professionally. If you aren’t happy with your voice, make an appointment today at one of our convenient locations.
Why Choose SFENTA?
SFENTA has been helping patients in South Florida find relief from their ENT symptoms for over 30 years. We’ve brought together the best in ENT treatments and created a world-class network of providers. Our staff includes over 50 board-certified physicians who specialize in the full range of ENT specialties, as well as 40 allied professionals ready to help address any concern. We understand that your voice is an integral part of who you are. At SFENTA, we work with patients to help them find the root of their vocal or swallowing difficulties and find a treatment that works for them.
Voice and Swallowing FAQ
How are vocal disorders treated?
The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.
Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and resolve problems, such as vocal nodules. When a patients’ problem is specifically related to singing, a singing teacher may help improve the patients’ singing techniques.
What can I do to prevent and treat mild hoarseness?
- If you smoke, quit!
- Avoid agents which dehydrate the body, such as alcohol and caffeine
- Avoid secondhand smoke
- Drink plenty of water
- Humidify your home
- Avoid spicy foods
- Try not to use your voice too long or too loudly
- Use a microphone in situations where you need to protect your voice
- Seek professional voice training
- Avoid speaking or singing when your voice is injured or hoarse
- Don’t sing when you are sick
Who can treat my hoarseness?
Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists (who have learned how to examine the larynx). When hoarseness lasts longer than two weeks or has no obvious cause, it should be evaluated by an otolaryngologist-head and neck surgeon (ear, nose, and throat doctor). Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are otolaryngologist-head and neck surgeons, speech/language pathologists, and teachers of singing, acting, or public speaking. Voice disorders have many different characteristics that may give professionals a clue to the cause.
How is hoarseness evaluated?
An otolaryngologist will obtain a thorough history of hoarseness and your general health. Your doctor will usually look at the vocal cords with either a mirror placed in the back of your throat or a very small, lighted, flexible tube (fiberoptic scope) that may be passed through your nose to view your vocal cords. Videotaping the examination or using stroboscopy (slow-motion assessment) may also help with the analysis.
These procedures are not uncomfortable and are well tolerated by most patients. Special tests (known as acoustic analysis) designed to evaluate the voice may be recommended in some cases. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that help establish a diagnosis and guiding treatment.
When should I see an otolaryngologist (ENT doctor)?
- If your hoarseness lasts longer than two weeks (especially if you smoke)
- If you have pain that is not from a cold or flu
- If you’re coughing up blood
- If you have difficulty swallowing
- If you find a lump in your neck
- If you experience loss or severe change in your voice lasting longer than a few days
Where is the temporo-mandibular joint?
You can locate this joint by putting your finger on the triangular structure in front of your ear. Then move your finger just slightly forward and press firmly while you open your jaw all the way and close it. You can also feel the joint motion in your ear canal.
How does the temporo-mandibular joint work?
When you bite down hard, you put force on the object between your teeth and on the Temporo-Mandibular Joint. In terms of physics, the jaw is the lever, and the TMJ is the fulcrum. Actually, more force is applied (per square foot) to the joint surface than to whatever is between your teeth because the cartilage between the bones provides a smooth surface over which the joint can freely slide with minimal friction.
Therefore, the forces of chewing can be distributed over a wider surface in the joint space and minimize the risk of injury. In addition, several muscles contribute to opening and closing the jaw and aid in the function of the TMJ.
What causes TMJ pain?
In most patients, pain associated with the TMJ is a result of displacement of the cartilage disc that causes pressure and stretching of the associated sensory nerves. The popping or clicking occurs when the disk snaps into place when the jaw moves. In addition, the chewing muscles may spasm, not function efficiently, and cause pain and tenderness.
Damage to the TMJ is often caused by:
- Major and minor trauma to the jaw
- Teeth grinding
- Excessive gum chewing
- Stress and other psychological factors
- An improper bite or malpositioned jaws
What are the symptoms?
- Ear pain
- Sore jaw muscles
- Temple/cheek pain
- Jaw popping/clicking
- Locking of the jaw
- Difficulty in opening the mouth fully
- Frequent head/neck aches
The pain may be sharp and searing, occurring each time you swallow, yawn, talk, or chew, or it may be dull and constant. It hurts over the joint, immediately in front of the ear, but pain can also radiate elsewhere. It often causes spasms in the adjacent muscles attached to the bones of the skull, face, and jaws. Then, pain can be felt at the side of the head (the temple), the cheek, the lower jaw, and the teeth.
A very common focus of pain is in the ear. Many patients come to the ear specialist quite convinced their pain is from an ear infection. When the earache is not associated with a hearing loss and the eardrum looks normal, the doctor will consider the possibility that the pain comes from TMJ.
There are a few other symptoms besides pain that TMJ can cause. It can make popping, clicking, or grinding sounds when the jaws are opened widely. Or the jaw locks wide open (dislocated). At the other extreme, TMJ can prevent the jaws from fully opening. Some people get ringing in their ears from TMJ.
How is TMJ pain treated?
Because TMJ symptoms often develop in the head and neck, otolaryngologists are appropriately qualified to diagnose TMJ problems. Proper TMJ diagnosis begins with a detailed history and physical, including careful assessment of the teeth occlusion and function of the jaw joints and muscles. An early diagnosis will likely respond to simple self-remedies:
- Rest the muscles and joints by eating soft foods
- Do not chew gum
- Avoid clenching or tensing
- Relax muscles with moist heat (1/2 hour at least twice daily)
In cases of joint injury, apply ice packs soon after the injury to reduce swelling. Relaxation techniques and stress reduction, patient education, non-steroidal anti-inflammatory drugs, muscle relaxants, or other medications may also offer relief.
Other treatments for advanced cases may include the fabrication of an occlusal splint to prevent wear and tear on the joints, improving the alignment of the upper and lower teeth, and surgery. After diagnosis, your otolaryngologist may suggest further consultation with your dentist and oral surgeon to facilitate the effective management of TMJ pain.