Lesley Childs, M.D. Answers Questions On: Voice Care
What can singers do to take care of their voices?
Hydration is something that I stress over and over. It sounds so simple, but it really matters! When they’re not adequately hydrated, the vocal cords and larynx have a very characteristic appearance. You’ll see thickened mucus, redness, and irritation. The vocal folds vibrate really fast – 200-300 times per second in women. That causes a lot of heat and friction, and thin, watery secretions help protect the vocal cords.
Also, singers sometimes don’t realize that their speaking voice can be more damaging than singing. I work to increase awareness of vocal demands and talking.
Tell me about hoarseness – and about vocal-fold growths like nodules.
Hoarseness suggests a possible growth on the vocal folds. It could also result from a functional voice disorder, which means the person has perhaps developed some bad voicing habits, but the vocal folds are normal. You can also be hoarse if one of your vocal folds isn’t moving, which can happen after a virus or surgery.
Benign vocal-fold growths like nodules, polyps, and cysts are usually the result of wear and tear. Malignant vocal cord lesions usually are the result of smoking and alcohol.
Nodules are like calluses you develop on your heel. They develop in pairs across from each other, one on each vocal fold. When the vocal folds hit each other over and over, the nodules can swell and prevent complete closure. With a speech therapist’s help, we can reverse the pattern of behavior that led to them. As a general rule, we do not operate on nodules. I could go in and remove them, but if that pattern isn’t changed, they’ll come right back.
How do you diagnose voice problems, and what treatments do you offer?
We look at the vocal cords in fine detail by doing a videostroboscopy through the nose or the mouth. I have patients speak and sing in the office so that I can see exactly what’s happening when they’re struggling vocally.
We laryngologists differ from many other surgeons because we almost always try behavioral interventions before surgery. With benign vocal cord lesions, we’ll send patients to the speech therapist. Later they come back to us and we see how things have improved.
If surgery is necessary, we can do a microflap excision, which is approached through the mouth so there are no incisions on the neck. Using microinstruments, we very gently dissect and remove the lesion.
We can do several procedures in the office, including some types of laser surgery. For patients with vocal cord paralysis, we can inject fillers into the one that’s not moving and enlarge it. We also inject Botox for neurologic disorders of the larynx, such as spasmodic dysphonia. We have the largest population of spasmodic dysphonia patients in North Texas.