The Vocal Health Program is eastern Wisconsin’s only voice clinic and the go-to choice for expert, reliable and timely relief for voice problems of all kinds.
Musicians, actors, broadcasters, lawyers, politicians, clergy, teachers, coaches, professional speakers and salespersons benefit from our program. If you have a concern about your voice quality, effort, loudness or pitch, schedule an evaluation with us and we'll talk about possible treatment.
24-Hour Hotline — 414-456-7464We understand voice problems can be urgent, so we offer a 24/7 hotline for our services — 414-456-SING (414-456-7464). For more than 25 years, our program has been a premier voice resource for people who value complete, personalized care with all of the best-practice resources of an academic medical center.
Voice Concerns — Just for Teachers
Teachers are more than twice as likely as people in other professions to suffer loss of voice or other problems that send them to the doctor. They talk all day, often projecting their voice in noisy environments with less than ideal acoustics, causing problems related to strain and overuse of the voice. Common voice problems for teachers include hoarseness, vocal fatigue, difficulty projecting the voice, throat pain, voice loss and slow vocal recovery.
Teachers are more than twice as likely as people in other professions to suffer loss of voice or other problems that send them to the doctor. Here are some tips for teachers to prevent voice problems.
- Vocal warm-ups and cool-downs prepare your voice for a long day of teaching and help decrease fatigue and strain.
- Protect your voice by taking breaks to rest your voices during the workday.
- Use a personal voice amplification device in the classroom to improve vocal endurance and decrease vocal strain.
- Try remaining silent rather than yelling over your students to quiet them. Non-vocal cues can also work.
- Keep your vocal cords hydrated. Dry vocal chords make voice problems worse.
- Try simple ways to reduce noise from areas surrounding your classroom, such as keeping the door closed.
Voice Problem Evaluation and Diagnosis
Through an evaluation, Vocal Health Program specialists find the root cause of your concern. They combine cutting-edge knowledge about voice health with state-of-the-art technology and techniques, including video analysis of vocal fold vibration, acoustic analysis of vocal function and office-based procedures. We use microphones, guitar and keyboard — all onsite — to facilitate care for performers.
All of us experience occasional hoarseness or have trouble speaking at times, but how do you know when your voice requires a professional look? Ask yourself the following questions.
- Has your voice been hoarse or raspy for longer than two weeks?
- Have you experienced a sudden voice change, even though you are not sick?
- Do you tend to “lose” your voice frequently?
- Has the pitch of your voice changed, or is your singing range limited?
- Does your throat often feel raw, achy or strained?
- Is it difficult for you to project your voice or speak in noisy environments?
- Is it difficult to perform your daily work duties due to your voice?
- Do you find yourself repeatedly clearing your throat?
- Does your voice fatigue easily?
If you answer "yes" to any of these questions, the Vocal Health Program is the solution. Learn more about throat and voice diagnostics.
Conditions That Cause Voice Problems
- Reflux laryngitis is an inflammation of the tissues of the voice box (larynx) that happens when acid from the stomach enters the esophagus and backs up to the throat. It is also known as gastroesophageal reflux disease (GERD) or heartburn. It is treated with medications to halt the production of acid and with lifestyle changes, such as avoiding foods that cause reflux or by avoiding eating for several hours before lying down.
- Vocal cord lesions, also known as vocal fold lesions, are typically benign growths that can present as nodules, polyps or cysts on the vocal cords. These growths can change the way your voice sounds, such as making you sound hoarse. A nodule can be thought of as a callous, and a polyp is similar to a blister.
The first-line treatment for these lesions is voice therapy. Lesions result from the way a person is using the voice. Without speech therapy to educate the patient and help them re-learn to use the voice appropriately, other therapies won’t be effective long-term.
When speech therapy alone doesn’t resolve vocal cord lesions, surgery may be an option. Physicians can help return vocal cords back to baseline health using various techniques such as microscopic dissection with specially designed steel instruments or special lasers that precisely target lesions and remove them while preserving normal tissues. A steroid may be injected to remodel vocal cord tissue from the areas where lesions were removed. The patient returns home the same day, and post-surgical recovery involves little to no pain. Complete voice rest for about a week following surgery is required for healing. Additional speech therapy may be required to continue healthy speech habits and prevent lesions from coming back.
- Vocal cord paralysis happens when one (unilateral) or both (bilateral) of your vocal folds stop moving as they normally do to produce sound. This condition can cause a hoarse, ‘breathy,’ or weak voice and changes in pitch and loudness. Some people may also notice choking or coughing while eating if the vocal cords can’t close the pathway to the lungs. Treatment may involve surgery, which could include injections and voice therapy.
- Vocal hemorrhage happens when a blood vessel in one of your vocal cords ruptures and leaks blood, causing a severe vocal disorder such as hoarseness or a change in your vocal range. It may also stop your voice entirely. These changes can become permanent if not appropriately treated. Treatment may include complete voice rest and medicines.
- Dysphonia is the medical term for a hoarse voice. When someone is hoarse for more than a couple weeks, it is important to consider a thorough medical evaluation to find the underlying diagnosis or reason for this symptom. Treatment varies depending on the diagnosis and may include voice rest, smoking cessation, voice therapy, anti-reflux medications or surgery. Common causes include inflamed vocal cords, overuse of the voice, vocal cord nodules or polyps. Rarely, dysphonia can be caused by laryngeal cancer, which represents less than 1% of new cancer diagnoses in the U.S.
- Neurologic voice disorders — many neurologic conditions are associated with a hoarse voice. Laryngeal dystonia, also known as spasmodic dysphonia, is a condition that particularly affects the speaking voice without other symptoms. Treatment is usually centered around surgical procedures that could include botulinum toxin injections. Parkinson’s disease is another example of a neurologic problem that can affect the voice. Many people are treated successfully with voice therapy but for some, surgical options are considered.
- Muscle tension dysphonia is often thought of a behavioral problem with using the voice that may or may not be associated with other underlying laryngeal diagnoses. Muscle tension dysphonia is treated with voice therapy but if another reason for the condition is found, it must also be addressed.
- Dysphagia means difficulty swallowing. The ability to swallow normally affects the ability to eat and has a huge impact on a person’s quality of life. Treatment options may include therapy with our expert speech-language pathologists or sometimes, medicine or an operation.
- Vocal process granuloma is a benign mass of inflamed tissue on the vocal cords that results from irritation. Causes may include reflux disease, excessive use of the voice or irritation from a breathing tube. Treatment may include anti-reflux medication, inhaled steroids, voice therapy, laser treatment or botulinum toxin therapy.
- Laryngeal papillomatosis refers to a benign, wart-like tumor that is typically found in the larynx. It is caused by the human papilloma virus. Hoarseness is the most common symptom, but if left untreated, papillomas can block the passage of air and cause problems with breathing. While there is no cure, papillomas are often removed in office-based and operating room procedures.
- Leukoplakia is a “plaque” or white or gray patch on the tongue or tissues on the inside of the cheeks. Leukoplakia can be caused by tobacco use and can sometimes be pre-cancerous. The patches are often biopsied to establish a diagnosis which may include dysplasia (a pre-cancerous change). Treatment involves encouraging smoking cessation along with surgical removal of the patches. Leukoplakia often requires long-term follow-up and surveillance by an experienced voice doctor.
- Laryngeal cancer is also called vocal cord cancer. Often, the only symptom of vocal cord cancer is a hoarse voice. Smaller tumors can be treated with voice preservation surgery using microscopic operative techniques. Vocal cord cancers require long-term follow-up and surveillance by an experienced voice doctor.
- Throat cancer
Treating Voice Problems
Many laryngeal procedures can be performed in the clinic under local anesthesia. This allows patients to return quickly to their usual daily activities and lifestyle. Our interdisciplinary voice clinic approach optimizes patient care by facilitating an accurate diagnosis and developing a personalized treatment plan. Most of our new voice patients see a laryngologist and a speech-language pathologist in the same clinic visit. Treatments may include:
- Voice therapy. A speech-language pathologist treats voice patients with the goal of increasing the efficiency and ease with which people use their voice. It starts with education to promote understanding of the fundamentals like how the voice is produced, breathing support, muscle use and resonation. A period of voice rest may be recommended. Exercises are introduced to reinforce appropriate use of the voice, to help with healing and to relieve vocal fatigue. Voice therapy may be needed before other treatments, as well as afterward to help insure the vocal condition the patient sought help for does not return.
- Lifestyle modifications. These may include resting the voice and learning to use it appropriately for different situations.
- Medications. The type of medication will depend on each individual’s vocal disorder.
- Clinic-based, minimally invasive laser procedures. These remove lesions or resolve other conditions.
- Vocal cord augmentation (injection). Used to treat a variety of laryngeal conditions, including treatment for vocal fold paralysis, paresis, atrophy and scarring.
- Laryngeal surgery. This precise surgery is performed on the vocal folds. It is used to evaluate and remove various vocal fold lesions which may include cancer, cysts, papilloma, polyps and other conditions.
- Botulinum toxin injections. Botox® blocks nerve signals to muscles, causing them to relax, which can improve voice quality for conditions like dystonia. The injections are usually performed in a clinic procedure and may be given through the neck or through the mouth. They can improve vocal quality for about three to four months and may need to be repeated periodically.
Vocal Health Research
The Voice Program team is active in national clinical research to improve patient care and outcomes. Research protocols have included studies of voice disorders, laryngopharyngeal reflux issues, dysphagia and airway management. The program’s specialists are also members of a national papilloma task force and have collaborated with colleagues in Froedtert & MCW specialties on clinical trials for GERD and cancer.
Vocal Health Experts Focused on You
The Vocal Health Program staff includes two board-certified and fellowship-trained laryngologists (vocal cord specialists), Joel Blumin, MD, and Jonathan Bock, MD. The team also includes a nurse practitioner, dedicated voice/speech pathologists and a singing voice specialist. These experienced voice health experts work together with a focus on your specific needs.
Many of our staff are active in the performing arts and come from professional voice backgrounds themselves. They understand and genuinely care about your concerns, and can connect you with specialists in the vast Froedtert & the Medical College of Wisconsin referral network for other health needs. For many chronic or severe voice problems, simple voice rest is not sufficient and not always possible due to high-pressure careers. Our goal is to help you rehabilitate and preserve your vocal quality while balancing your professional demands.
Around-the-Clock Vocal Health Care
The Vocal Health Program offers a 24/7 hotline service, 414-456-SING (414-456-7464). Call this number to:
- Schedule an appointment during normal business hours.
- Connect during off-hours with the on-call Froedtert & the Medical College of Wisconsin Vocal Health Program physician if you have a voice issue that will affect an upcoming performance or other need.