When your patients experience vocal concerns, they may or may not tell you. While it is common for professionals like teachers, attorneys, coaches and members of the clergy to experience these issues, they may consider them facts of life they must suffer through within their profession. Some vocal problems are temporary and easily managed with basic therapies like resting the voice. However, when your patient has persistent hoarseness or other long-lasting voice problems that affect quality of life and communication abilities, it may be time for a deeper look.
The multidisciplinary Froedtert & the Medical College of Wisconsin Vocal Health Program offers an accurate diagnosis and personalized treatment. One of few dedicated voice programs in Wisconsin, the Vocal Health Program offers the expertise of specially trained laryngologists and MCW faculty members Joel Blumin, MD, FACS, and Jonathan Bock, MD, FACS. Speech-language pathologists and other clinical professionals complete a comprehensive team that treats everyone from teachers to opera singers.
Disease, Injury and Misuse
“Vocal conditions arise from a host of causes,” Dr. Blumin said. “Infections, nodules, polyps and cysts on the vocal cords, vocal cord scarring, benign tumors, papillomatosis, malignancies such as squamous cell carcinoma, and neurological conditions like Parkinson’s disease can all cause vocal disorders.” An acute injury or a virus can also affect the voice.
Additionally, the manner in which an individual uses the voice can lead to a behavioral voice disorder. “When people use their voice inefficiently, it can become hoarse or weak,” Dr. Blumin said. “It gives out at the end of a sentence or at the end of the day.”
For example, teachers are particularly susceptible to behavioral voice disorders because they strain to be heard in a loud environment and their training does not include voice instruction. “The treatment for a behavioral voice disorder focuses on voice therapy that is managed by a specialist in speech-language pathology,” Dr. Blumin said.
Treatment
The Vocal Health Program provides patients and their physicians with prompt answers to their concerns. Dr. Blumin evaluates patients by listening to the voice first, followed by an examination of the larynx with a high-definition endoscope.
“We record the laryngoscopy and review the findings with the patient in a single office visit,” he said. The findings are then reported to the patient’s referring physician.
Many problems can be treated with speech therapy alone, while others require surgery, medical management or a combination of modalities. A number of procedures are performed in the office.
“For instance, we treat benign tumors and papillomatosis in the office with lasers,” Dr. Blumin said. “This 15-20 minute treatment is effective and gets the patient back to work or home shortly after the appointment.”
Other procedures, such as injections to strengthen weak or paralyzed vocal cords or to treat inflammatory conditions, are also office-based. More complex conditions may require surgery.
Beyond addressing common voice problems, the Vocal Health Program team is experienced in treating people who have rare disorders, including laryngeal dystonia. Dr. Blumin is a medical advisor for the National Spasmodic Dysphonia Association.
Personalized Approach
“Voice changes are very personal, and it’s important to offer treatment that considers each individual’s goal,” Dr. Blumin said. “An individual with hoarseness might only want confirmation that symptoms are not cancer-related, while a singer who is missing a semitone may worry about her career.”
If a hoarse voice persists for more than two weeks and your patient has recovered from potential benign causes like a cold, it may be time for a specialty referral, especially because cancer of the vocal cords may be a consideration.
“Our team will evaluate the referred patient to pinpoint a diagnosis and form a treatment plan,” Dr. Blumin said. “We’re collaborative — the patient and referring physician will be fully informed about what’s going on and the steps we’ll take to treat the problem.”
Specialists within the Vocal Health Program can help anyone who experiences voice issues, breathing or swallowing problems. “We’re the doctors of human communication,” Dr. Blumin said.
