HealthWatch: Protecting Your Voice May Start With Your Stomach


MIAMI, Fla. (Ivanhoe Newswire) — Using our voice … it’s how we express ourselves. But if it becomes hoarse and raspy, it could be a sign of a medical condition. See how one man whose voice is his career found out how to protect his precious resource.
Nicholas Richberg’s voice is how he makes a living.
“I love being on stage, I love the connection with the audience,” Richberg said.
But with performances up to seven times a week, it can put a strain on his voice. 
Richberg shared, “All of a sudden I started feeling like my voice wasn’t responding the way I would expect it to.” 
David Rosow, MD, of University of Miami Health System says natural wear and tear on our voice happens over time. 
“Just like we are more prone to having issues with our knees and joints and muscles, the vocal folds are no different,” stated Dr. Rosow.
And it’s not just performers. 
“Teachers, parents, parents of small children, have incredibly high voice demands,” continued Dr. Rosow.
Doctor Rosow says if hoarseness during a cold lasts for more than two weeks, see a doctor.
“You feel like there’s been a change, it’s persistent and it’s not getting better or in fact it’s getting worse,” explained Dr. Rosow. 
Make sure you see an ear, nose and throat doctor. 
“We also see people who have benign nodules or polyps on the vocal folds,” said Dr. Rosow. 
Nicholas was surprised to learn his hoarse voice was due to gastroesophageal reflux disease.
“It was acid that was coming up and washing over my vocal folds,” explained Richberg.
Nicholas made some lifestyle changes. 
Richberg continued, “I couldn’t eat late after performances anymore, cutting out caffeine, cutting out alcohol.” 
He also learned vocal exercises  like light humming – to reduce inflammation. 
“It’s how we communicate, to not have it working right is a scary thing,” exclaimed Richberg.
Because the show must go on! 
Nicholas also stays well hydrated and sleeps with his head elevated to keep his voice in check. Doctor Rosow says with age men’s voices tend to get a little higher, while women’s voices get a little lower. 
Contributors to this news report include: Janna Ross, Field Producer; Roque Correa, Editor; and Judy Reich, Videographer.


BACKGROUND: Hoarseness may cause changes in pitch and volume, ranging from a deep, harsh voice to a weak, raspy voice. Hoarseness is generally caused by irritation of, or injury to, the vocal cords. The larynx is the portion of the respiratory tract containing the vocal cords. The cartilaginous outer wall of the larynx is commonly referred to as the “Adams apple.” The vocal cords are two bands of muscle that form a “V” inside the larynx. Hoarseness can be caused by a number of conditions. The most common cause of hoarseness is acute laryngitis (inflammation of the vocal cords) caused most often by an~upper respiratory tract infection and less commonly from overuse or misuse of the voice (such as from yelling or singing). The rapidity of onset and any associated symptoms will depend on the underlying cause leading to hoarseness. A physical exam will focus on the head and neck. Often times, a diagnosis can be made based on this initial assessment. In some instances, a long lighted flexible tube (fiberoptic scope) will be inserted into the throat to directly visualize the vocal cords if no other cause is initially identified.

CURRENT TREATMENT: The treatment for hoarseness depends on the underlying cause. Acute laryngitis caused by an upper respiratory tract infection will usually improve on its own as the infection clears the body. Conservative treatment with~cough~suppressants and humidified air can be helpful. Voice rest is also recommended in order to avoid further irritation or injury to the vocal cords. Antibiotics are not indicated for most cases of acute laryngitis. Individuals with hoarseness caused by vocal overuse or misuse should adhere to voice rest, as serious injury (such as vocal cord hemorrhage) can occur to the vocal cords if the voice is strenuously used during episodes of acute laryngitis. Medications for gastroesophageal reflux (GERD) or~allergies~can treat hoarseness if either of these is found to be the underlying cause. And, in some instances, surgery may be necessary for benign nodules or polyps, trauma to the larynx/vocal cords and for~cancer~of the larynx.  

ONGOING TREATMENT FOR HOARSENESS: The 2018 update provides an algorithm for healthcare providers to determine when acceleration of care is needed. These include but are not limited to recent surgical procedures involving the head, neck, or chest; presence of a neck mass; respiratory distress; history of tobacco use; or whether the patient is a professional voice user. In addition, the update shortens the timeframe that hoarseness can be managed conservatively, from 90 days to four weeks, before evaluation of the larynx is recommended to determine the underlying cause. “One of the goals of the update is to provide clarity to healthcare providers on circumstances where early referral to an otolaryngologist for visualization of the larynx is necessary,” said David O. Francis, MD, MS, guideline development group assistant chair. “Hoarseness is often caused by benign conditions, like the common cold, voice overuse, age-related changes, and others; however, it may also be a symptom of a more serious condition, like head and neck cancer. Failure to evaluate the larynx can delay cancer diagnosis, resulting in the need for more aggressive treatment and reduced survival.” Voice problems affect one in 13 adults annually, however, it can affect patients of all ages and sex. There is an increased prevalence in singers, teachers, call-center operators, older adults, and other persons with significant vocal demands. The guideline also provides recommendations on treating patients presenting with isolated hoarseness.

? For More Information, Contact:

Joanna Palmer, Director of Media Relations/University of Miami Health System 

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