Voice disorders center offers treatment options for vocalists

By Russell Rian

UT Southwestern has gathered a team of specially trained physicians and therapists to launch a new center for voice care dedicated to disorders of the voice and larynx.

“The voice is really the window to your soul. People’s emotions are very tied to their voice,” said Dr. Ted Mau, newly recruited assistant professor of otolaryngology — head and neck surgery and director of the Clinical Center for Voice Care. “Especially for those who depend on their voice for their profession and their livelihood, we are able to help and really make a difference in their lives.”

The voice care center targets professionals who rely on their voice — singers, actors, public speakers, lawyers, preachers and teachers — as well as seniors or anyone else experiencing deterioration or other problems.

Members of UT Southwestern's new Clinical Center for Voice Care include (left to right) faculty associates Allison McFarland and Janis Deane, clinical associate professor Dr. Barbara Schultz, and assistant professor and director Dr. Ted Mau, all from the Department of OtolaryngologyHead and Neck Surgery.

“Voice issues affect more people than you would expect,” said Janis Deane, one of two specially trained speech and language pathologists at the new center. “A lot of times people live with problems with their voice because they don’t know what to do. Or they get hoarse, and they think it’s just a sign of aging, or maybe they had a trauma, and they think that their voice is going to be kind of raspy.”

A full range of treatment options are available at the center, Dr. Mau said.

“We see people with vocal-cord polyps, cysts and nodules that cause hoarseness,” he said. “Small ones may respond to voice therapy alone, but large ones may require a combination of therapy and surgery.”

Leta Henderson, a chemical company employee, said she first suspected something was wrong when co-workers began asking about her voice.

“People would make comments about my voice and asked me what was wrong while I was speaking,” she said. “I sounded like I was running out of breath, and for a long time I was in denial. I thought it was just stress.”

But the problem didn’t go away.

“In department meetings, I wouldn’t speak because I was afraid of what my voice sounded like. It’s humiliating to try to communicate with people when you can’t talk,” Ms. Henderson said. “The more attention I put on it the worse it got, to the point it wasn’t my voice. I called it 'the voice,' but it wasn’t the voice I remembered.”

After seeing several physicians, she visited a UT Southwestern otolaryngologist who determined she had spasmodic dysphonia, which is caused by involuntary movements of the larynx or voice box. The condition, more prevalent in women than men, causes a strained or breathy voice and, in some cases, can make it difficult to speak more than a couple of words at a time.

Ms. Henderson first tried therapy, which gave her some useful coping skills but didn’t solve the problem. She then was treated with botulinum toxin injections, which help for about six months at a time.

“My life has been impacted drastically from having this; however, Botox has helped to reduce the spasms, and I am grateful,” she said.

Unfortunately, many people fail to seek professional help for voice problems, said Dr. Mau, a fellowship-trained laryngologist who completed his training at Vanderbilt University. He earned his medical degree at Harvard Medical School and his Ph.D. from the University of California, San Francisco.

Problems with hoarseness and swallowing can adversely affect quality of life and even health, according to fresh research presented in September at the annual meeting of the American Academy of Otolaryngology — Head and Neck Surgery. Nearly three-quarters of seniors with voice problems did not seek help for problems that made it hard to talk, eat or drink; and more than half did not even know treatment was available.

In addition, a National Institutes of Health study of voice problems revealed that while obvious voice users such as singers were on the top 10 list of those seeking help at voice centers, the majority of patients were retirees, homemakers, factory workers, executives, teachers, students and nurses. Most are people who rely on their voice on a daily basis. In one of the largest studies that examined voice problems, teachers accounted for only about 4 percent of the population but represented about 20 percent of those seeking help at voice centers. Other studies have demonstrated that educators are nearly twice as likely to report voice-related problems such as hoarseness.

“Many of the patients I see are not professional singers. More often they are teachers, salespeople, stay-at-home moms, clergy — anyone who uses his or her voice on a regular basis,” Dr. Mau said.

Voice Care Center Services
The UT Southwestern Clinical Center for Voice Care, on the seventh floor of the James W. Aston Ambulatory Care Building, offers these services:

Videostroboscopy, which allows patients to see how their vocal cords are functioning.

Voice therapy, to teach techniques designed to correct vocal patterns that may be contributing to vocal abuse or misuse.

Botulinum toxin (Botox) injections, which treat spasmodic dysphonia.

Thyroplasty and vocal-fold augmentation, operations on the voice box to strengthen weak vocal cords that are causing hoarseness or breathy-sounding voice.

Microsurgery of the vocal folds, a minimally invasive procedure to remove polyps or cysts causing hoarseness.

So when should someone see a voice specialist?

“Anyone with a cold can lose their voice temporarily, but if a voice problem persists and the reason is not clear, then that should be evaluated,” Dr. Mau said. People with voice problems such as hoarseness or changes in pitch that last more than two months, as well as those with persistent laryngitis or a sudden loss of voice, should see a specialist.

Others seeking care may include singers who want an analysis of their voice while healthy for later tracking purposes. The Dallas-Fort Worth area is home to two professional opera companies and several major choral groups, along with traditional church and school choirs and numerous university vocal programs.

“Voice care is similar,” Dr. Mau said. “You may have a voice coach, but you may also need a vocal therapist to make sure you are using muscles in the most efficient way. If they develop an injury, they may need surgery.”

Common causes for voice problems include misuse, such as loud talking in noisy environments and excessive coughing; exposure of vocal cords and larynx to smoking or acid reflux; and indirect causes, such as musculoskeletal tension. Allergies, medications and water consumption can also affect the voice. Neurogenic disorders such as spasmodic dysphonia, Parkinson’s disease, amyotrophic lateral sclerosis and multiple sclerosis also can contribute to vocal dysfunction.

The Clinical Center for Voice Care is staffed by Dr. Mau and Dr. Barbara Schultz, clinical associate professor of otolaryngology — head and neck surgery. Ms. Deane and Allison McFarland, another voice therapist, specialize in voice and swallowing rehabilitation, voice restoration therapy and care of the professional singing voice. To make an appointment, please call 214-645-8898.