There is a current advertising campaign for a major insurance company that features a football fan at a game cheering  with all his might. The ad goes on to say that voice therapy for the resulting vocal cord injury (Phonotrauma) that limited his daily living activities and threatened his livelihood, was proudly covered under most of their policies.  
                                                                                                            
   The term Phonotruama has been used to label the impact of certain vocal behaviors on vocal cord tissue. People with Phonotrauma or other voice disorders frequently have a hard time getting their health insurers to pay for voice treatment. Although some major insurers continue to exclude coverage unless there is evidence of anatomic abnormality, private health plans are increasingly covering voice evaluation and intervention.

   There are several professions that are hazardous to vocal health. Teachers, Coaches, Ministeres, Lawyers, even restaurant managers tend to burden their voices by speaking loudly for long periods without sufficient rest or recovery. Complicating the problem are noisy work areas, inhalation of aiborne irritants, and varying stress levels. According to reports, an estimated 5% to 10% percent of Americans rely on their voice as their primary tool of trade (I. Tize, et. al Journal of Voice 1997).  Throat discomfort, strain during voice use, vocal fatigue and difficulty producing a lound/clear voice, contribute to a large portion of work disruptions, absenteeism and even career changes. Because of lost workdays and treatment expenses, the societal costs in the United States alone have been estimated at a staggering $2.5 billion annually by K. Verdolini and L. Ramig in their 2001 article. (Logopedics, Phoniatrics, Vocalogy)
                                                                                        
   Specific patterns of voice use that typically need attention include speaking too loud, long or fast; speaking with a tightly clenched or restricted jaw; using a pitch that is too high or too low; frequent yelling, shouting or screaming; excessive coughing or throat clearing; and singing outside of a natural range. (This last behavior is most apparent on the many television shows designed to find the latest "stars", some of whom are encouraged to use extreme vocal styles to get attention.)

   Whether caused by job related, competition, or game day activities, the most common result of vocal overuse is that the vocal cords collide with greater tension and force causing a swelling response and over time, the formation of nodules. With most clients 'basic treatment concepts' of self-monitoring and increased hydration will help treat the nodules caused by Phonotrama. Some additional voice use suggestions include:

  • Learn how to increase volume safely by cheering or yelling at a lower frequency level where, theoretically, vocal cords are more lax and shorter and less susceptible to voicing impact.
  • Take voice naps. Make time during the day when talking time is limited.
  • Substitute behaviors such as sipping water and using a hard swallow for throat clearing.
  • Use an easy onset, rather than a hard attack, and speak softly, as if you were telling a secret.
  • Anticipate noisy circumstances- for example parties and sports events. Identify 'triggers' for vocal overuse and rehearse the strategies that lead to easy voice.
  • Hydration-drinking water based beverages.
  • Consider the use of a cool mist humidifier which increases the moisture in the air to decrease drying effects and keep excess mucus thinner and more easliy cleared. Humidifiers also contribute to decreased coughing and throat clearing.

    For other factors causing voice difficulties more extensive treatment may be required. Allergic reaction to environmental allergens that cause irritative nasal or sinus drainage or incidents of esophageal reflux can create symptoms that affect the larynx. 
    Dr.Robert Sciacca at Alabama ENT is proud to provide evaluation and treatment services for these conditions and to prescribe medications as needed that can help reduce acid reflux and nasal or sinus drainage that finds its way to the throat and larynx. In association with the specially trained SLP's (Speech Language Pathologist) of Franklin Vocals, Alabama ENT patients are assisted with the identification and evaluation of voice disorders and given access to qualified and licensed professionals that provide treatment and advocate for appropriate coverage.

This article is adapted from the March 2013 issue of the ASHA Leader-Vocal Health www.asha.org/leader

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