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Talking About Voice Disorders

They're an under-treated problem

FRIDAY, Oct. 18, 2002 (HealthDayNews) -- Demi Moore's raspy voice might sound sexy to her fans, but to voice disorder specialists she has a problem.

They think it might be nodules on her vocal folds, though they couldn't be sure without an examination.

And Clint Eastwood's menacing whisper? It could be an actor's trick to get "in character." But it could also be a stiffness of the larynx that comes with aging.

Voice disorders are a common but under-treated problem, voice experts say. About 3 percent to 9 percent of the U.S. population has a voice disorder, according to the American Speech-Language-Hearing Association. And about 70 percent of people over age 48 develop problems with their voice because of aging.

"People really don't think much about how they speak until there's something wrong," says Joseph Stemple, director of the Blaine Bloch Institute for Voice Analysis in Dayton, Ohio.

What is a voice disorder?

"Anything that impairs your voice enough that you have to modify how you function, whether it's not talking on the phone or having to work hard to make your voice sound normal," says Julie Barkmeier, an assistant professor of speech and hearing sciences at the University of Arizona. It's "anything that results in abnormal production or absence of voice quality, including pitch, resonance, loudness or duration."

Laryngitis is a transient voice disorder that just about everyone gets at some point, but other voice disorders are more serious.

There are psychological voice disorders. Some people entirely lose their voice due to extreme stress and anxiety, Stemple says.

There are neurological voice disorders as well. One is spasmonic dystonia, which occurs when the vocal chords spasm uncontrollably, leading to choked and strangled-sounding speech. Spasmonic dystonia can be treated with Botox, the same muscle-paralyzing toxin that's used to erase wrinkles, Stemple says.

The people most susceptible to many types of voice disorders are the people who need and use their voices the most -- teachers, actors, singers, salespeople, receptionists and telemarketers, though you won't find much sympathy for them, Barkmeier admits.

"Some people have had to change their profession because of it," she says.

One common problem is nodules on the vocal folds from overuse, or misuse, of the voice. It's characterized by a hoarse, raspy voice.

To make sound, air passes over the vocal folds (the clinical term for vocal chords) and they vibrate. When the folds vibrate too much, they can smack against each other, leading to soft and swollen spots that eventually develop into callus-like nodules.

Barkmeier guesses that rock singer Rod Stewart has them. Julie Andrews also had them and underwent surgery to have them removed. She sued the surgeons afterward, claiming the surgery ruined her singing voice. The lawsuit was settled for an undisclosed amount.

Many other performers, including some of Barkmeier's clients, never get their nodules treated. "They're not very motivated to get it treated because they think it sounds sexier," she says, adding there are many other things you can do for nodules before resorting to surgery.

Laryngeal cancer, or cancer of the larynx, can also cause a change in your voice quality. If you have a pronounced change in your voice that persists for two weeks or more, you should get checked out by your doctor, Barkmeier says.

So how can you prevent voice disorders? Voice specialists encourage you to take care of your voice by practicing good "voice hygiene."

"A lot of people could prevent having problems in the long run if there was information out there about good vocal hygiene," Barkmeier says. "We know using the voice, especially improperly, for long periods of time can cause a breakdown of the voice overtime."

Here are some tips on protecting your voice:

  • Don't yell or talk loudly over background noise. Speak at a comfortable pitch and loudness.
  • Don't cough or clear your throat frequently.
  • Stay well-hydrated. Drinks lots of water and reduce your caffeine intake.
  • Don't smoke. It can irritate the vocal folds.
  • Before speaking, take a deep breath. Lack of air can strain the muscles of your larynx.
  • Give your voice a rest.

What To Do

For more information on voice problems, check the American Speech-Language-Hearing Association or the Center for Voice Disorders at Wake Forest University Baptist Medical Center.

SOURCES: Julie Barkmeier, Ph.D., assistant professor, speech and hearing sciences, University of Arizona, Tucson; Joseph Stemple, Ph.D., director, Blaine Bloch Institute for Voice Analysis, Dayton, Ohio
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