Professional Voice - Penn Medicine Becker ENT & Allergy

If you are a professional voice user (i.e. you rely on your voice for your living), even a mild voice disorder or change in your voice quality can cause you to experience big challenges in your daily life, both personally and professionally. Professional voice users require daily, prolonged, and extensive voice usage for their career success and are therefore at an increased risk of developing voice disorders due to the nature of their work. The term “professional voice user” can include many different types of works, but some of the most common professions include: singers, actors, teachers/professors, voice teachers, attorneys, clergy, telemarketers, physicians, customer service representatives, salespeople, and more. For a professional voice user, a voice disorder can result in a temporary loss of income, loss of employment, and/or increased emotional stress and anxiety.

At Penn Medicine Becker ENT & Allergy, not only do we have a group of excellent physicians who understand your concerns, we also have a highly specialized speech-language pathologist who has extensive training in the particular areas of voice and singing voice disorders. Carly has worked with and rehabilitated hundreds of professional voice users from CEOs to teachers to Broadway performers. She not only has a background in treating and rehabilitating these professional voice users, she was one herself as a previous performer and went through a vocal injury with vocal rehab.

With this specialized team, Penn Medicine Becker ENT & Allergy has the unique ability to understand the urgency and magnitude of your voice problem and the way it can and likely is impacting your daily life. Our goal is to help you through your vocal recovery as seamlessly and efficiently as possible with as little impact on you emotionally and financially.

Common Professional Voice Injuries (not limited to:)

Vocal Fold Nodules:

Vocal Fold Nodules are benign (non-cancerous) lesions, typically found bilaterally (on both vocal folds). Vocal fold nodules are most often the result of voice abuse, misuse, or overuse over an extended period of time. The repeated impact on the surface of the vocal folds often results in callous like lesions. Nodules can vary in size greatly, from pin-size to quite large.

Vocal Fold Hemorrhage:

A Vocal Fold Hemorrhage is a bleed into the superficial lamina propria of the vocal fold (the layer that gives the pliability to the vocal fold vibration). Vocal fold Hemorrhage is the result of phonotrauma (stress or abuse to the surface of the vocal folds or the tiny blood vessels in the vocal fold).

Vocal Fold Polyp:

Vocal Fold Polyps are benign, fluid filled lesion which can be found unilaterally (one sided) or bilaterally (two sided) on the vocal folds. Polyps may appear broad based and more blister like (sessile) or may appear to be attached by a stalk (pedunculated). Vocal fold polyps are thought to be caused by trauma to the vocal folds (i.e. misuse/abuse of the voice).

Vocal Fold Scarring:

Vocal Fold Scarring of the vocal fold means that the mucosa (covering of the vocal fold) is tethered to the underlying tissue and cannot vibrate freely. Vocal fold sulcus is slightly different and means that the good tissue in the Reinke’s space of the vocal folds (or the superficial lamina propria) is missing (or may be filled with scar) and therefore cannot vibrate normally.

Muscle tension dysphonia:

Muscle Tension Dysphonia is described as dysphonia/hoarseness/voice disruption without any physiologic abnormality found in/on the vocal folds. Often, patients with MTD will report periodic pain in the sites of the larynx, neck, and other areas from the neck up. Patients with MTD may report large variability in their voice, from moments of complete normal voice to moments of aphonia (complete voice loss), but there can be patients with MTD who have more moderate dysphonia at all times. MTD can be present only in the singing voice and not in the speaking voice for some individuals.

Vocal Fold Cyst:

Vocal Fold Cysts are benign (non-cancerous), fluid-filled growths that can be present congenitally (since birth) or can be acquired later in life. Cysts typically occur unilaterally on the vocal folds (one-sided), but can occur bilaterally (both sides). Cysts occur under the mucosa of the vocal fold and cause the vocal fold to be stiff in the area of the cyst.

When to Seek out Evaluation from a Voice Team (Otolaryngologist and Voice Pathologist)

If you are experiencing a minor voice change that has lasted 2 or more weeks, you should seek out an evaluation with a multidisciplinary team regardless of your profession. However, if you are a professional voice user and rely on your voice daily for your income and success, you should seek out an evaluation with a voice team within two days if you experience sudden changes in any of the following areas:

Sudden onset of hoarseness, raspiness, or breathiness in the speaking and/or singing
Abrupt changes to voice sound quality in speaking and/or singing voice (breathy, raspy, pitch breaks or cracks)
Significant changes to your vocal range (i.e. loss of high notes, loss of low notes, loss of mid range)

Minor voice changes may include:

Increased warm up time
Straining or increased effort when talking and/or singing
Throat pain or discomfort with speaking and/or singing
Decreased ability to control dynamics in singing voice
Increased effort in specific styles of singing (i.e. belting, classical singing, etc)
Increased vocal fatigue

*Note: It is absolutely crucial that you seek out care from a team who is well versed in care for professional voice users. Not all Ear Nose and Throat Doctors specialize in care for the professional voice users. When you get an exam of your voice, it should be a videostroboscopic examination which should be an exam performed with slow motion imaging, recorded on a screen, and played back for you and explained in detail. If you do not receive this level of care and evaluation, you should seek out a second opinion.

**Additionally, we recommend that if you are a professional voice user and rely on your voice for a living that you consider getting a baseline exam. This means that you come for a videostroboscopic examination when you are feeling 100% vocally and physically healthy. Not everyone’s vocal folds appear anatomically normal and that is okay. When you are feeling vocally normal, we can assess the structure and function of your vocal folds and know what your baseline looks like. Therefore, if you ever come upon a symptomatic problem in the future, you will know what your baseline is to compare to and ensure no findings are actually incidental. You can take a video of your stroboscopic video on a phone or smart device and have it with you indefinitely.

PATIENT TESTIMONY:

“When it comes to vocal health, Carly Schiff absolutely changed the game for me. Her vast knowledge, skillful care and warm bedside manner made my post-injury healing process a breeze. Don’t even think twice, call her up and get your voice stronger than you ever thought it could be.” – Nik Walker, Aaron Burr in Hamilton An American Musical on Broadway and US Tour.