Singer John Mayer Has Recurrence of Vocal Cord Granuloma

In September 2011, grammy-award winning singer John Mayer announced the cancellation of a number of concerts as well as an album due to the development of a vocal cord granuloma of his voicebox. Read a blog article about this.

On Oct 20, 2011, he underwent surgery to remove the granuloma and was on strict voice rest for several weeks with plans to resume live singing in the first quarter of 2012.

Unfortunately, on March 9, 2012, it was found that his vocal cord granuloma has recurred in the same location. In a statement he publicly released:

"Because of this, I have no choice but to take an indefinite break from live performing. Though there will be a day when all of this will be behind me, it will sideline me for a longer period of time than I care to have you count down."

 Is this unusual that his vocal cord granuloma recurred?

Unfortunately, it is not...

Vocal cord granulomas are benign masses that commonly are due to repetitive mild vocal trauma resulting in exuberant growth of a specific region of the voicebox lining. An imprecise analogy of what a granuloma is would be a keloid of the skin. Unfortunately, such repetitive mild vocal trauma includes talking/singing, hence the high risk of recurrence. The key to treatment is to allow the granuloma site to heal COMPLETELY prior to any further phonotrauma (ie, talking/singing).

Strict voice rest as well as voice therapy helps as it eliminates the repetitive phonotrauma that promotes regrowth. Reflux control is also essential. However, it is not unusual that steroid injections to the granuloma site as well as even botox injection to partially and temporarily paralyze the vocal cord may need to be pursued for complete resolution. Laser and mitomycin C application has also been found to be helpful.

Surgical removal of the granuloma may have looked something like this video...

To summarize, the steps followed when a granuloma-like mass is discovered on exam is as follows:

1) Trial restricted voice use and reflux medications. Voice therapy also strongly recommended. Strict voice rest is preferred if possible.

2) If no improvement after a period of time, surgical excision to ensure it truly is a granuloma and not cancer or some other pathology

3) Follow-up with steroid injections to the granuloma site. Watch video below.

4) Botox injection can be considered which chemically prevents complete vocal cord adduction preventing the repetitive trauma to the granuloma site.

5) Re-excision may be required at which time mitomycin C application can be tried.

Read more about voicebox granulomas.

Source:

John Mayer's Granuloma Returns, Singer Taking "Indefinite Break From Live Perfoming". E Online 3/9/12

What is the Voicebox Doing When You Scream? Yodel?

In the same spirit of a recent TEDMED talk by Nate Bell and re-published on CNN Jan 12, 2012 whereby he performed various beatboxing noises while stroboscopy was performed, I decided to record a similar video with a person performing various unusual human vocalizations to see what happens.

For those who don't know what stroboscopy is, click here.

Such vocalizations recorded included various types of human screams and a yodel.

Check it out here...

Respiratory Spasmodic Dysphonia

Respiratory spasmodic dysphonia is one of the most rare subtypes of a class of laryngeal dystonia collectively known as spasmodic dysphonia. It is also known more accurately as laryngeal adductor breathing dystonia or respiratory spasmodic dystonia or respiratory laryngeal dystonia.

Introduction

Spasmodic dysphonia is a type of dystonia in which there are involuntary muscle spasms or contractions of the muscles involved in voice production. This disorder is similar to the involuntary eyelid twitches of blepharospasm. Spasmodic dysphonia should not be, but is often confused with muscle tension dysphonia or tremor. There are 2 main types of spasmodic dysphonia: ABductor and ADductor. Other much more rare types include mixed and respiratory.

ADductor dysphonia is when the vocal cords comes together suddenly while talking resulting in voice stops and effortful speech. Often, the voice chokes off. Counting from 80 to 89 is harder than counting from 60 to 69. Stressful situations often exacerbate the condition. ABductor dysphonia is when the vocal cords suddenly moves apart while talking resulting in loss of voice (breathy). These patients find counting from 60 to 69 harder than counting from 80 to 89. ABductor dysphonia is not as common as ADductor dysphonia.

Respiratory Spasmodic Dysphonia

Respiratory spasmodic dysphonia is when the vocal cords come together suddenly when inhaling. So the voice actually sounds quite normal... until the patient takes a breath in. During such inhalation, one can hear an audible choking sound.

A brief word about nomenclature. "Dysphonia" means hoarseness. As such, the term respiratory spasmodic dysphonia is not accurate. Rather, "dystonia" should be used instead which is defined as an abnormal muscle contraction.

In the video clip shown above, in the first half of the video, listen to the audio of a patient suffering from respiratory spasmodic dystonia talking. The latter half is a video of the patient's voicebox while vocalizing. Note that the vocal cords intermittently do not move apart when she is taking a breath in. Normally with breathing, the vocal cords should move apart to allow air to pass between the vocal cords.

Treatment

Treatment is the same as for ADductor spasmodic dysphonia. Botox is injected into the vocal cords which reduces the spasms when she takes a breath in.

Watch a video of botox being injected.

Click here to read more about spasmodic dysphonia.

Dr. Chang performs botox injections for this disorder every Friday afternoon.