Voice Problems Trouble Teachers

A hoarse voice is an endemic problem in professions who use their voices a lot including preachers, journalists, lawyers, and especially teachers. In the general population, 1 in 4 report a voice problem at some point in their life. Among teachers, 47 percent report some degree of voice abnormality on any given day; 20 percent of teachers report missing work due to voice problems, and 1-in-10 teachers has been forced to leave the profession by voice woes.

Even in Fauquier County, every year there are a few teachers I place on short-term disability due to the severity of their voice disorder.

Read a news article on this subject here.

Reference:
Voice Problems of Classroom Teachers: Incidence, Symptoms, and Associated Factors http://www.drwag.com/939.html (Presented at American Speech-Language-Hearing Association Annual convention, Philadelphia, 2004)

Prevalence of voice disorders in teachers and the general population. J Speech Lang Hear Res. 2004 Apr;47(2):281-93.

Dr. Chris Chang... The Ex-Cellist...

I've had plenty of patients ask me about my musical background given my Eastman School of Music Diploma in Cello Performance hanging in my waiting room.

First off... I graduated from the Community Education Division of Eastman School of Music... Not the undergraduate or graduate program. However, it was a very fine education I received there which lasted from 1987-1992 (started playing the cello at age 5 until 24).

In order to receive this diploma (or perhaps a better term would be certificate), I had to complete a specified curriculum including music theory (levels 1-3), composition, music history, piano, chamber music, as well as the dreaded solo performances in Kilbourn Hall and Howard Hanson Hall... not just once, but several times a year.

While attending Eastman, I took private lessons from three awesome teachers including Polly Hunsberger, Ingrid Bock, and David Ying. I was pleased to see my first two teachers still playing with the Rochester Philharmonic Orchestra. Prior to Eastman, I took private lessons at a SUNY Geneseo college with Prof James Kirkwood.

Orchestra-wise, I participated with the Rochester Philharmonic Youth Orchestra, Greater Buffalo Youth Orchestra, and the New York All-State Orchestra. In college, I continued to play the cello with the Yale Symphony Orchestra as well as various chamber groups. I believe I played in my last concert in 1998 after which I pretty much stopped playing.

Some of my favorite cello pieces I played include Cello Concerto No. 1 by Saint-Saens and Cello Concerto in D minor by Lalo. The last cello piece I was working before "retiring" was Cello Concerto No. 1 by Haydn.

My most exciting moment playing the cello is perhaps Overture to Candide by Bernstein with the New York All-State Orchestra.

Another fine moment was Russian Easter Overture by Rimsky-Korsakov with the Greater Buffalo Youth Orchestra.

And yes... the picture posted here is my very own trusty cello... which usually hangs out in my closet, but opened up briefly for the purposes of this blog.

Here's my complete musical CV here.

Will I ever play again??? Well maybe... someday...

Caffeine Can Cause ENT Problems

After reading an interesting article in Forbes that described caffeine as a natural pesticide (for real!), I thought I would pipe in and report the types of problems caffeine can cause in humans from an ENT perpective...

Caffiene can contribute to (some proven, some suspected, some debatable):

• Tinnitus
• Meniere's Disease
• Migraine Headaches
• Headaches
• Dizziness
• Reflux
• Lump in Throat Sensation (Globus)
• Chronic throat clearing
• Dry throat
• Phlegmy throat

Alcohol and salt are other big as well as under-recognized items that may cause similar ENT issues.

Bone Drugs May Increase Risk of Throat Cancer

Well, at least that is what USA Today reported on September 3, 2010 with the title "Bone drugs may raise throat cancer risk". In actuality, bone drugs like boniva, fosamax, actonel, etc may possibly increase the risk of esophageal cancer which is actually not "throat cancer" and is in fact treated by a totally different specialty than ENT who is historically considered the throat expert.

Really, the specialty to see regarding esophageal cancer are the gastroenterology doctors or a general surgeon.

In any case, the study published in JAMA found that when taking bone drugs, the risk of developing esophageal cancer (not throat) was 2 in 1,000. Normally, the risk of developing cancer of the esophagus in people aged 60 to 79 is 1 in 1,000.

The increase is not that staggering. Not even close. I call it a "blip" of an increase.

Read the USA Today story here.

Read the JAMA research abstract here.

NPR on Muscle Tension Dysphonia aka (Hyper-)Functional Dysphonia

NPR reported on July 12, 2010 one woman's travail overcoming a raspy voice due to laryngeal hyperfunction (also known as muscle tension dysphonia). Voice therapy provided a cure for her condition.

I should state that muscle tension dysphonia (MTD) is NOT the same as spasmodic dysphonia and the two disorders are often confused with each other... and treated completely differently from each other.

MTD is when the muscles of the voicebox are too tight causing a raspy voice. This very commonly occurs after a viral laryngitis/cold. My (unsupported) hypothesis is that the brain tries to achieve a normal sounding voice in a setting of laryngitis where the voicebox is inflamed and swollen. This attempt at normalcy usually results in hyperfunction of the muscles composing the voicebox.

Unfortunately, once the laryngitis resolves, the patient is still locked into a mode of hyperfunctional voice use, even though there's no more need to do so. In essence, it has become muscle memory or a bad habit.

Voice therapy in its purest form tries to get the brain to revert back to a more normal muscle pattern while talking by essentially teaching the patient to break this bad habit. Whether that includes laryngeal massage as in the article or via specific vocal exercises, it depends on the patient. There is not one specific treatment that will work on everyone with this condition.

Spasmodic dysphonia is when specific muscles of the voicebox goes into spasm, much like people with eye twitches. It is involuntary and occurs at random without warning. Treatment for spasmodic dysphonia is botox injections. Voice therapy does play a limited role in allowing for a longer duration of botox effectiveness which typically wears off in about 3 months before repeat injection is required.

Read the NPR story here.

Read more about muscle tension dysphonia here.

Read more about spasmodic dysphonia here.

Of note, our clinic specializes in these disorders.