Reporter Suffers Garbled Speech on Live TV

Many folks are already aware of a Los Angeles reporter, Serene Branson, who was covering on live TV the Grammy's when she suffered symptoms of garbled speech (dysarthria being the medical term).



It was initially conjectured that she was in the middle of a stroke, TIA, seizure, or something else bad... but it finally was determined by her doctors that it was due to a migraine.

This scary incident brings me to explain what a speech and what a vocal problem is. First some definitions.

Voice is sound production. Speech is what ultimately comes out the mouth after the sound is modified by the throat muscles, palate, tongue, lips, teeth, etc. Examples of voice problems are hoarseness and breathiness. A speech problem would be stuttering, mumbling, or sounding nasal.

This distinction is very important as it helps point the right way to treatment. Otherwise time is wasted on the patient's part seeing inappropriate doctors.

Generally, voice issues can be treated by an ENT as it generally is due to some physical voicebox problem whether it be vocal cord paralysis, vocal cord nodule, or spasmodic dysphonia.

Speech problems are due to the dis-coordination of the throat and mouth muscles and is NOT because of a physical problem that can be addressed surgically (generally speaking, though there are exceptions). The problem is at the brain level.

So taking the reporter above as an example... her vocal quality was quite normal. What was abnormal was her speech. Given the speech difficulties, the problem was at the brain level and not the voicebox. As such, an ENT is NOT the right doctor to see, but rather a neurologist.

However, there is one speech issue that CAN be addressed by an ENT quite well and that is nasal-sounding speech due to irregular nasal airflow (either too much or too little).

Rapid Strep Test Positive But No Sore Throat

Occasionally, I see patients who have received throat swabs for strep that have come back positive... even if they have no signs or symptoms of pharyngitis.

In this situation, there are 2 main actions a physician may take (I am biased towards one):

1) Prescribe antibiotics until throat cultures are normal
2) Do nothing

Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for???

Also, a person can be a carrier for strep without suffering any health problems. As such, even if the strep test is positive, but if the patient has no symptoms, I do not recommend treatment. (Which again begs the question of why bother getting a strep test if no treatment will be recommended regardless of the test result.)

I would go so far even to say follow-up cultures are NOT necessary after antibiotic treatment for strep throat if a patient does not have any more symptoms and exam is normal.

Which is why I find it surprising when children and adolescent patients receive multiple courses of antibiotics when they feel perfectly fine, but have received treatment just because a strep test came back positive.

Of course... that's just my opinion as I do acknowledge that there's another school of thought which supports antibiotic treatment of all strep positive cultures with follow-up cultures to ensure eradication.

Depending on the doctor you see, you will get different opinions. But it is good for patients to be aware of the varying views on this topic given how common sore throats are.

Get a Nosejob Without Surgery!

Well, only in Japan at least. Courtesy of Dr. Houtan Chaboki, I came across one of his posts showing this advertisement of a device that can mold your nose to the perfect shape (ie, rhinoplasty or nosejob)... all without cutting or any plastic surgery.

Before you go running off to buy one... I have been assured it doesn't really work.

However, before pooh-pooing molding as a scam, it IS an acceptable form of changing the shape of human features... such as the skull (craniosynostosis defects)... but only when the anatomic part being shaped is still cartilaginous.

Natalie Portman, Scientific Genius in REAL Life!

The New York Times published a great article about the serious scientific credentials of some of hollywood's most celebrated stars, Natalie Portman among them.

As a student at Syosset High School on Long Island back in the late 1990s, Ms. Portman made it all the way to the semifinal rounds of the Intel Science Talent Search competition. Her project was a new “environmentally friendly” method of converting waste into useful forms of energy. She also went to Harvard University and studied neuroscience and the evolution of the mind.

Ms. Portman apparently is not the only actor with serious scientific credentials.

Hedy Lamarr, the actress considered the "most beautiful woman in Hollywood,” was a rocket scientist on the side, inventing and patenting a torpedo guidance technique she called “frequency hopping,” which thwarted efforts to jam the signals that kept the missiles on track.

Danica McKellar, who has appeared on such shows as “The Wonder Years,” “The West Wing,” “NYPD Blue” and “Young Justice,” graduated summa cum laude in mathematics from the University of California, Los Angeles, where she helped devise a mathematical proof for certain properties of magnetic fields — a theorem that bears her name along with those of her collaborators.

Mayim Bialik plays the adorably frumpy-nerdy neurobiologist Amy Farrah Fowler on the "Big Bang Theory" sitcom. In real life, she also has a Ph.D. from U.C.L.A. in neurobiology.

Read this great story in the NYT here.

Olympic Athlete Hopeful With Vocal Cord Dysfunction

There was a recent article about Hannah Lupton, a heptathlete, who suffers from vocal cord dysfunction. This disorder is basically when the vocal cords come together during inhalation when it should be apart resulting in shortness of breath localized to the throat area.

Normally, during breathing, the vocal cords are apart as shown in the picture. When talking or swallowing, the vocal cords come together (TVC is True Vocal Cord).

Laryngospasm, which is the most severe form of vocal cord dysfunction, is when the vocal cords come together completely preventing any air from moving into the lungs resulting in a high pitched squeal when trying to breath. People may even faint due to lack of oxygen when this happens.

The vocal cord exercises as described in the news article may encompass these strategies among others:

METHOD 1: Breathing Technique
There are 3 steps to this particular method.

1. As soon as one feels an attack coming, SLOWLY breath in through the NOSE. DO NOT BREATH IN THROUGH THE MOUTH! Sometimes deliberately holding breath for 5 seconds prior to nasal inhalation helps.
2. More quickly exhale out the mouth with pursed lips.
3. Continue slow nasal inhalation, and quick mouth exhalation with pursed lips until the episode passes.

Why does this work? For some reason, nasal breathing reinforces the brain to keep the vocal cords apart when inhaling. Quick inhalation through the mouth seems to do the opposite and encourage the vocal cords to close which exacerbates the problem. Also, quick inhalation reinforces the Bernoulli Principle that as a fluid (air in this case) passes through a pipe that suddenly narrows (the vocal cords), the pressure actually decreases which encourages further narrowing (or vocal cord closure). Therefore, SLOW breathing helps keep the vocal cords apart! You can test this principle yourself by sucking air on a narrow short straw slowly and than quickly. You will find that the straw will tend to collapse when sucking in quickly.

METHOD 2: Straw Breathing

This method essentially forces a person to decrease the speed of breathing allowing for vocal cord relaxation. In essence, cut a regular drinking straw to half its length. When an attack occurs, place the straw in your mouth and make a tight seal. Breath thru the straw (via mouth) until attack passes.

Patients with recurrent laryngospasm attacks typically keep a straw in their pocket/purse to have immediately on hand.

METHOD 3: Pressure Point

Another manuever that may work is firm pressure in the "laryngospasm notch." Basically, with an attack, quickly with your (or somebody else's) index fingers, press very firmly just behind both your earlobes where there is a notch between the bone of your mastoid process and ear. Press deep and forward towards the nose. It should hurt. If it doesn't hurt, you are not pressing hard enough. The attack should resolve within 10 seconds. Here is an article describing this method.

METHOD 4: CPAP

This particular method applies only if laryngospasm attacks occur mainly at night while sleeping. Essentially, one uses a CPAP machine which blows air into your lungs while you sleep. This treatment helps by preventing the body from believing it is "drowning" which would result in vocal cord adduction. By having a persistent positive airflow from the CPAP device, it also reinforces to the brain to keep the vocal cords apart. At worst case, if an attack occurs, the CPAP machine helps push air into your lungs past the vocal cords. Indeed... if you ask any anesthesiologist what they do when a laryngospasm attack occurs during intubation, they'll say apply strong positive pressure by mask (along with other things of course).

Make sure you use heated humidification. Please be aware that the air pressure being applied MAY actually cause laryngospasm due to direct vocal cord irritation of the forced air. Unfortunately, there's no way to predict someone who will respond vs someone who will do worse with this treatment method.

Other Treatments

Oftentimes, the above strategies help enough that a patient finds these attacks occur less frequently with decreasing severity over time until they altogether stop. Rarely, a benzodiazepine medication will be prescribed for these attacks to help with the anxiety aspect until the strategy is internalized. Working with speech pathology has also been found to be helpful. In certain situations, laryngeal sensory neuropathy (LSN) may be contributing to VCD and treatment geared towards LSN improves VCD. Of course, treatment of the trigger whether it be allergy, asthma, or reflux is important.

In rare cases, I will consider injecting BOTOX into the vocal cords which will physically prevent the vocal cords from coming together and as such, prevent the difficulty in breathing should an attack occur. In some people, it decreases not only the severity, but also the frequency of attacks. The way BOTOX is injected into the vocal cords is shown below in the video. Please note that the vast majority of patients upon whom I perform vocal cord BOTOX injections are those suffering from spasmodic dysphonia.



Read the news article here.

Read more about vocal cord dysfunction here.