• 3/31/2005
  • Ann Arbor, MI
  • University of Michigan Health System as reported by Newswise.com

Alice Lundsten thought it was just a cough that wouldn’t go away. But it turned out to be much more than that. Sounding hoarse, and feeling like there was something stuck in her throat, Alice went to her doctor for a checkup. The doctor suspected something was wrong but couldn’t see it, so she sent Alice to a specialist.

And that’s when Alice learned she had cancer — on one of her vocal cords.

After laser microsurgery to remove the tumor, and voice therapy to optimize the quality of her voice, Alice is sounding so good that she’s been able to work as a church receptionist. But her experience should be a lesson for others, she warns.

“It would’ve been helpful if I had listened to my own voice earlier and gone to the doctor” sooner, she says. “Now I know that that’s the thing to do — not to wait.”

The voice specialist who discovered and treated Alice’s cancer couldn’t agree more.

“She’s the perfect example of why it’s important to pay attention to a voice change,” says Norman D. Hogikyan, M.D., F.A.C.S., who heads the University of Michigan’s Vocal Health Center. “People need to be aware that a voice change can indicate health problems.”

He notes that voice specialists have designated April 16 as World Voice Day to bring attention to the many voice problems that can occur, and ways to prevent them. Hogikyan is heading World Voice Day efforts in the United States through the American Academy of Otolaryngology – Head and Neck Surgery, a professional society for ear, nose and throat specialists.

Not all voice problems are due to something as serious as cancer. But they should never be ignored, particularly if they persist for a period of time or progressively get worse. And some can be prevented.

Despite all this, many people take their voices for granted, Hogikyan says, and don’t seek help until a problem with their voice starts interfering with their life. For people whose careers revolve around speaking, such as teachers, salespeople, clergy and receptionists, untreated voice problems can greatly interfere with their work.

So, says Hogikyan, it’s important to take voice symptoms seriously. Such symptoms can include hoarseness that sticks around or gets worse over time; loss of vocal range, especially the upper “notes” of the voice; loss of volume or ability to project a loud voice; and loss of endurance, causing the voice to die out over the course of a day. Neck muscle pain or throat soreness after voice use can also indicate a problem.

People who smoke are especially at risk for cancer of the “voice box” or larynx, says Hogikyan, an associate professor of otolaryngology – head and neck surgery at the U-M Medical School and associate professor at the U-M School of Music. Smoking is the number-one risk factor for laryngeal cancer, and regular heavy drinking of alcohol also raises the risk.

“Larynx or voice-box cancer most often presents as hoarseness, and the American Cancer Society estimates that about 10,000 new cases will be diagnosed this year,” says Hogikyan. As with many other cancers, the chance of curing it is best if it is discovered at an early stage. An estimated 3,770 people will die this year from laryngeal cancer.

Occupational voice users, and just plain talkative people, can develop vocal problems related to the strain they put on their vocal cords, which doctors call vocal folds. One such problem involves benign (non-cancerous) nodules that form on the vocal folds, and can cause hoarseness and limitation of the vocal range because of abnormal vocal cord vibration.

Colds and other infections can cause laryngitis, a few days of hoarseness or weakened voice. And over-zealous sports fans can lose their voice temporarily from rooting too hard for the home team.

But other voice problems can stem from problems with the muscles and nerves that control the movement of the vocal cords. Hogikyan and his colleagues see many cases of spasmodic dysphonia, in which the voice cuts out, or is uncontrollable, because of spasms of the vocal cords. U-M research has shown that injections of Botox, which is better known as a wrinkle treatment, can relax the vocal muscles and restore a patient’s voice.

Not every voice problem is preventable, but many are. Here are some tips to protect your voice:
• Stop smoking and/or drinking heavily. Not only will you reduce your risk of cancer, you’ll cut down on the irritation of the voice box that can cause hoarseness or long-term voice changes.
• Avoid screaming or shouting. If you feel like your throat is dry, tired, or your voice is becoming hoarse, stop talking.
• Don’t clear your throat regularly. If you feel you have to, there may be an underlying problem.
• Drink lots of water and caffeine-free non-alcoholic beverages. “Moist is good for the voice,” Hogikyan quips.
• Warm up your voice, just like athletes warm up their muscles. If you’ll be teaching a class, leading a meeting, or giving a speech, take a few moments beforehand to get your voice ready. “Warm-ups don’t have to be complicated,” Hogikyan says. “Simple things like gliding up and down in your vocal range on different vowel sounds, making lip trill sounds, or tongue trills, can get you ready for the vocal task you want to perform.” This will reduce the chance that your voice will start to give out during your presentation, or be tired afterward.
• If you can, use amplification for public speaking. That way, you can use a conversational volume and still reach the people who need to hear you, while avoiding strain on your voice box.

Above all, Hogikyan says, seek specialized help if you’re experiencing a problem with your voice, especially one that persists or gets worse over time. Start with your primary doctor or health care provider, and seek a referral to a specialist if needed. If you’re not sure whether you need specialized help, you can take an online vocal health quiz offered by the American Academy of Otolaryngology and based on Hogikyan’s research into voice-related quality of life. It’s online at http://www.entlink.net/news/voicedisorderstest.cfm.

The U-M Vocal Health Center, like many voice centers across the country, offers specialized help through a team of doctors, nurses, speech pathologists and vocal arts professionals.

“We opened the Vocal Health Center in 1996 as a place where people who are having trouble with their voice could come for innovative and comprehensive care,” says Hogikyan. “That includes anybody having a voice problem — but in particular, we have a special interest and expertise in caring for the occupational or professional voice user.”

Facts about voice health and voice problems:
• The voice is the sound made when the vocal cords vibrate due to the passage of air through the larynx. The sound made by the cords is amplified and shaped when it passes through the nose and mouth.
• Common symptoms of a voice problem include hoarseness or raspy-sounding speech; a raw, achy, or strained throat with voice use; increased effort needed to talk or sing; and loss of ability to hit high notes when singing.
• The most common cause of a voice problem is an upper-respiratory infection such as a cold. But voice problems can be related to anything from acid reflux to cancer to nerve damage.
• Voice changes are the most common sign of laryngeal (voice-box) cancer, which is diagnosed in nearly 10,000 Americans each year and kills more than 3,700 of them. More than 95 percent of people diagnosed with the most common type of laryngeal cancer are smokers. Heavy or regular drinking, especially combined with smoking, can raise the risk.
• Experts recommend that if a person’s voice does not return to its normal state within two to four weeks after a cold, he or she should seek a medical evaluation by an ear, nose, and throat specialist. A throat examination after a change in the voice lasting longer than one month is especially important for smokers.
• Some voice problems are caused by non-cancerous nodules, cysts or polyps on the vocal folds; treatment for these includes voice rest, voice therapy, singing voice therapy, and microsurgery on the vocal cord.
• Nerve and muscle problems can also interfere with the voice; treatments for such problems include Botox (botulinum toxin) injections in the vocal folds.
• Some medications can affect the voice by drying out the mucous membrane of the vocal folds, or by causing fluid to build up in the vocal folds. Others can cause hoarseness by promoting yeast infections in the voice box. Such medications include antidepressants, birth control pills, allergy and asthma medications, and diuretics (“water pills”) for blood pressure.