When something goes wrong with your voice, you might simply say, “I am hoarse.” Your funny best friend might ask with a smile, “Got a frog in your throat?” Then what? Do you rest your voice? Do you gargle? Do you eat chicken soup? Do you see a doctor? Do you pick up a pill at the pharmacy? Which doctor do you see?
If you are a doctor: Is it simple or difficult to discover the cause of a hoarse voice? What do you need to do to make a diagnosis? Do you look in the mouth? Do you guess? Do you write a prescription for a pill?
Unfortunately, after saying “I am hoarse,” getting a diagnosis can be a long, tough process. You may see your family doctor or even several specialists. You may receive some type of treatment. You may be told that it will get better with time. In any case, you may wonder about the explanations you receive.
If you are saying “I am hoarse,” you have every right to ask your doctor not only what you should do, but, “Why am I hoarse?” Understanding why you are hoarse will more likely put you on, and keep you on, an optimal treatment path.
A Personal Story
I purchased an endoscope and a stroboscope and began filming vocal cords, trying to find something wrong with hoarse voices — finding a visible problem at times, but not consistently. Every month or two I took a week off from my otolaryngology practice to study with various laryngologists, seeing what I could learn and improve my skills.
I visited one laryngologist in Chicago, Robert Bastian, and discovered a physician who had taught himself how to listen to a patient’s history and her voice, then describe what we were likely to find before we looked in the throat. I returned the following year to study with Robert for another six months. After that study, I limited my practice to only laryngeal disorders and soon became aware that I was able to hear voice problems before I made a video recording of the vocal cords with an endoscope. That was the beginning of when I felt like I was becoming a voicedoctor, when I could both hear and see voice disorders.
What Patients Tell Me
On my website, I present some of my ideas about voice disorders that with regularity trigger email from people with a voice problem. My patients tell me strikingly similar stories in the office. While each person’s story is their own, frequent themes are:
- The explanation for my hoarseness doesn’t make sense.
- I have tried so many treatments without success.
When I put a tiny camera into the throat and show a patient her own vocal cords enlarged on a video screen, I have the sense that the views of the moving vocal cords, coupled with an understandable explanation, often meet the needs of the hoarse patient. Frequently enough, the explanation leads further, to a remedy or a resolution — though at a minimum, it gives at least an understanding by the patient of what her voice problem is. The explanation for the hoarseness makes sense. This understanding seems to be more than she has received before and, consequently, I write this book so that more people might come to understand hoarseness.
What to Expect from This Site
In How Voice Works, voice is defined and I sort out what we really mean when we say, “My voice is hoarse.” In effect, I define the difference between normal voice and abnormal voice. This lays a straightforward foundation for how to think about hoarseness.
Behavioral Hoarseness and Structural Hoarseness categorizes and maps out specific types of vocal problems. This approach makes problems with the voice easier to identify. A correctly identified voice problem is really the only reasonable way to start an effective treatment.
I receive many emails that begin with, “I have been diagnosed with ___ as a cause of my hoarseness …” and they conclude with, “but I am not getting any better. Can you suggest a stronger pill to treat ___?” Imagine — before you ask for a stronger pill, would you prefer to have an accurate diagnosis of an infection that is then treated with an average antibiotic, or would you rather have the most powerful antibiotic in the world for a problem which turns out not to be an infection? The accuracy of the diagnosis matters more than the power of the treatment. So, a hoarse person with a voice that is not improving is far more likely to be suffering from an inaccurate diagnosis than from inadequate strength of medication.
Diagnosis & Examination highlights various ways of examining the voice — for students, new physicians, and patients alike. I highlight how you might determine if you are getting a good examination from an otolaryngologist, or even a subspecialist known as a laryngologist. If you are hoarse, almost certainly you will benefit from a video recording of your vocal cords. Most vocal events happen too fast to perceive without some capability to slow down and review the images. Even video needs some help from a stroboscope or high-speed recording to catch events well.
Perspectives discusses thinking errors — for example, if everyone believes in a pill, it must work. I also discuss how to maximize the value of an examination. Hoarseness can be visualized and, with a few guidelines, can be understood. This book will provide a framework for that understanding.
All of the stories in this book are true cases. For privacy, all of the patient names are fictional. While the gender of the patient is unchanged in each case described, I try to randomly use male and female pronouns when referring to generic people or physicians.