Diagnosis and Treatment of Vocal Problems In Professional Voice Users: Part 2 of 2

Treat with Care

Three main modalities of treatment are used to treat vocal problems, ranging from the most noninvasive to the most invasive. You have behavioral treatment, which is essentially speaking and singing therapy. You have medical treatment, which treats allergies and reflux and dryness and things of that nature. And then you have surgical treatment, said Dr. Ossoff.

According to Dr. Ossoff, because many benign vocal lesions are acquired through overuse, misuse, or abuse of the voice, a behavioral or medical approach is first used, with surgery reserved only if these other methods fail. He emphasized, however, that if noninvasive measures do not work, surgery is needed because if they [singers] don’t get [the problem] corrected, their career is on the sidelines.

For problems that commonly plague singers, such as symptoms of allergies and reflux, the use of medications is critical so that further damage is not done. Simple measures such as increasing water intake for better lubrication and reducing the amount of substances that thicken the mucus (such as caffeine, chocolate, alcohol, and dairy products) can help with symptoms of upper respiratory allergies. The use of antihistamines and nasal steroid therapy are also options when used with care.

Although there is controversy over use of steroids, both Dr. Woo and Dr. Ossoff agree that their judicious use is acceptable-that is, if they are not used on a chronic basis. However, Dr. Ossoff cautioned that singers need to be aware that although steroids will help their condition and allow them to perform, the steroids are also masking their symptoms. They may not realize that they may be singing away on damaged property or causing some damage because the steroids could be masking those symptoms, he said.

When Surgery Is Needed

Any time a singer needs surgery, it is a much bigger decision process than for the average person. Even minor structure problems can be a big problem for a singer, said Dr. Woo, cautioning that surgery in a professional voice user requires a more complex decision tree that must address issues about the timing of surgery, recovery period, and when a singer can return to performance.

For Dr. Ossoff, surgery really should be the last resort for non-neoplastic or benign vocal lesions when all other noninvasive modalities have failed. For those patients in whom surgery is determined necessary, he emphasized the need to try to select your patients appropriately and carefully and obtain informed consent from the patient so that the expectations you set for the patient are understood.