Body and Voice Connection, Vocal Fold Mobility Impairment Video, and PYV!

Body and Voice Connection...

TAKING CARE of your BODY

will HELP YOU

TAKE CARE of your VOICE.

I say this all the time but got reminded of it’s awesomeness when I heard @yassmeen.abdelaty.md say it on a podcast with @meganthesingingslp  (Great job ladies!)

HOW does taking care of your BODY help you take care of your VOICE?! 

There’s actually A LOT of research on ALL of these where prioritizing/taking care of the BODY will also help you prioritize/take care of your VOICE. I’m actually not citing the research here (weird for me I know ha ha), but mentioning several of the research related ideas. Look back on some of my posts to find related citations &/or stay tuned for more in the future!!

Exercise #movementismedicine (for body, voice, mental health, and  for those endorphins!)

Cardio (strengthens the lungs, gets air moving, gets body moving, encourages practice of efficient breathing coordinated with movement, improves overall cardio-respiratory endurance)

Strength (improves postural support, improves core support and engagement/involvement for voice)

Sleep (promotes voice rest, promotes healing of VF tissues, reduces VF stiffness,   encourages regeneration of the cellular matrix of the VFs, and encourages healthy breath patterning)

Movement (see the above first three points; again, MOVEMENT IS MEDICINE).

Stretching (encourages breathflow as we do get deeper in stretches on the exhalations, encourages incorporation of breathing and body movement, allows for a more relaxed state, encourages extension of muscles that are often habituated to flexion, encourages a more flexible body and musculature versus a stiff/tight one). Let’s also include massage, manual work, tension release, and/or myofascial release here too.

Managing stress (improves breathflow patterns/reduces breathholding patterns, reduces overall stiffness and tension in the body, improves mood, and improves overall awareness and mindfulness)

Exposure (reducing exposure to environmental irritants and medication-related irritants, reducing exposure to diet-related irritants, reducing your exposure to the negative committee in your head, and reducing exposure to people with negative energy)

Nutrition/Vitamins/supplements (this is kind of an easy one.. you are what you eat — this affects body, sleep, voice, energy, mental health, focus, etc.; do all you can to promote immunity and health via the things you put in your body)

Your OVERALL HEALTH does contribute to your VOCAL HEALTH. That includes physical health, emotional health, intellectual health, & spiritual health.. Do you realize the POWERFUL effect YOU can have on your VOICE by prioritizing your overall HEALTH?!

#voxfit #voice #prioritizeyourvoice #vocalhealth #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #voicespecialist #fitnessinstructor #takecareofyourbody #takecareofyourvoice #voicetherapy #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #voicesfittoinspire #chooseyourbestvoice #letsgo

Vocal Fold Mobility Impairment Education...

Check out the full video at this LINK but a short intro clip is featured in this post above...

I am grateful to have been asked by Dysphonia International to provide an educational video related to the diagnoses of vocal fold paralysis and vocal fold paresis. I created a presentation that highlights these vocal fold mobility impairments (the WHAT), discusses NERVE-related information, the most common CAUSES of these conditions, the possible RISK factors for mobility impairments, COMPLAINTS related to vocal fold mobility impairments (often involving voice, breathing, and swallowing), the pathway by which vocal fold paralysis and paresis are DIAGNOSED, common QUESTIONS related to these conditions, the variety of TREATMENTS available (surgical, therapeutic, combination, etc.), and photos and videos to further enhance the importance of the COLLABORATIVE model of treatment and overall understanding. Additionally, I also highlighted some relevant RESEARCH studies that discuss vocal fold paralysis and paresis, as well as some recommendations for QUESTIONS TO ASK your provider (if you are experiencing this diagnosis or know others who may be). 

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LOTS of good educational info below.. feel free to READ THROUGH or check out the video link above!

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Vocal fold paralysis is a voice disorder/mobility impairment that occurs when one OR both of the vocal folds (VFs) do not open or close as they should. It can be unilateral (more common) or bilateral (more rare). Unilateral is when only one vocal fold is paralyzed; when this occurs, the person may have trouble speaking or swallowing, depending on the position of the paralysis. Breathing problems are not as common if only one vocal fold is paralyzed. It is important to know WHAT POSITION the VF is paralyzed in: VFs can be paralyzed in the median (straight up and down/midline position), paramedian (about 1.5mm away from midline), or lateral position (a more open position, 3.5mm+ away from midline). If there is a bilateral paralysis, this means that both vocal folds are paralyzed; when this occurs, the VFs often end up close together, which restricts the airway/breathing. This can be life-threatening without treatment.

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As mentioned, PARALYSIS is a complete absence of vocal fold movement, caused by a complete loss of nerve input, but PARESIS is a weakened vocal fold movement, caused by a partial loss of nerve input. Depending on your needs (especially related to occupational voice use), VF mobility impairment (some form of a movement disorder/impairment—paralysis or paresis) can cause mild to significant difficulty. If you’re a professional singer (or a heavy voice user with consistent vocal demands), even mild paresis might dramatically affect your career, but if you work in a job that requires very little voice use, you may experience minimal impact.

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The most common causes of VF mobility impairment include surgery (especially those that occur on or near the head/neck/upper chest), neck or chest injury (trauma to these regions can injury the larynx itself and/or the nerves that control the larynx), tumors (can grow in or around the muscles, cartilages, or nerves that control the function of the larynx), infections (can cause inflammation and directly damage the nerves that control VF movement), neurological conditions (especially those that involve nerve deterioration and damage), autoimmune diseases (can interfere with how nerves communicate with muscles), poisonous substances (can harm nerve tissue and impact those that control VF movement), and idiopathic causes (unfortunately, this means there is no obvious reason for the mobility impairment). 

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The most common complaints related to a VF mobility impairment include: breathy/weak voice, hoarseness, vocal strain, vocal fatigue, noisy breathing, stridor, shortness of breath, loss of vocal pitch variation, reduced pitch range, choking or coughing while swallowing food/drink/saliva, the need to take frequent breaths while speaking, inability to speak loudly, reduced vocal power/volume, reduced vocal endurance, occasionally a loss of your gag reflex, ineffective coughing, reduced cough strength, and frequent throat clearing. Related to what VF paralysis or paresis may feel like, you probably will not feel that a vocal fold is not moving...BUT, you will likely feel the effects of this via the symptoms as mentioned above and especially the feeling of the need to ”push” for voice and/or vocal fatigue, a feeling of aspiration (food/liquid/secretions ”going in the wrong pipe”, and/or the feeling of mucus in the throat that is very difficult to clear.

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As a result of VF mobility impairment, you may have trouble speaking, swallowing or even breathing — as ALL of these vital functions DEPEND on MOVEMENT of the VFs. 

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Related to TREATMENT for VF mobility impairments, the most common treatments include voice therapy and (temporary as well as more permanent) surgical interventions. Of note, some people's voices will naturally recover sometime during the first year after diagnosis, which is why doctors often delay (permanent) surgery for at least a year. Within this first year (hopefully soon after diagnosis), the doctor may recommend referral to a speech pathologist for voice therapy, which may involve exercises to strengthen the vocal folds or improve breath control and/or vocal use patterns while speaking. Voice therapy is a good idea if touch closure of the VFs is achieved. If not, temporary surgical intervention is warranted to improve the anatomy prior to voice therapy. The doctor may also want to perform an injection augmentation (filler injection) to assist in improving VF closure (for improved voice & swallowing safety). Voice therapy and VF augmentation/filler injections can help reduce symptoms while waiting for the VFs to recover. Several surgical procedures are available (depending on whether one or both of the VFs are paralyzed): these procedures usually result in a stronger voice and are often followed by additional voice therapy to help improve/enhance the voice. The most common procedures that change the position of the VF include: VF injection augmentation (temporary, although some filler materials last longer than others), medialization thyroplasty/laryngoplasty (more permanent procedure that involves inserting an implant to improve VF closure; occasionally, the doctor may need to readjust/revise the implant over time if it moves out of place), and/or an option for stitches to reposition the laryngeal cartilage and bring the vocal folds closer together. Related to if/when the VF are both paralyzed, a tracheotomy (trach) may be required to ensure there is an airway, which will improve/guarantee breathing. This means that an incision is made in the front of the neck and a breathing tube is inserted through the opening (stoma) into the trachea: breathing now happens through the tube and the risk of “inability to breathe” is dramatically reduced. Speech pathology intervention is still helpful as it will focus on learning to use the voice again, prioritize use of a speaking valve, improve swallowing safety, and learn how to properly care for the breathing tube. The aforementioned treatment options improve the effects and symptoms related to the mobility impairment. However, there is a reinnervation surgery option where the doctor/surgeon takes a nerve that connects to other muscles in your neck and reattaches it to the nerve that moves your VFs.

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Some interesting research studies about VF mobility impairment:

*Peak airflow during maximal cough changed after vocal fold augmentation and may lead to improved peak airflow during volitional cough after augmentation. (Dion et al., 2017)

*Subjects with UVFP exhibited faster adduction compensation in the contralateral vocal folds, and the contralateral cricoarytenoid joint's metabolism in subjects with UVFP was higher. (Xu et al., 2021)

*Laryngeal electromyography is useful in diagnosing neuromuscular dysfunction of the larynx and best practice recommends its continued implementation along with laryngostroboscopy. While recurrent laryngeal nerve lesions are more likely to present with a lateral vocal fold, this does not occur in all cases. (Maamary et al., 2017)

*A significant improvement of voice quality and quality of life after voice therapy is an often reached and reasonable goal in patients with UVFP. (Schindler et al., 2008)

*A long duration (up to 12 months) of acceptable quality of voice was achieved by augmentation with Restylane, if the glottal gap was 1mm or less videolaryngostroboscopically during phonation. The authors recommend this therapy for temporary voice improvement and to augment vocal therapy, if spontaneous recovery of voice is likely. (Rudolf & Sibylle, 2012)

*Voice therapy is effective in patients with UVFP and its benefits are sustained over time. Early referral for voice therapy seems to be associated with greater benefit, but quality of life also improves for patients despite delayed treatment. (Busto-Crespo et al., 2016)

*Voice therapy following injection laryngoplasty is beneficial to patients with UVFP. Combined treatment can help to maintain improved voice quality more than six months after IL. (Jeong et al., 2022)

*With the exception of severe TVF range of motion disturbance, there seems to be poor validity of laryngoscopic findings in predicting the affected side in vocal fold paresis. We recommend neurophysiologic testing to confirm the clinical diagnosis of vocal fold paresis. (Song et al., 2022)

*For unilateral vocal fold paresis/paralysis after thyroidectomy, we recommend absorbable mass injection laryngoplasty, voice training, and neurolysis during the first 12 months but laryngeal reinnervation after 12 months. For bilateral vocal fold paresis/paralysis, we recommend early laterofixation and combined laser arytenoidectomy with posterior cordectomy after 12 months. (Chen et al., 2014)

*If UVFP (unilateral vocal fold paralysis) has not begun to recover within 6 months after a thyroid surgical procedure, permanent surgical intervention may be considered because recovery is otherwise unlikely. For patients with UVFP secondary to esophageal and mediastinal surgery, heart and lung surgery, vagus nerve injury, brain surgery, or idiopathic cause, the findings suggest that permanent surgical intervention may be considered 1 year after the initial onset. A treatment policy for the optimal timing of permanent intervention may be associated with reduced unnecessary deterioration of quality of life among patients with UVFP. (Lee DH et al., 2019)

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Here are some good questions to ask your provider if you have been diagnosed with VF mobility impairment and/or know someone who has:

1) What is the cause of my vocal cord paralysis?

2)  Is my vocal cord completely paralyzed or only partially paralyzed?

3) In what position is my VF paralyzed?

4) Does vocal cord paralysis affect my ability to swallow properly?

5) What are the chances of recovery if I don’t pursue any treatment?

6) How can I pursue treatment quickly? I need my voice for my job…

7) What are the chances of complications (ex: inability to breath, aspiration pneumonia, etc.) if I don’t pursue any treatment?

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Check out the video for additional info and insight...and feel free to reach out if you have any questions!

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#voxfit #voice #vocalfoldparalysis #vocalfoldparesis #vocalfoldmobilityimpairment #breathing #swallowing #voicing #prioritizeyourvoice #videostroboscopy #vocalhealth #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #voicespecialist #fitnessinstructor #collaborativemodel #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #larynxlove #research #dysphoniainternational 

Anddd of course, always REMEMBER to PRIORITIZE YOUR VOICE!  

How are YOU prioritizing your voice today? And everyday? As an OCCUPATIONAL VOICE USER, it SHOULD be one of your top priorities! 
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What do you need to know to keep your voice healthy?  You should understand how the voice works, how to protect and care for your voice, and how to use your voice and entire vocal mechanism in the most efficient, effective, and dynamic ways possible.  
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I’m super PASSIONATE about this population of voice users (I’m one and most of you are too!), and am HERE TO HELP! Reach out with any questions, concerns, or if you’d like to work together. Email me at [email protected] 

#voxfit #voice #prioritizeyourvoice #videostroboscopy #healthyvoice #vocalhealth #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #voicespecialist #fitnessinstructor #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #sovte #semioccludedvocaltractexercises #vocalwarmup