Curing Hopeless Voices - The Strangled Voice (Spasmodic Dysphonia) & Other Voice Problems with Direct Voice Rehabilitation
by Dr. Morton Cooper & Dr. John M. Curtis

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CURING "INCURABLE" SPASMODIC DYSPHONIA

The Medical Mystery Solved by a Doctor's Natural Voice Treatment: Direct Voice Rehabilitation

Curing Hopeless Voices by Direct Voice Rehabilitation or DVR describes Dr. Morton Cooper's groundbreaking, clinically proven direct voice treatment for Spasmodic Dysphonia (SD) and other voice disorders. This book is a journey through today's medical/pharmaceutical complex, which has been using Botox, surgery, and indirect voice or speech therapy to treat SD. Yet in the 135 years since this problem was first diagnosed, medical treatments have not found any cures for this dreaded condition, also known as "the strangled voice."

Medical professionals and academicians are humane, well intentioned, and compassionate in treating SD, but they are on the wrong road. Dr. Cooper is the only Doctor in the world reporting and documenting peer-reviewed cures of SD (in 1980 by one of the world's leading speech pathology associations, the International Association of Logopedics and Phoniatrics). He has also published extensively about cures of other voice problems by DVR.

Dr. Cooper discovered this remarkable natural, non-medical SD cure after leaving UCLA Medical Center to concentrate on his private practice. His Direct Voice Rehabilitation for SD is a proven alternative to a lifetime use of Botox and also the only treatment that has provided cures.

If you have "hopeless" SD or a troubled voice, reading this book will give you invaluable information that could change your life. To see cures of SD by DVR watch Dr. Cooper's DVD entitled "Cures of Spasmodic Dysphonia". For written testimonials of cures and clips of "before and after" recordings of cures, visit www.voice-doctor.com.

Talking Points from the Book:

• Only Direct Voice Rehabilitation has reported ongoing cures of SD for over 35 years.
• There has never been a medical cure of spasmodic dysphonia.
• The medical paradigm today believes spasmodic dysphonia is neurological, and a medical problem.
• I find SD is not a medical paradigm, not neurological nor a dystonia but is caused by voice misuse and abuse and is a dysphonia (non-medical problem).
• Botox and surgery create high expectations for recovery.
• Botox and surgery yield inconsistent results.
• Patients expect and want hardcore science and high-tech treatments for SD from medicine yet none have been shown to actually work to a cure.
• Patients are programmed to doubt an alternative DVR to medical treatments.
• Results of treatment must be measured by listening to patients’ voices. Do the voices remain normal and lasting?
• Botox and Reflux drugs are simply hopefully palliative.
• Implants, such as collagen, bone, gels, silicone, Teflon, stents, cadaver skin, etc., are intended to be a medical voice lift when a natural voice lift by DVR is available and overwhelmingly effective.
• Cure of SD is a dirty word.
• Faulty neurology isn’t the cause of SD.
• I discovered the answer to SD by accident in 1968.
• Speaking and/or singing incorrectly and using bad voice habits cause SD.
• Failed medical paradigms don’t readily accept and even block access to new discoveries and breakthroughs.
• Powerful political and corporate influences suppress non-medical cures.
• SD is treated as a chronic lifetime condition with 4-10 Botox shots or more a year, each and every year for life.
• Cures of the spasmodic voice by non-medical care is regarded as unacceptable.
• The SD voice is not a medical problem. Medicine has not one single cure of the condition since Traube in 1871 described the condition as “a spastic form of nervous hoarseness.”
• I have ongoing cures and recoveries of all types of SD for over thirty-five years by Direct Voice Rehabilitation.
• Spasmodic dysphonia is not a psychiatric problem save for a case here and there.
• Spasmodic dysphonia is not caused by faulty neurology, or biological cause save for a case here and there.
• Neurological problems follow Mendel’s laws of genetics.
• Biological explanations don’t explain spasmodic dysphonia.
• The medical paradigm has difficulty processing new information.
• Powerful corporate interests affects how paradigms operate.
• My “Voice Stress Model” or “Voice Suicide Model” is related to Selye’s “Stress Theory.”
• Without changing the SD medical paradigm, medical history is doomed to repeat itself, and ongoing failure to cure
• Optimal pitch, tone focus, rate, volume and mid-section breath support are key variables in treating voice disorders, in a step by step order.
• Psychiatric problems don’t basically cause spasmodic dysphonia.
• Faulty neurology has little to do with dysfunctional voices.
• Molecular biology, including acid reflux, has little effect on disabled voices including deep throat, raspy and spasmodic dysphonia voices.
• Bad voice habits cause the lion’s share of common problem voices.
• Direct Voice Rehabilitation reverses counterproductive voice habits.
• Most patients want instant cures and quick fixes.
• Failed paradigms interfere with adopting new discoveries and information.
• Surgery and Botox treat hypothetical neurological and biological voice problems.
• The strangled voice (SD) and deep throat raspy voices stems from bad voice habits causing disabling “wear-and-tear.”
• Does Botox give patients back lasting, normal voices, or does it create the “Botox voice”?
• Is Botox the world’s next penicillin?
• Botox is a therapeutically diluted form of botulinum toxin.
• SD Patients wait in long lines for Botox because they’re desperate for treatment.
• High-tech gadgetry and diagnostic equipment don’t improve outcomes.
• Botox injections rely on doctors’ clinical judgments.
• Science becomes art when needle placement and dosage are subjective.
• Science becomes politics when non-profits market for public corporations.
• Botox is a voice roller coaster ride
• No one knows the possible long-term risks of using the Botox voice.
• The Botox voice effectiveness in the short-term is questioned by the e-mails, letters and calls I receive as well as my clinical SD cases.
• Voice image and voice identities are essential parameters in Direct Voice Rehabilitation.
• Voice image and voice identity can interfere with following directions in treatment.
• Unresolved voice image and voice identity undermines successful treatment.
• Pop culture and family background contribute to faulty voice images and voice identity. Medical approaches breed deep suspicion about alternative treatments.
• Society values deep-throat voices in both men and women.
• Deep throat voices in men and women can lead to voice breakdowns.
• Physicians need to spend more time listening to disabled voices.
• The Medical Paradigm basically attributes voice problems to medical causation.
• Direct Voice Rehabilitation is based on proven learning principles.
• Prolonged deep throat speaking leads to voice problems and voice breakdowns.
• It’s necessary to deprogram misconceptions about voice problems.
• Most voice problems are not caused by faulty neurology or biochemistry.
• Quick fixes, like drugs and surgery, are no substitute for voice behavior modification.
• Direct Voice Rehabilitation corrects counterproductive voice habits.
• Voice Charisma stems from learning improved voice control.

Excerpt from the book:

For all too many patients I see, it’s “the Botox voice”—a disfigured shell of the former voice, superimposing vocal cord paralysis on an already strangled voice. Patients submitting to Botox treatments, of course, expect normal voices, not deformed artifacts of their pre-morbid voices. Yet all too often I find following repeated Botox treatments, the voice doesn’t snap back as expected.

If the voice does snap back, it is for all too often short periods of time, so short it may be considered a roller coaster ride. Another Botox shot is given and so one may be given a Botox shot every two weeks, or month or on average four to ten times a year, each and every year for life. Does it help? I have encountered SD patients who have had 1, 3, 5, 10, 20, 30, 40, 50 shots without getting a normal voice and sometimes losing their voice. Patients tell a litany of trying Botox shots, once a month with never a return of any voice; some having had 10 shots, and no normal voice to speak of; another 20 Botox shots and no normal voice to talk with. An SD patient tried 17 Botox shots, 16 failed to return a voice, over 4 years. Another tried 45 Botox shots over 15 years and had only a whisper voice from Botox. Asked why she didn’t stop, “my doctor told me to continue.” Another SD patient had 50 Botox shots and still no voice to speak with. He gave up on his own. Keith Fraser, author of The Voice Gallery tried a number of Botox shots for years. He gave up. He reports others trying Botox shots find limited results though they may undergo many shots. Some may get some relief on one of many shots, and others no relief and no normal voice found. Botox is extensively iffy in outcome. Tom had 46 shots over a period of eight years. Not one of those

shots gave him any relief. A young lady had a Botox SD shot and reported to her ENT specialist that her hair was falling out, rashes on her body, and that her lip now had a tremor. The ENT assured her it wasn’t from the Botox shot but from the dystonia. The Reverend Sellers had one Botox shot only to lose his voice for six months. Others tell of losing their voices for weeks and months. Botox shots are well intentioned, humanitarian and compassionate in seeking to help SD patients and other voice problem, but…

A well-known ENT doctor who reports how successful Botox is for his SD patients leaves out his notable failures. Another ENT is quoted in national news as praising his SD successes, ignoring a failed case after two Botox shots left his SD patient with bowed vocal cords, and no voice, only a bare whisper.

A spasmodic dysphonic patient underwent a surgical procedure for SD only to find she was left with a whisper for a voice. She reports her doctors told her, her vocal cords came together on the vowel “e” ninety to one hundred percent of the time. But when talking, she had no voice to speak with. And on other vowels her vocal cords were not functioning normally. It appears to suggest the patient talk only on “e” vowels? The definition of “success” leaves the patient and the outcome in question. The surgeon’s definition of “success” may impress other physicians, but does it make sense to the patient? Meanwhile other SD patients who underwent surgery tell of the loss or serious impairment of their voices on the Internet and elsewhere. Doctors do not basically report their failures. A famed ENT, when asked about his successes with a new surgical procedure described in a medical journal, told his audience all the successes failed, but assured them, you do not report your failures.

Doctors report their successes, not their failures, it seems. And they report on the “honor system.” That may mean there is no check on their successes. And their failures. What is real?

Dazzled by High-Tech

Another interesting bugaboo for patients seeking treatment for spasmodic dysphonia is their fascination with high-tech procedures. Most patients think “exotic” conditions like the strangled voice can only be treated with the aid of sophisticated computer technology, high-tech equipment, MRI’s, Cat Scans, and more. Pop culture, through TV and film, convey images that high-tech, today’s modern science of medicine has answers for everything. Without high-tech props like videostroboscopy, phonatory printouts, computer technology, patients become skeptical, lose faith and develop pessimism over treatments. Medical offices and medical centers satisfy the desires of patients for fancy electronic equipment believed essential for effective treatments and successful outcomes.

Diagnosing spasmodic dysphonia in medical offices and centers, patients are often wired to monitors, making the best use of high-tech video equipment, producing elaborate scans and printouts on electrical activity in the voice box. Videostroboscopy, where the vocal cords are actually videotaped with the aid of fibroptic tubes and detailed phonatory work-ups are extensive diagnostic procedures that may take hours—if not days—leading to the diagnosis of spasmodic dysphonia. Yet, experienced clinicians and voice experts, with highly trained clinical ears, can easily diagnose the strangled voice without the use of high-tech contraptions, often in a matter of minutes, even seconds on the phone.

The best of medical hi-technology does not show the laryngeal resonance to be a dystonia. You can palpate laryngeal resonance, you can hear laryngeal resonance pressure, but you can not see laryngeal resonance as far as I can tell. I can help excessive laryngeal resonance in seconds or minutes although excessive laryngeal resonance is medically believed to be a dystonia. Using my revolutionary discovery called the C-spot, I am able to refocus the lower throat laryngeal resonance to the face proving quickly, SD is not a dystonia (neurological and not changeable) but a dysphonia (wrong voice use changeable by right voice use). Medicine is baffled and frustrated when SD does not basically show nodes, polyps, contact ulcer or other growths on the vocal cords, or visible pathology to cut out.

No matter how sensitive the diagnostic equipment, the medical paradigm does not prove that underlying neurology or possibly inexplicable molecular events are causing the strangled voice. Within the medical paradigm, it’s not permissible to consider alternative explanations for spasmodic dysphonia, including the clinical reality that the condition is due to faulty learning, incorrect voice habits and prolonged “wear-and-tear,” not neuropathology. If incorrect voice habits are indeed responsible for spasmodic dysphonia and other common voice problems, then no drug, surgery or high-tech procedure can reverse these conditions.

Specialists using Botox for SD like to give patients detailed graphs proving that the Botox is doing its job. They try to map out the cycle that occurs after Botox injections, including periods of expected muteness or breathiness, then brief cycles of improved voice. All the while, physicians like to identify the effects of Botox as falling into a predictable pattern leading to eventual improvements. But the Botox voice may not fall into a predictable pattern. Patients’ Botoxed voices may end in whispers for weeks and months, and still the “normal” voice does not return. Getting the Botox voice may disappoint patients hoping to restore voices to preexisting states, before being afflicted with spasmodic dysphonia. Even after repeated Botox injections, patients still expect voices to return to normal. When the voices don’t, the patients are told to be patient. When repeated injections still don’t reestablish normal voices, patients are told it’s due to reflux. GERD, Gastroesophogheal reflux disease is thought to be one of the leading theories causing spasmodic dysphonia. Patients are often prescribed acid reflux medications prior to or along with Botox shots. I do not find acid reflux causing deep throat, raspy voices leading to SD or that reflux drugs will alter wrong voice talking which leads to deep throat, raspy voices. I report that deep throat, raspy voices are overwhelmingly due to voice misuse and abuse, citing an extensive medical and academic number of studies. (See my book, Modern Techniques of Vocal Rehabilitation on my bibliography). SD patients do not find a cure to their failing voices with acid reflux drugs.

No matter how results disappoint, patients typically stay with treatments, sometimes getting ongoing injections before realizing that the Botox has its limitations. But only a small cadre of specialists called Otolaryngologists and some Neurologists actively use Botox to treat the strangled voice. The American Society of Otolaryngology endorses Botox for SD. Together with the National Spasmodic Dysphonia Association (NSDA) and other national and state organizations, they disseminate information about the scientific sophistication and effectiveness of Botox treatments. They endorse Botox as the treatment of choice. Although national and state associations like the American Speech- Language-Hearing Association (ASHA) and the NSDA say they’re neutral with respect to treatments for spasmodic dysphonia, they actually promote Botox, wholeheartedly. And the medical profession insists that SD is a hopeless problem, a lifetime death sentence, assuring all patients with SD, that there is only Doctors Gloom and Doom who seek to relieve symptoms, but not cure the problem.

The National Spasmodic Dysphonia Association (NSDA) gets donations of money from Allergan the maker of Botox for its newsletter, website and SD support groups that endorse Botox. Meanwhile, I find even some of the most devoted and dedicated of SD patients who are associated with the NSDA or officials within the NSDA are abandoning Botox shots, having taken them for years.

Dot Sowerby, President of the NSDA, has been Botoxed for years and years. She was talking with a severely strangled voice when I talked with her by phone. Peggy, who has SD, has also given up on Botox after years of treatment. She is a high official of the NSDA.

David Barton, recently replaced Dot Sowerby as the President of the NSDA. He reports in writing that only three of thirty-seven Botox shots worked for him.

In a highly polished video presentation used by the NSDA, claims are made that highly trained medical specialists determine the precise Botox dosage, and location of injections while treating spasmodic dysphonia. However, according to firsthand reports, both dosage and location of the injections may be more intuitive than scientific. Physicians may use experience and clinical judgment—not high-tech gadgetry per se as described in the NSDA video—to determine dosage and location of injections. That may come as a surprise to many patients sold on the idea that Botox is a high-tech, scientific treatment. It is said by those in medicine that negative outcomes of Botox are due to the doctor’s lack of expertise with giving Botox shots. Yet the very best, the elite, and crème de la crème give Botox shots. Is it the Botox or the doctor responsible for the iffy Botox outcomes I see and hear? A patient who underwent many Botox shots reports needle placement may be uncertain. His statement is:

“My doctor assured me that the procedure would feel like a bee sting. However, when they told me to lie down on a cold, metal table and hang my head off one end, I began to get very nervous about what Dr. X was preparing to do. He told me, as he held a large needle in front of me that he was going to permanently rearrange the muscles in my neck. This did not sound too pleasant but he assured me that I would be okay.

“When Dr. X began prodding my neck, it was much more painful than a bee sting. In fact, at that moment, I would have welcomed a bee sting. It hurt so bad I instinctively began yelling and asked him to stop. At first, he sharply addressed me and told me to be quiet. However, the pain was so bad, I could not. It felt like he was going to puncture my throat. I was choking from the needle going into my throat. Finally, after telling him repeatedly to stop, he quit and I tried to regain my composure. The second time after about 10-15 agonizing minutes of this horrific procedure, he then administered the Botox shot. After receiving the shot, Dr. X left, no one said anything to me, and my wife and I just walked out of the hospital. After this first Botox experience, my throat and neck hurt so bad, I could not even look up into the sky for a week. It felt like a prizefighter had punched me in the Adam’s apple.” This patient is not alone.

Another SD patient, trained in mathematics, reports of his Botox experience: “There is no repeatable reference information relative to the placement of the needle. i.e. the clinician takes best guess on where to insert needle into the neck to target cords. Once this location is randomly chosen (the available target area for the placement of Botox is limited to the area within a defined diameter of the throat) the clinician penetrates the skin. Since each of us has different physiology, the placement of the Botox into the cord is random and non repeatable.

“There is no reference to a set of benchmark data that allows the clinician to improve or repeat an injection. I received one good injection; it could not be repeated even with numerous attempts. I believe one of the reasons was that there was no “data” upon which to draw. As an engineer, who is trained in scientific methods, I find this procedure almost comical in its approach.

“There are numerous variables inherent in the process that are not controlled, specifically: the location of skin penetration, the location of penetration of the Cord (from top to bottom), the position of the needle within the diameter of the cord, centered, biased right to left, past center and penetrating the far wall, the rate of injection, too fast and the Botox is not absorbed in cord, and finally, movement by the patient (the cords are not immobilized, the patient does his best to ‘stay still’).

“The signal generator is by its nature a very coarse measurement system. It is used typically as a GO/NO GO gauge. Noise means you have a connection, no noise, no connection. Its use as a guidance system with degree of noise as an indicator of position is not repeatable. At best it tells you that you have contacted some portion of the vocal cord with the needle. Nothing is conveyed about specific location.”

The video used by the NSDA on SD patients tells that the procedure is nothing more than a bee sting, but enough patients report excruciating pain to make me wonder. Others complain about severe post-injection complications, including weakness and respiratory problems, and loss of voice totally leaving them with a whisper voice, or worse. Yet others report that Botox, apparently delivered to precise locations in the vocal fold muscles, causes swallowing problems, and some life threatening breathing impairments; all in all, the process isn’t the automated scientific procedure described in an NSDA video that I have seen. Yet being good troopers, desperately seeking help and hoping for the best, most patients with spasmodic dysphonia endure almost any hardship to rid themselves of the condition.

Programmed to Fail

When you think of it, it’s far easier or simpler to be told you have neurological condition than counterproductive bad voice habits. Some patients take it personally when told they’re been misusing and abusing their voices—though not deliberately. Even so, getting rid of bad habits takes more work than getting anesthesia, surgery or drugs. If treating spasmodic dysphonia was medical, medicine would have found a cure or effective treatment long ago. But a little attention to history suggests the opposite. For almost 135 years since Traube first described the condition called “nervous hoarseness,” medicine has not been able to crack the mystery of the strangled voice. With almost 135 years of fruitless psychiatric treatments and now over 45 years looking at faulty neurology, medicine still doesn’t have a single cure or reliable treatments.

The Hippocratic Oath sworn to by medical doctors says, do no harm and natural healing. Medical SD care is not conservative as sworn to. It is extremely radical. My approach is conservative and in keeping with the Hippocratic Oath. DVR is safe and effective and can be curative with fully cooperative patients. Botox may not be as effective in the short run as advertised, I find in my clinical practice with SD patients. And in the long run, nobody knows the long-term effects on the body.

From the get-go, patients with spasmodic dysphonia may acquire more than healthy skepticism following years of frustrating experience with conventional medical treatments. Told there are no cures, patients have little reason to believe that a simple, noninvasive approach like my Direct Voice Rehabilitation provides sufficient documentation that cures of SD exist and prevail. It’s also acutely embarrassing to highly trained medical doctors that high-tech procedures and designer drugs can’t cure or consistently improve spasmodic dysphonia. Confined to a paradigm that permits only medically acceptable techniques and procedures, medical specialists’ hands are tied with respect to accepting and using an alternative treatment.

When I found a cure for spasmodic dysphonia, I was struck by its simplicity yet comprehensive way it corrected the patients’ symptoms, voice tremors, spasms of the vocal cords, and other symptoms stemming from the lower throat voice use. This lower throat voice is the precise pattern leading to the strangled voice and other common voice problems. No medical procedure can basically undo years bad voice habits leading to what I call “Voice Suicide”. This is an insidious process where by the voice literally wears itself out by repetitive voice-use that is forced from the lower throat (laryngeal resonance). I agree with medical specialists treating SD that spasmodic dysphonia is always located in the lower throat. Where medical experts and I diverge is on what causes the voice to drop into the lower throat. Medical experts believe severe vocal spasms are caused by neuropathy in the lower throat, with nerve connections to the basal ganglia in the brain creating a “focal laryngeal dystonia.” I call it a misphonia or dysphonia. A dystonia means you cannot change the problem. A misphonia or dysphonia (wrong voice use) means you can change the problem with meaningful treatment by Direct Voice Rehabilitation. I often report changing the so-called” focal laryngeal dystonia” in the initial consultation. I point out SD is not a dystonia; a dystonia cannot change by non-medical verbal directions. I agree that all SD is a focus or focal placement in the lower throat. I agree only excessive laryngeal resonance is utilized. But the word “dystonia” in the medical definition of SD is where I part company. I find clinically that SD is merely an imbalance of resonance to the lower throat. Only excessive laryngeal resonance is used exclusively by SD patients because of voice misuse and abuse—wrong voice talking—not a dystonia, or medical problem. SD is basically a problem of incorrect pitch and resonance focus, poor breath support, and a wrong voice image and voice identity.

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