Dr. S.D.
UPDATE: 17 Years
In April 1995, upon referral from my family care physician, I
went to see an otolaryngologist in Oregon to address the chronic
hoarseness in my voice, with the feeling of 'a lump in the throat'
and occasional 'voice just going out' which I had been experiencing.
As an educator this illness was particularly difficult.
Dr. 'X' found a contact granuloma (ulcer) on the vocal cord and
he gave me his interpretation that the cause was gastro-esophageal
reflux disease (GERD), albeit I was totally asymptomatic of such
acid reflux. He showed me some literature (e.g., Laryngoscope
April 1991) and a continuing medical education video which argues
that the first suspect for vocal problems such as chronic hoarseness
and laryngitis is GERD. For the next 4 months I went on a regimen
of dietary changes and prescribed medication with regular consultation
with Dr. 'X'.
In August, with the systems persisting and my questioning about
lack of GERD symptoms, Dr. 'X' urged me to seek another opinion
by an otolaryngologist and to seek professional vocal/speech therapy,
since he said he had little experience with my kind of vocal cord
granuloma and problem.
I had earlier experience with vocal rehabilitation. In 1982 I
had a slipped disc and cervical laminectomy. Awakening out of
that surgery I had a paralyzed tongue and vocal cord on one side,
and partially paralyzed diaphragm, all indicating damage to the
recurrent laryngeal nerve. After some months with that condition
and a voice which was a barely audible whisper, I was referred
to the _____ clinic. After some months there, they referred me
to Dr. Morton Cooper, author of Modern Techniques of Vocal Rehabilitation,
who in his years at UCLA Dept. of Head & Neck Surgery (1961-70,
now in private practice) reported cures and success in cases with
a paralyzed vocal cord. I spent some months making trips of a
couple of days per month to Los Angeles to work with Dr. Cooper
and the results were excellent and very different from what I
had experienced at the ____ clinic.
After the discussion with Dr. "X" in Oregon, I called
Dr. Cooper in August 1995 and explained my condition and he said
I should consult with another MD otolaryngologist who had more
experience with my situation but he was sure he could help me.
I then went to Los Angeles and consulted Dr. 'Y' until recently
a clinical professor at UCLA who found a contact granuloma and
redness of the cords. He said the hypothesis of GERD as causative
for such problems was much exaggerated and he doubted that was
a factor in my case. He prescribed vocal rehabilitation and was
optimistic that it would solve my medical problem, but also let
me know that it would take a dedicated and intense regime of therapy.
Dr. Cooper immediately stated that my problem was voice misuse,
and while I was unaware of it, he would demonstrate the problem
and help me change. He reiterated what his research and publications
have stated, namely, that chronic hoarseness and contact granulomas
are a primary symptom of vocal misuse. His clinical experience
is that this is independent of any patient also experiencing GERD,
and that one can have GERD but eliminate the granuloma through
vocal rehabilitation.
For the week of August 7-11, 1995 I spent virtually all day each
day in Dr. Cooper’s office. For hours on end he worked with
me one-on-one to demonstrate what I was doing wrong, how to breathe,
how to pitch my voice (done for some hours on a vocal pitch machine
with play back units), how to project my voice so as to stop the
misuse which aggravated the vocal cord. His office includes a
battery of machines for measuring voice and training correct pitch;
audio-video taping to hear and see what I was doing wrongly, with
him coaching me to learn when I was speaking correctly. I felt
the difference each day. I was shown videos of other patients
with my exact same problem, some of whom were also told for a
long time that GERD was the cause of their difficulty. Dr. Cooper
instructed me on learning to see what they were doing wrongly
and correctly. He then spent hours with me getting me to hear
all this in myself and to learn to change the misusing of my voice,
and to be aware of when I was misspeaking. I left at the end of
the week amazed at how much I had learned and how well the hour
after hour of drill, exercise, commentary and training had worked.
I was given tapes to take home to continue to work on this, exercises
to work on, and I have had regular telephone consultations with
Dr. Cooper in the 3 months since that time.
During the 4 months of Dr. 'X's examination and treatment for
GERD which Blue Cross helped to support, I did not recover. Symptoms
continued and were severely problematic and affected my work life.
In the 3 months since the intensive week of vocal rehabilitation
with Dr. Cooper, things have changed dramatically I am happy to
say. The symptoms dissipated rapidly and within a month after
I started working with him they were gone. In short, the treatment
has worked, for which I am most grateful.
During the days I was there he worked with me all day long; he
worked with one other patient while I was alone working on the
machines and practicing, taping, etc. I spent 42 1/2 hours that
week in Dr. Cooper's care. This even included lunches where he
intentionally took me to eat near his office so that I could practice
speaking quietly in noisier environments and do so properly without
reverting to misusing the voice. The approach is single-patient
oriented and, it would seem, Dr. Cooper only works with 2 patients
at a time in such intense treatment (the other patient was also
there for one week only from across the country).
The vocal rehabilitation with Dr. Cooper and follow-up since
has obtained excellent results.
DR. S.D.
