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.