There are now many websites with extensive information on medical voice care. These sites are great for educating yourself about the vocal instrument. But voice problems cannot be diagnosed or judged accurately by sound of by how your throat feels to you. Do not try to diagnose yourself online!
Remember that when the voice works well, you don’t feel anything at all. Changes in the sound or comfort of your voice – hoarseness, pain, or fatigue – are important to notice as signs that something might be wrong. However, these altered sounds or sensations are vague indicators; the same huskiness could be simple overuse, a cold, or cancer (although the later is usually not the case!).
A specific voice diagnosis and the best treatment plan for the diagnosis are impossible to know without having a doctor’s exam that includes looking (indirectly) at your vocal cords.
When to Go
There are four main reasons to go to a doctor for a throat exam:
- Hoarseness or other change in the sound or ease of the voice that last more than two weeks.
- Pain associated with using the voice.
- Sudden loss of voice or other sudden change, especially during a performance.
- Lack of normal progress in voice training, as judged by the teacher in comparison to other similar students.
Even if nothing is wrong, in the best of all possible worlds, every serious vocal artist would get a laryngeal check-up every year.
Where to Go and Who to See
Your quest for medical voice care may begin with a visit to your primary or general-practice doctor. This visit is required by some insurance plans, but it may not be necessary once you have a relationship with a voice specialist. You might instead start with an ear-nose-throat physician (ENT, or otolaryngologist), someone with more expertise in this whole area of the body than a general practitioner.
Within the ENT field, however, voice medicine (laryngology) has now developed as a small, more detailed subspecialty. If you use your voice heavily or professionally, this is the type of specialist you should seek out.
Laryngologists who are especially interested in voice are often singers themselves, or are otherwise involved with music. They have probably sought advanced training at a major research center, they are most likely to have invested in good diagnostic equipment, and they stay up to date by attending the professional conferences at which the special problems of singers, lecturers, and other voice performers are investigated and discussed.
What to Expect
Currently, the most advanced type of voice exam is called videostroboscopy. An endoscope is inserted through the nose (known as a “flexible scope”) or placed into the mouth (a “rigid” or “fixed scope”). These small tubes have either a fiber-optic lens and light attached to a small camera or a digital-camera chip built in. A strobe light attached to these instruments provides a slow-motion view of the vocal folds in motion. There are no good substitutes for a visual exam with videostroboscopy and a laryngologist who is familiar with the needs of vocalists and who stays up to date at conferences on voice medicine.
Treatment by a laryngologist typically involves some combination of medication, referral to speech therapy, and in some cases, surgery.
Reluctance to Go
Singers are often reluctant to go to a medical doctor for voice issues, resulting in serious voice problems that don’t go away by themselves. Why would this be? There may be a lack of trust in voice related medical care. However, good clinics exist, staffed by physicians and allied professionals who genuinely know and care about vocal health. Voice medicine is a young field, but it’s maturing fast.
Students may also deny that there is a problem. Real or imagined pressure to sing from opera directors, choir conductors, or peers may give singers fear of being thought a “diva” for not just muscling through. Singers may feel like talent is supposed to overcome vocal trouble. Others may feel that treating the “magical” voice as a normal organ that deserves regular checkups and care just ruins the mystique. The power of the voice may always be somewhat mysterious, but its mechanics are less and less so.
Every human being deserves voice care. Well-intentioned advocates and this manual can only show you the door, however. The bottom line is to remember that you only have one voice and that you have to be your own best advocate. Be honest with yourself, and seek out medical care if you need it!