Voice of the people

Most people take the sounds that come out of their mouth for granted, but when acute or chronic conditions appear, ear-nose-and-throat and clinical communications specialists should be consulted.

April 26, 2015 01:26
A doctor stands with stethoscope in this undated handout photo.

A doctor stands with stethoscope in this undated handout photo.. (photo credit: REUTERS)


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Many teachers suffer from it, as do telemarketers, salespersons, aerobic teachers, lawyers, actors, stall owners and employees in public markets, Knesset members and maybe a few journalists. And because exuberant, hot-blooded Israelis do a lot of shouting, chronic hoarseness is a widespread condition that requires good habits, guidance and sometimes treatment.

World Voice Day was marked on April 16 around the globe and in Israel to increase public awareness of throat diseases (dysphonia) such as hoarseness, which affects some six percent of the general population at all ages and 10% or more of people in problematic professions, as well as 30% of children. Other conditions are throat cancers.

The annual event was marked in various institutions, including Sheba Medical Center at Tel Hashomer and Ariel University in Samaria, where students produced flyers on vocal hygiene that were widely distributed.

Dr. Michal Icht, a clinical communications specialist teaching at Ariel University who also has a private practice treating patients in Herzliya, gave an interview to The Jerusalem Post recently to mark the occasion.

There are famous cases of people whose careers depend on having healthy voices who have suffered from hoarseness, such as actress and singer Julie Andrews, who had to stop singing for years.

The late Israeli actor and comedian Sefi Rivlin died last December after a long struggle with throat cancer; in the earlier stages, he had to use sign language and erasable tablets to communicate.

But many ordinary people suffer from throat problems, said Icht. There are even politicians, such as Zionist Union chairman MK Isaac Herzog, who had to learn to improve their voices so as not to strain them and to earn more public credibility with a lower pitch. The communications specialist thinks Prime Minister Benjamin Netanyahu’s natural low voice accords him, in the ears of the public, extra credibility, especially before elections. Icht noted that one scientific study found a connection between the baritone voice of a company’s new chief executive officer and rises in the firm’s stocks.

HORMONES AFFECT the voices of teenage boys bursting with testosterone (making the pitch deeper); centuries ago, young singers were castrated so their sweet, pure voices could be preserved. Menopausal women and middle-aged men whose hormone levels change, said Icht, notice their voices have altered as well.

Most people take their voice for granted – meaning that they don’t take care of them – but disorders of the vocal chords and other parts of the throat are numerous and common.

Fortunately, for most patients, hoarseness is only temporary, said Icht, who was born in Tel Aviv, is married and has four children. She studied clinical communications when Tel Aviv University was the only university offering it. Now there are more, at the University of Haifa, Hadassah Academic College in Jerusalem, Kiryat Ono (for the ultra-Orthodox) and Ariel (now in its fifth year).

Women constitute the vast majority of practitioners, as it is a “caring” profession, said Icht, who worked for years as a clinician at Maccabi Health Services, but some men entered it through voice therapy. “It is as much an art as a science,” she noted.

There are famous women, such as former minister Limor Livnat and Israel Radio military correspondent Carmela Menashe, who have low, raspy voices, apparently from years of smoking, that sometimes makes them sound male.

“Tobacco causes harm to the vocal cords, but one can’t know if somebody smokes from his voice. There are other causes – such as polyps or cysts on the vocal cords – that can cause changes as well,” said Icht.

Among her favorite voices in the media are Israel Radio’s Alex Ansky, Israel TV’s Haim Yavin and Ya’acov Eilon and Channel 2 TV’s Ilana Dayan. Famous singers with hoarse, rough voices include Aviv Geffen and Gidi Gov, she added.

THROAT AND vocal cord cancer or physical trauma to the throat can cause severe problems. One of the six beacon-lighters at the recent Remembrance Day event could be heard only by applying an electro- laryx device to his neck; his voice suffered serious damage when he was subjected to medical experiments as a young man in a concentration camp by the infamous Nazi physician Dr. Josef Mengele.

In such cases, when no voice remains, victims can use a vibrating device, the electro-larynx or a hole made in the throat and the speaker covering it with a hole to make sound possible from the chest. Better still, a hole can be punctured in the neck between the esophagus and trachea and a plastic device inserted to make sound possible.

“There is no such thing, at least at present, as a vocal-cord transplant, as the structure is so complex, but I’m sure physicians who are ear-noseand- throat specialists [ENTs] are working on it,” said Icht, who added that speech is possible even with a single vocal cord.

Speaking is a physical action requiring the coordination of breathing by activating several groups of muscles.

Like in any other physical task, there are efficient and inefficient ways of using your voice. Excessively loud, prolonged, and/or inefficient voice use can lead to vocal difficulties, just like improper lifting can lead to back injuries. Excessive tension in the neck and laryngeal muscles, along with a poor breathing technique during speech, leads to vocal fatigue, increased vocal effort and hoarseness.

Voice misuse and overuse puts you at risk for developing benign vocal cord lesions or a vocal cord hemorrhage.

Others with voice problems include sufferers of chronic neurological diseases such as Parkinson’s, amyotrophic lateral sclerosis, multiple sclerosis and Guillain-Barre syndrome.

When throat tissue has to be removed, conventional rather than laser surgery is used because the rays can cause adhesions, said Icht.

Laryngitis – inflammation of the larynx – can be caused not only by viral, fungal or bacterial infection but also by acid reflux disease (in which acid from the stomach rises to the throat), excessive coughing and clearing of the throat, thermal or chemical burns, laryngeal trauma and allergy to cats, dust or other things. When the two vocal cords are swollen, it is always difficult to speak. Polyps in the nasal passages can also cause resonance problems for the voice.

Chronic laryngitis can also be caused by low-grade infections such as yeast infections of the vocal cords in people using inhalers for asthma.

Chemotherapy patients or others whose immune system is not working well can get these infections too.

To take care of one’s voice, one should drink a lot of water, avoid stress, screaming and whispering (the latter two are equally hard on the vocal cords), and not constantly clear one’s throat (because it slams the cords together). Never smoke, and avoid cola, caffeine and salty foods. “Don’t drink very hot or cold water,” said Icht.

In general, situations harmful to the voice are speaking in noisy situation, using cellphones too much or holding a regular telephone with the handset cradled to the shoulder, not using microphones when speaking in public and using a too high or too low a pitch when speaking.

Serious injury to the vocal cords can be caused by strenuous voice use during an episode of acute laryngitis.

Since most acute laryngitis is caused by a virus, antibiotics are not effective. Bacterial infections of the larynx are much rarer and often connected to difficulty breathing. Any problems breathing during an illness requires emergency evaluation.

A vocal cord can become paralyzed or weakened (paresis) from a viral infection of the throat, after surgery in the neck or chest, from a tumor or growth along the laryngeal nerves or for unknown reasons.

If the vocal cords are spastic or if they have difficulty closing, injections of Botox (botulism toxin) provide effective although temporary relief. Surgery may be performed to move a vocal cord to a different place to be more effective. Fat can also be injected to improve the voice. It there is no pathological problem, one of Icht’s main tasks is to teach clients how to breathe properly.

AS FOR what can help the voice be healthy, one should rest is whenever possible, Icht advised. Inhalation of water vapor [hydration therapy] is beneficial, “which is probably why some people sing in the shower.”

Someone with laryngitis will not benefit from swallowing honey or the combination of honey, raw eggs and oil, as these don’t reach the vocal cords or trachea. “If people think this helps, it is just a placebo effect,” she said. If hoarseness continues for two weeks or more, go to an ENT or general practitioner.

Clinical communications specialists work hand in hand with ENTs when a patient comes in complaining about his or her voice.

“I will not work with people who come to me unless they have first gone to a physician, preferably an ENT, for an examination and assessment,” said Icht. “If not, I might mistakenly instruct a patient to exercise their vocal cords in a way that can hurt their voices.”

“I wanted to become a clinical communications specialist,” she recalled, “because I thought it was a very interesting field with a lot of variety, and I wanted to be in a caring profession to help both children and adults,” adding, “I have lots of hats.” She studied but does not treat stammering or hearing problems, having decided to specialize in speech and voice.

There are probably a couple of thousand Israeli professionals in her field; “We had a professional conference not long ago that 900 attended, and not all of them were there.”

There are “not yet” too many specialists in Israel, but this may occur in the future. It would be a shame for people to study for four years in the academic field and then find no work, she stressed.

Some 45 or so graduate from the clinical communications department at Ariel. The students work with patients during their studies, and after they graduate they have to spend a year under supervision with professionals in hospitals, health fund clinics, schools, kindergartens and other locations.

“What limits the number of professionals is the number of places where they can get supervision from a licensed and experienced professional.

This is a lot of work and responsibility.

Those who complete the year have to pass a Health Ministry examination before getting their license.”

As Arab-Israeli communications specialists are too few in number, it is fortunate that some attend academic institutions in Jordan and return here for work. A number of Jews who immigrated from the Former Soviet Union practice here, but they also need to know Hebrew, she pointed out.

“In Ariel, there are many immigrants from the FSU. Young children are usually taken care of by Russian- speaking grandmothers for a few years. Only later are they exposed to Hebrew in mandatory kindergarten and in school. As the parents and grandparents may not speak Hebrew very well, some children need treatment for speaking problems in two languages.”

Cantors, opera singers and popular singers may also initially have voice problems, she said, but they learn very early in the profession how to breathe properly.

“A voice is like a fingerprint – unique because of the structure, length, position and mass of the vocal cords and the throat,” said Icht. “Even in identical twins, voices are different, because other factors can affect them.” She is in awe of actors and comedians working in the satirical Eretz Nehederet show who managed to adopt the voices of politicians and others. But if the voices were analyzed, she said, even though they might sound similar they are actually very different.

“A computer program would easily notice the difference. This and ventriloquism are talents that have to be learned,” she said.

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