Advancing treatments help people find their voices again
By the end of last summer, Thomas Kikta could no longer control the gurgling, raspy sounds that came from his throat when he sang.
The 53-year-old musician and professor's voice had been deteriorating since spring, when he noticed while recording an album that he couldn't reach the highest notes in his vocal range. When he sought treatment at the end of September, a UPMC Voice Center doctor discovered two noncancerous polyps in his right vocal cord.
A surgeon removed the polyps. Kikta could not speak at all for a week, and then slowly began to talk again. During his recovery, he learned what doctors and patients say is a common revelation for people who find themselves without a voice.
“It was very odd not being able to communicate like that,” Kikta said. “It gave you a great appreciation for the gift of being able to talk.”
The Voice Center, housed in UPMC Mercy in Uptown, is one of a growing number of facilities in the country dedicated to improving care for voice problems. As treatments advance, voice specialists said, more people are finding remedies for problems that have been considered inevitable byproducts of heavy use or aging.
Specialists at the center focus on vocal cords, two approximately inch-long pieces of tissue that are positioned horizontally in the windpipe. Muscles in the cords are covered by a specialized elastic tissue that allows them to open and close at rates of 100 to 200 times per second or more as the lungs push air through them, producing sound.
Vocal-cord lesions like Kikta's, often a result of overuse, are increasingly common as more people work in communications, sales, management and other voice-dependent fields, said Dr. Clark Rosen, the Voice Center's director and founder.
“It's a huge, huge issue because we don't have much of a labor economy anymore,” Rosen said. “Our economy is based on communication.”
The lesions are treated with a combination of surgery — sometimes with a laser — and therapy, he said. Vocal cords slacken with age, letting more air through and creating the hoarse and whispery qualities of seniors' voices. But as people live longer, more seniors need their voices to work and socialize, Rosen said.
While many view loss of voice strength as a natural part of aging, a majority of seniors likely can improve their voices by changing speaking techniques, including changing how they use tension in the laryngeal muscles, he said.
Other common voice problems come from stomach acid affecting the throat, head and neck muscle tension and neurological problems, voice experts said.
A less obvious side effect of voice problems is the psychological impact.
Maureen Puskar, a 59-year-old semi-retired nurse, said her voice started to quiver and shake about three years ago. She wondered whether stress had caused the change.
She started a treatment with Botox at the Voice Center about two years ago but stopped because it affected her ability to swallow. But her voice worsened, making it difficult to communicate with patients at the Veterans Affairs hospital in Oakland where she works.
“It's just really annoying when your voice doesn't do what you want it to do,” she said. “It doesn't sound like you. You become very self-conscious and you think about it all the time, and I think you make it worse.”
She restarted treatment in November and expects to continue for several more months.
“Our voice is sometimes part of our personality,” said Dr. Paul Bryson, director of the Cleveland Clinic Voice Center. “When people have hoarseness, it's not uncommon for (them) to feel alienated or withdraw a little bit. It can be significantly distressing.”
Specialists can help in some way the majority of patients who visit a voice center for treatment, Bryson said, though therapy can take months. Treatment increasingly happens in an outpatient setting under local anesthesia, disrupting people's lives less than inpatient procedures under general anesthesia.
Kikta underwent surgery to remove the lesions on his vocal cord Dec. 1. Before the surgery, he recorded several lectures he had planned to give students at Duquesne University, where he is the director of classical guitar and recording arts and sciences.
After playing the recordings, he typed answers to students' questions into an app that read them aloud.
He couldn't speak at all the week after his surgery, and then could speak only five minutes each hour for a week. He did voice therapy for about two months before he could fully sing again. He has mostly recovered except for side effects such as an altered sense of taste — beer and Italian bread still taste strange to him.
Kikta said he learned ways to use his voice that are less damaging.
“For something that was really unfortunate to happen, it really was an amazing experience, and I'm probably better off for it because I learned so much from it,” he said.
Rosen estimated the UPMC Voice Center can help 85 to 90 percent of patients. Among those, about 60 percent are able to return to normal voice function, he said.
The UPMC center and others are working to advance treatment of some of the more difficult problems, he said.
The least treatable problems are neurological problems and vocal-cord scarring, said Dr. Lee Akst, director of laryngology in the Department of Otolaryngology at Johns Hopkins University School of Medicine in Baltimore.
Neurological problems can rob a vocal cord's ability to tighten against the other cord, leaving space that weakens the voice, Akst said. The best treatment now is to reposition the damaged cord so that the other cord can tighten against it.
“I can change where it sits, but I can't make the nerve work to move the muscle again,” he said.
The UPMC Voice Center is testing a drug called nimodipine that shows promise for restoring motion to damaged cords, while other centers are testing surgeries to connect other nerves in the neck to paralyzed muscles in the voice box to restore function, Akst said.
Vocal-cord scars are difficult to treat because removing scar tissue causes growth of more scar tissue, which is relatively inflexible.
Voice treatment as a subspecialty has existed for only about 25 to 30 years, Akst said. He said the field's recent growth is not likely a product of an increase in voice problems.
“What's growing, I think, is awareness, on the part of possible patients and on the part of other (ear, nose and throat specialists) that subspecialty care does exist,” he said. “That living with it and just dealing with it aren't the only options anymore.”
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.