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Before After larynx, they attempt to relieve the sensation of swelling through throat clearing or coughing. This only exacer- bates the problem. "Vocal irritations may stem from sea- IMAGES COURTESY OF DR. NICOLE MARONIAN, UNIVERSITY HOSPITALS CASE MEDICAL CENTER sonal allergies and can lead to habitual throat clearing or coughing," says Newman. "The video stroboscopy helps up determine etiology and direct treatment. Speech therapy techniques, in conjunction with medical treatment as appropriate, are very effective in breaking the 'muscle memory' a patient may have created." A 45-year-old male who is a radio talk show host had increasing hoarseness over several months. A large left vocal cord lesion (left image) was noted on stroboscopy consistent with a vocal process granuloma from voice overuse. The patient underwent successful surgical resection (right image) and speech therapy to achieve a return of his normal voice. Therapy Helps Break Poor Voice Habits Dr. Maronian frequently prescribes indi- vidualized therapy with Tracey Newman, MA, CCC-SLP, who also participates in all patient exams. Therapy, which often begins with initial guidance following diagnosis, is designed to help patients break poor voice habits that can develop secondary to lesions or a cold. Patients also learn how to use their voice properly, as well as how to strengthen and protect it. Newman assists patients in managing a variety of voice disorders, such as muscle tension dysphonia, paradoxical vocal-cord dysfunction and conditions that involve breath-holding. She uses a two-fold therapy strategy which involves the healing of a vocal cord injury, coupled with retraining in proper voice usage. "Vocal healing and wellness require changing some habits," says Newman. "In addition to better amplifi cation, increased water intake, humidifi cation and use of a headset microphone when possible, we also train patients to use their voice in a different way, with better diaphragmatic control and usage." Newman notes that the center sees a number of pediatric patients who need care for phonotrauma, which results from misuse of the vocal cords, such as screaming, talking too much or at too high of a pitch. "We often work with families and schools to make environment changes that promote vocal wellness," adds Newman. Often, patients will develop vocal cord edema from phonotrauma. When individuals sense the change in the 18 | Cleveland-Akron-Canton MD NEWS MDNEWS.COM SEPTEMBER-OCTOBER 2011 Early Referrals are Best Referrals to UH Laryngology and Voice Disorders Center come from a variety of sources, including other otolar- yngologists, family practice and internal medicine physicians, neurologists and gastroenterologists. Keeping the referring physician in the loop is part of the center's multi-disciplinary approach, according to Dr. Maronian. She recommends referring early, particularly if a patient's hoarse or raspy voice — which can be debilitating in daily life — persists for more than two weeks. Those who have a choking problem, or who complain of food sticking or other swallowing complaints, require immediate attention. Other recommended referrals include patients with stridor or noisy breathing, particularly during walking or other exertion with no apparent pathology, and those with a chronic cough. "We see patients who tell us they've been coughing for 25 years," Dr. Maronian says. "When everything else is normal, the cough is often habitual. We can initiate therapy to help desensitize the larynx, which may be irritable and swollen. Working closely with allergists and pulmonologists, we also use many conservative remedies, such as gargling, throat lubricants and injections, which have yielded good success. In the end, our main goal is to give patients control again over their voice and airway." For more information about the UH Laryngology and Voice Disorders Center, or to refer a patient, call 216-983-3455 or 1-866-UH4-CARE (844-2273). n