Using a combination of medical and therapeutic strategies, the team at Mercy's Voice Clinic tailors treatment to the needs of the individual patient. A speech therapist works to educate patients about their voices, how sound is produced and how certain behaviors, such as smoking or consuming excessive amounts of caffeine, can damage the voice. "It is vital for people who use their voice for their occupations to understand the importance of vocal wellness," according to speech pathologist, James Olson. "The patient is an important part of the treatment team, " adds Julia Goth-Avery, also a speech therapist at the Voice Clinic.
Mercy's Voice Clinic treats three broad categories of vocal disorder: speech disorders caused by chronic infection and inflammation of the larynx (voice box), disorders resulting from trauma to the larynx or neck, and neuromuscular diseases that affect the muscles of the neck and larynx. In this last category, the most common disorder seen at the Voice Clinic is Spasmodic Dysphonia or SD. SD patients have a difficult time producing sound, and their speech is characterized by uncontrollable voice and pitch breaks. Until recently little could be done to help these patients, but an innovative treatment now available at the Voice Clinic, Botox injection, can bring SD patients considerable relief.
With Botox injection, a small amount of the neurotoxin produced by the bacteria Clostridium botulinum is injected into the muscles around the larynx (voice box). Although this toxin is responsible for some types of food intoxications, in the clinical setting it can bring great relief to SD patients. In SD, the Vagus nerve inappropriately signals the muscles around the larynx to contract. This over contraction prevents free and easily vibration of the vocal folds as air passes over them. Botox acts by stopping this inappropriate nerve signal. Tension on the vocal folds is relieved, and the SD sufferer has much less difficulty producing sound.
As quickly as three days after the injection patients report that speaking is easier and that their voices are improved. The patients keep a vocal diary where they record information about the ease of speech and the sound of their voice as well as other information such as colds or other stresses that could impact their speech. The diary is reviewed thoroughly by the team at the Voice Clinic in order to help maximize the benefits of the Botox injections. "One disadvantage of the Botox injections," says Dr. Wagner, "is that it isn't a permanent cure. The effects usually wear off in 3-4 months." In spite of the temporary nature of the treatment, most patients report that they are happy with the effects of the Botox injection.
In addition to voice therapy, and Botox injection, phonosurgery is offered through the Voice Clinic. Phonosurgery involves surgical procedures that are performed to enhance the voice. For instance, for a person suffering from a paralyzed vocal fold, the paralyzed fold can be surgically moved to the middle of the larynx so that it is closer to the working vocal fold. This allows the working fold to make better contact, and provides some relief to previously untreatable speech disorders.