by Liza Blumenfeld, MA, CCC-SLP
Imagine going through life unable to speak loudly enough to be heard, or having to use a feeding tube because you cannot swallow solid foods or even drink liquids. And, imagine there’s not treatment available.
Often, people with voice or swallowing problems don’t realize that their conditions can be treated. At the Scripps Center for Voice and Swallowing at Scripps Memorial Hospital La Jolla, specially trained voice and swallowing therapists (including a professional opera singer who treats voice disorders through singing) use innovative techniques and leading-edge technology to diagnose and treat a wide range of disorders.
The process of swallowing is one of the most complex interactions in the body. Swallowing problems, known as dysphagia, can develop for a variety of reasons, including neurological problems, cancer, underlying pulmonary problems, injury, and weakness of the structures related to swallowing.
Its impact on quality of life can be devastating, especially if people cannot eat or drink normally as a result.
In some cases, swallowing disorders can lead to other problems. Aspiration pneumonia, the leading cause of death in people over age 70, results from food and liquid “going down the wrong way” during meals.
In these patients, the muscles in the throat become so weakened that they don’t even realize they are not swallowing properly. Only when they are hospitalized for pneumonia is the underlying cause discovered.
At Scripps, we use advanced biofeedback techniques to help patients visualize what is going on inside of their bodies when they try to swallow. We place a scope in their throats which transmits images to a video monitor, enabling them to literally see inside their throats during therapy.
By watching the muscles and tissues move while they try to swallow, they can learn to make subtle changes that have a huge impact. Moreover, they see the progress they’re making, which motivates them to keep working.
Another biofeedback device that has shown great success targets the tongue. The tongue plays a vital role in swallowing; improved tongue function improves swallowing. Biofeedback enables patients to see how much force they can generate with their tongue and greatly increases the outcomes of therapy.
Neuromuscular re-education, or electrical stimulation, also helps train the muscles to work properly. We place electrodes on the muscles of the neck and gradually increase the amount of energy sent to the nerves, which in turn stimulates muscle contraction and strengthens the muscles.
These techniques have had amazing outcomes; we have seen patients who haven’t had solid food for two or three years get rid of their feeding tubes, resume normal eating, and enjoy a much improved quality of life.
Voice disorders can affect anyone at any age. We treat the full spectrum of voice disorders, from professional singers whose voice is their livelihood to people whose voices have been impacted by injury or illness.
Many patients with Parkinson’s disease, for example, often have difficulty speaking normally; instead, they speak very slowly, softly and in a monotone. Because people can’t hear them speak, they often feel a loss of identity.
We offer a technique called Lee Silverman Voice Therapy (LSVT), a speech treatment program that has been proven to increase speaking ability in these patients. The 16-session program can increase vocal intensity by almost 20 decibels — patients have gone from being barely audible to loud enough to be heard over background noise.
Upon completion of the program, patients continue to participate in a monthly “voice club” at Scripps to preserve the gains they have made and socialize with other patients. LSVT has also been found to help with swallowing problems associated with Parkinson’s Disease, and most insurance plans cover the treatment.
As with swallowing, a voice disorder may also be at the root of other health problems. We have seen children and young adults develop difficulty breathing, wheezing and other symptoms that seem to mimic severe asthma; however, asthma medications do not help.
In many cases, these patients actually have Vocal Cord Dysfunction (VCD), or abnormal closure of the vocal cords that interferes with inhalation. Our therapists who specialize in VCD treatment have helped many patients regain normal breathing function without the need for medication.
Therapists work with patients to identify the specific triggers that are associated with the disorder; patients then learn how to avert symptoms altogether through a regimen of biofeedback and breathing techniques. Often, symptoms can be eliminated in as few as two sessions.
If you suspect you or a loved one may have a voice or swallowing disorder, contact your physician or make an appointment to be seen by a therapist. The Center for Voice and Swallowing Disorders also offers public education programs and information. To learn more, call 858-626-4444.
This Scripps Health and Wellness information was provided by Liza Blumenfeld, MA, CCC-SLP, manager of the Center for Voice and Swallowing Disorders at Scripps Memorial Hospital La Jolla.