Treating The Aging Voice
Father Ray Selker spends most of his days talking. As a Friar Priest at
St. Anthony's Shrine in Boston, he often officiates two masses daily in addition to several hours of confession and dozens of one-on-one discussions with churchgoers each week. So when he noticed last summer that his throat was often irritated and his voice was becoming weak, he was concerned.
"It wasn't the same voice I had when I was ordained eight years ago," recalls Father Selker. "I'd be speaking but the whole word wouldn't come out. "
The 47-year-old priest was worried that his lack of voice was affecting his ministry, so he mentioned the problem to his primary care physician during a routine checkup and was referred to
Dr. Pavan Mallur in
Beth Israel Deaconess Medical Center's
Otolaryngology Division in the
Department of Surgery.
"Most people don't realize there are things that can be done to fix the voice," says Dr. Mallur. "We want to educate the public and say this is not something you have to live with, there are things we can do to help."
Dr. Mallur used a scope to get a look inside Father Selker's throat and found that his vocal cords were atrophied.
"A lot of people as they age tend to lose muscle tone and muscle bulk in their larynx, just as they do in other parts of their bodies," notes Dr. Mallur. "If they're trying to make up for that, they'll compensate by using other muscles in their neck and this can lead to vocal fatigue."
Just as our voices change during childhood and adolescence, they continue to change as we age. In some cases a voice may become raspy or gravelly, in others the pitch will change. In Father Selker's case, his vocal muscles were deteriorating. Dr. Mallur recommended Father Selker start his treatment by meeting with BIDMC Speech Pathologist Laura Bauman for
speaking voice therapy to work on improving the mechanics of his voice.
"It's a little like physical therapy for the voice," says Laura Bauman, MS, CCC-SLP. "We educate patients about proper vocal mechanics and how to take care of their voice as well as teach them vocal techniques aimed at improving their vocal mechanics and changing patterns of voicing that may be harmful."
The speaking voice therapy helped, but after several sessions, Father Selker felt his voice wasn't improving enough. Dr. Mallur recommended the next level of treatment, a trial injection into the vocal cords to help increase the muscle bulk. The procedure was done in the doctor's office and Father Selker noticed the results right away.
"The next morning when I woke up, I found immediate strength in my voice. It was much stronger and clearer," recalls Father Selker.
The material used in the injection is a temporary substance that dissolves after about three months. If the injection helped, it's a sign that a more permanent procedure may be in order.
"It's called a trial vocal fold injection because we're not sure the patient will benefit from the increased muscle bulk," says Dr. Mallur. "If they did get a benefit, we have pretty good evidence to show they'll get further benefit from a permanent procedure."
There are several different options for a permanent procedure, including injecting a more durable substance into the vocal cords that lasts about 18 months, injecting the patient's own fat to bulk up the vocal cords, or open surgery to place an implant. Father Selker will undergo the implant surgery later this winter. The procedure will be done under light sedation, so doctors can monitor his voice during surgery.
"The neat part of this procedure is we'll assess the vocal folds while the patient is awake and we'll be able to fine-tune the results. So what they need is what they'll get in terms of the implant," notes Dr. Mallur. "We'll be able to customize it and provide the best outcome."
In the meantime, Father Selker is taking advantage of what he's learned in his speaking voice therapy sessions and the improvements from the temporary injection to keep his voice as strong as possible so he can continue to use it to minister to his parishioners.
"It's good because it's a combination therapy. I feel more confident now and the people I work with closely have commented more than once that the quality of my voice is much clearer," he says.
"Our voices are important. They're our main means of communication," stresses Dr. Mallur. "So I like to tell patients that just because it's this way now doesn't mean that there aren't ways we can try to improve it."
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Posted January 2012