My friend and colleague, a pediatric allergist, sat across from me frantically scribbling notes. She had lost her voice two days before from an unusual type of laryngitis. As a consequence, she was unable to work for an entire week. As arrangements were made to reschedule her work patients for the week, I was reminded that the professional voice user is not limited to the actor or singer but includes a myriad of professions all of which depend on the voice. Add ‘physician’ to the long list of voice-dependent professions.

Care of the professional voice is a major component of Laryngology, a subspecialty of Otolaryngology, or “Ear, Nose & Throat.” Our voices are the basic component of human com­munication and an expression of our personality. In the modern world, relationships are forged based on person-to-person com­munication whether that be in person or on a telephone line. Many relationships are based on the voice at the other end of the line, with minimal if any person-to-person contact. Many if not most jobs are dependent on voice communication at some level. Some, such as classroom teachers and telephone operators depend heavily on being able to maintain a normal voice on a day-to-day basis with vocal strength and stamina. Similarly, entertain­ers, professional and amateur, have much more complex vocal demands that require good vocal health.

Care of the voice includes diagnosis and treatment of acute and chronic complaints, address­ing long-term goals, as well as managing the possible affects of other illnesses. The Jefferson Center for Voice and Swallowing (JCVS) is a center of excellence at Thomas Jefferson University at the Center City Philadelphia Campus. It is dedicated not only to the professional voice but also to care of complex swallowing and airway problems.

Basic voice care begins with vocal hygiene: stop abusing your voice and start taking care of it.

Here are some basic tips:

1. Drink plenty of water
2. Limit throat clearing
3. Avoid speaking over noise
4. DON’T SMOKE
5. Periodically rest your voice
6. Seek medical care when hoarseness per­sists for more than 2 weeks

Hoarseness is a com­mon symptom of swelling of the tissues of the larynx associated with the com­mon cold, influenza and seasonal allergies. It will usually go away with the other symptoms of nasal congestion and cough. More long-stand­ing voice change can result from chronic irritation. Overuse and abuse of the voice, speaking too loud and/or too much can lead to swelling and development of benign growths (vocal nodules, singer’s nodules) that prevent normal vocal cord function. Mucosal irritation can be caused by tobacco smoke, reflux stomach acid and post-nasal drainage. All of these conditions are treatable with medications, therapy, and occasionally, minimally invasive surgery.

Less commonly, hoarseness is caused by problems with vocal cord motion. Paralysis can lead to weak, breathy voice and some­times difficulty with breathing. Other types of problems with vocal motion are caused by spasms of the muscles that move the vocal cords causing a wide vari­ety of voice complaints. Accurate diag­nosis involves comprehensive evaluation by a voice team, neuromuscular testing, and often radiologic tests. The JCVS employs many innovative treat­ments for these conditions. Vocal weakness can be corrected with temporary or permanent vocal cord augmentation. Spasmodic conditions are often controlled with oral medications or Botox injections. In all cases, treatment is dependent on integrated voice therapy.

An additional major concern is laryngeal cancer with about 30,000 new cases reported in the US each year. While this number has remained fairly stable, the percentage of women has steadily increased due to the increase of cigarette smoking among women in the last century. Hoarseness is the earliest and most common symptom. Some patients with early laryngeal cancer also note throat irritation, sore throat and pain in one ear. When laryngeal cancer is detected at an early stage, it is successfully treated with preservation of voice. The leading risk factor is cigarette smoking. The risk is reduced substantially five years after a patient stops smoking and the risk continues to decrease for ten years more. We are active in pro­moting and encouraging smoking cessation for all of our patients and employ many resources to help patients quit. The JCVS is a leader in clinical research to develop a program of medical treatment and support for smok­ing cessation throughout large medical practices.