The Ann Arbor News
Wednesday, January 26, 2000
Actor James Earl Jones, singer Billie Holiday,
college football announcer Keith Jackson - you
don't need a face to know them: All it takes
is a few words or notes. Rich and deep,
lilting with a touch of sorrow, or tinged
with a Southern drawl, their voices are
Probably most of us don't think of our
voices as our essence. Yet many people count
on their voices daily to earn a living.
Teachers, lawyers, professors, ministers,
and a few singers and actors come to the
Vocal Health Center, part of the University
of Michigan Health System, when hoarseness
or a weak or breathy voice make them aware
their built-in musical and speaking instruments
aren't working as they should.
"Everybody tends to take the voice for
granted until they have a problem," says
Dr. Norman D. Hogikyan, director of the
center, located in Livonia.
The clinic, which opened in 1996, diagnoses
and treats patients with conditions ranging
from a voice weaker from age or misuse to
laryngeal cancer. Hogikyan, a laryngologist,
may perform surgery for some conditions.
Many patients also see Marc Haxer, a speech
pathologist, and Leslie Guinn, a retired
U-M music professor who knows first-hand
about keeping a voice in top shape: As a
classically trained baritone, he's sung
Wagnerian arias and art songs in a 40-year
career in America and Europe.
In the center's multidisciplinary clinic
for vocal professionals, the three men help
patients work on new strategies for using
their voices healthily. Voice therapy, usually
in six to eight sessions, is a lot like
physical therapy for an injured knee or
hip. Patients learn to avoid overuse and
how to use their voices differently through
breathing and other vocal exercises.
When we speak or sing, air from the lungs
comes up the windpipe and vibrates tissues
in the larynx, also known as the voice box.
Two pairs of vocal folds (often called vocal
cords), which are mucous membranes in the
larynx, expand and contract to produce varying
pitches. The sound then resonates in the
throat, mouth, and nose.
"Bad habits can arise without the patient
being aware of them," says Haxer. He helps
patients learn to use the right muscles
for inhaling and exhaling, and to coordinate
exhalation with voicing a sound. Most of
the time, people handle these tasks well
naturally. But sometimes things get out
of kilter: the voice's power and resonance
Marian Cohen of Ann Arbor uses her voice
as a social worker teaching residents in
the U-M Medical School's family practice
program, and also as a choir member at Temple
Beth Emeth. She lost her voice in a case
of laryngitis two years ago, after attending
a friend's wedding where she had to talk
over the sound of the band.
"It took a really long time before I got
my voice back," she says. Even then, she
was still hoarse and had trouble reaching
Diagnosed with vocal fold nodules, she
ended up at the Vocal Health Center. Guinn
and Haxer determined she needed to change
her habit of speaking in the lower part
of her natural range.
"Dr. Haxer found a good pitch for me to
aim for," she says. "There was a spot in
my voice that was not being used enough." Gradually,
by drinking water frequently to hydrate
her larynx and doing breathing and vocalizing
exercises, she's restored her voice and
has no problems with hoarseness.
When a voice sends distress signals
The most common complaint Hogikyan hears
is persistent hoarseness. Other patients
notice their voices become tired more easily,
or that they can't sing or speak in the
higher range. A soprano may feel she ought
to be singing tenor, or a father who reads
to a child may not be able to mimic animal
voices the way he used to.
Hogikyan stresses that people who find
these symptoms persist should see a doctor,
since they can indicate minor or serious
conditions. "A voice change can be indicative
of something as simple as a cold or as severe
as cancer or a paralyzed vocal cord," he
says. To diagnose a problem, he may listen
to a patient read a text and use an instrument
that allows him to look inside the voice
box and videotape vibrations there.
Some voice disorders, such as smoker's
polyps and nodules, result from voice overuse
or abuse, while others don't. Viral or neurological
conditions that bring some patients to the
center include paralyzed vocal folds and
spasmodic dysphonia, a neurological disease
experienced by National Public Radio talk
show host Diane Rehm. Botulinum toxin treatments
successfully reduce the symptoms temporarily.
Dr. Ameed Raoof came to the center after
he realized his voice, which he uses extensively
to lecture to medical and dental students
as an anatomy professor, was hoarse and
not its normal pitch after he had a cold.
Hogikyan diagnosed and removed a hemorrhagic
polyp from Raoof's vocal fold. After three
months of rest and voice therapy, Raoof
considers himself fortunate.
"I haven't had my voice in this good shape
for a long time," he says. He still practices
vocal exercises in the morning or while
Nodules on the vocal folds are an inflammation
that singers and others voice specialists
call "vocaholics" may experience if they
overuse their voices. At the center, they
learn to recognize signs they're pushing
their voices too far and also better ways
to produce vocal sounds. Nodules usually
resolve with vocal therapy, but sometimes
Patients coming to the center with a hoarse
or gravelly voice, especially early in the
day, may have another common problem, acid
reflux laryngitis. It occurs when stomach
acid backs up and irritates the voice box
and vocal folds. "In the last five years
we've really turned our attention to this
(condition)," says Hogikyan. Treatment includes
altering food and drink habits.
When Guinn sees a patient, he first listens
as they talk in normal conversation. "Our
voices generally reflect our personalities," he
He asks some questions, perhaps offering
pointers on keeping the larynx hydrated
or avoiding certain foods.
"Then I talk with them about breath flow.
Do they talk on residual air? Do they even
think to breathe when they speak?"
Guinn says helping a patient find the optimal
way to use his or her vocal capacity is
like coaching a tennis player to find the
sweet spot. "That same process is available
to singers, speakers, and actors," he says. "I
help them awaken these sounds," he says.
As for people like James Earl Jones, do
they come by their distinctive voice through
special attention or luck? A bit of both,
says Haxer. Someone like Jones is likely
to care for a golden voice through training
and good habits, but also has individual
physical gifts: vocal folds of a certain
mass or length and a fine resonating space
in the mouth or nasal cavity.