Case Study # 3 - Allergies & Voice Loss
A college theater major with gradual loss of vocal range and endurance.
The Initial Struggle
A 19-year-old theater major in college noted a gradual loss of her singing voice, with increased raspiness, fatigue, and loss of vocal range. As a theater performer, she had attributed this to lack of singing practice but then noted it did not improve even as she worked on her singing voice. She had been trained by a vocal coach while in high school but had not had voice lessons since starting college 9 months earlier.
Notes:
Intermittent symptoms are reassuring. Consistent symptoms suggest injury
While lack of practice can impact vocal function, ability often returns quickly when working on your voice
The Approach
This student is developing her career based on her voice and performance. Even in theater acting, a clear strong voice is required. Inefficiency and inconsistency impact performance and the ability to emote and perform nightly. The vocal needs of a theater actor are athletic and require expert evaluation and care.
Details
This actor had never seen a laryngologist. She had a flexible scope by an ENT once in high school. Though an inadequate exam for any performer, she was diagnosed with reflux and sent on her way with medications. This was likely not an accurate diagnosis but does bring up the possibility that something has been going on since then and only worsened with the higher demand of school.
In this case, the patient did not have an acute “triggering event.” Triggering events are situations in which the voice suddenly changes (like with illness) and are common parts of a story of vocal injury. Gradual voice loss with symptoms that are sometimes better is less suggestive of injury. She also had a pressed speaking voice, with muscular engagement suggestive of compensation. Compensation with other muscles (ie neck, tongue) often occurs when the vocal cords themselves are not working correctly. Part of treatment would be unloading these compensations through voice therapy to get a cleaner sound and less vocal effort.
Stroboscopy demonstrated inflammation (laryngitis) and a minute early injury of the left vocal cord. Given her story, the small area of injury was likely established when she was in high school. The high demand of school and working at a restaurant, combined with laryngitis from allergies, resulted in worsening of her voice.
Thick mucous on the vocal cords - large amount of mucous on the right vocal cord (left of screen).
Pink hue of the vocal cords indicative of laryngitis/inflammation.
Minute area of polypoid thickness on left cord.
**Strobosocpy is vital to detect microscopic areas of injury such as these, which have subtle symptoms. Early intervention prevents worsening voice symptoms and possibly surgery.
Challenges & Considerations
A baseline exam before starting a voice-dominant major in college is vitally important. Early detection of minute injuries allows implementation of strategies to prevent worsening. It also allows the student to engage in care with an expert laryngologist when they are not in crisis. Then, throughout their educational career, as issues arise, they have a trusted professional guiding them who also has the context of their vocal history.
This case is more difficult to manage due to the presence of three concurrent issues: laryngitis (allergy), minor injury, and muscular compensations. However, with a strategic approach that combines medical optimization with muscular therapies and vocal rehab, she is able to return to normal voice within about 2 weeks.
During this time of rehabilitation, medical documentation was provided to lessen vocally-heavy demand at work and allow her a period of rest. In this way, the medical team takes lead on advocating for the vocal athlete’s best health and facilitates the quickest return to normal voicing.