Annual Vocal Physical: PART 3 - the General ENT exam
The third part of a thorough annual vocal physical is a general ENT, ear, nose and throat exam.
A lot of clues can be found when examining the ears, nose and mouth, and feeling the neck. Good medicine does not tunnel vision down to an area of sub-specialty. The whole body may impact the voice in various ways and it is vital to do a complete evaluation for this reason. Simple postural issues or allergic findings in the nose can have dramatic impact on the voice and are only discovered when doing a complete ENT exam.
Why is it important to examine the ears, nose, and throat of a professional voice user?
The complete exam is a form of data acquisition. When evaluating the vocal athlete, querying general ENT concerns allows them to convey seemingly little things that may be impacting the voice. For example, looking in the mouth may reveal signs of reflux or post nasal drip. We can observe dryness of the mouth and lips that may give clues to systemic/wider issues. The neck exam may reveal a thyroid mass or muscular tightness that creates vocal inefficiency. If this is bypassed to simply do stroboscopy, we miss clues of vocally impactful findings.
Can’t you see it all with the strobe/scope?
When examining a singer or actor with a voice complaint, it’s tempting to jump to the scope and use the detailed picture to determine the diagnosis. However, this is simply bad medicine and is the reason a lot of singers will leave doctor’s offices with prescriptions for reflux medications, steroids, or unnecessary vocal rest.
Previous content has addressed the importance of taking a good history of the artist’s symptoms and of testing the patient’s voice. Even if a good history and voice evaluation are done, it is vitally important that the laryngologist do a complete head and neck evaluation. This includes the components of a general ear, nose and throat exam.
All laryngologists were ear, nose and throat physicians first, trained in ENT and head and neck surgery. Laryngology requires extra training to specialize in voice surgery and medical care of the voice. While laryngologists are experts of the voice and larynx, the ear, nose and throat must still be attended to. Many conditions that affect these areas can affect the larynx and be the cause of voice disorders. These will not show up on scopes and strobes.
The most important thing is to make sure you are having a comprehensive assessment of any areas of the whole body that may impact voice in order to get an accurate diagnosis. Accuracy and customized treatment ensure vocal longevity for our athletes.
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Meet Dr. Gupta, the top voice doctor in LA, and Tressa Cox, the leading voice therapist specializing in voice rehabilitation.
Learn more about their expertise and services at the Center for Vocal Health.