A new sunrise singing a happy tune
As a trained vocal performer, Brad understands the importance of his voice. But, when severe hoarseness made it difficult to speak, let alone sing, it was more challenging than he’d expected. As efforts to rest his voice didn’t help, he became distressed and began to think “What would I do if I couldn’t talk?”
Then he came to UMPhysicians and met with Stephanie Misono, MD, MPH, otolaryngologist, and Deirdre D. Michael, PhD, CCC-SLP, speech language pathologist. Their examination revealed that Brad had a complex hemorrhagic vocal fold polyp. Working together, they helped him through surgery and therapy to total recovery – talking, singing and laughing, again.
Stress of losing your voice
In the spring of 2011, Brad noticed his voice was suddenly very hoarse the day after he’d been coaching his son’s little league baseball team. As a professional vocal performer, he knew something was wrong and he took steps to rest his voice.
But, resting his voice was more difficult than he imagined. Brad also works as a customer service manager and uses his voice all day – on the phone, with clients, in meetings with colleagues. “It’s not easy to not talk,” Brad explains. “Your injury isn’t visible, so people don’t understand why you can’t talk to them. They take it personally and get very frustrated.”
After several months of dealing with these issues, Brad was frustrated, too. And, he’d given up singing. He was emotionally exhausted and still not feeling better. Then Brad was referred to the Lions Voice Clinic at the Ear, Nose and Throat Clinic at University of Minnesota Medical Center, Fairview, where he met with Stephanie Misono, MD, MPH, and Deirdre D. Michael, PhD, CCC-SLP. Their multidisciplinary approach and expertise would help Brad get on track to recovery.
A collaborative approach to healing vocal problems
Drs. Misono and Michael examined Brad together during his first visit. In fact, their approach is entirely collaborative. “In our clinic, the laryngologist and speech pathologist work side by side,” explains Dr. Misono. “We examine patients together and benefit from our collective experience and expertise in diagnosing and treating them. Understanding the impact of the vocal problem not just on the patient’s voice, but on his or her life, allows us to treat the patient more comprehensively.”
Dr. Misono has had specialized training in the diagnosis and management of voice problems; she completed a dedicated fellowship in Laryngology and Care of the Professional Voice at Vanderbilt University following a six-year residency in otolaryngology. Her partner, Dr. Michael, holds a PhD in communication disorders, and is a trained vocal performer with 35 years of experience as a singing teacher, which brings a unique perspective to her work.
They used a scope with a camera on the end of it to look at Brad’s vocal folds, which showed he was suffering from a complex hemorrhagic vocal fold polyp. Vocal folds (commonly known as vocal cords) are made up of three layers of tissue: muscle, a soft gelatin-like substance and skin, like the lining of your mouth. In a hemorrhagic polyp, tiny blood vessels have ruptured and bled into the second layer, causing a tissue injury that affects the vocal fold vibration.
Vocal fold polyps are commonly removed surgically. But, before they took that step, Dr. Misono wanted Brad to work with Dr. Michael on voice therapy exercises.
“It’s critical that the patient first learn how to use the voice safely and efficiently,” Dr. Michael explains. “Patients work on breathing and vocal exercises to reduce stress on the vocal folds. It ensures they are prepared for surgery and helps them succeed afterward.”
This conservative approach was helpful for Brad. “Dr. Misono and Dr. Michael took time with me to understand the medical issues with my voice and my emotional state,” Brad confides.
Brad’s therapy progressed well, and part of the lesion resolved. But, after a few visits, it became clear that surgery was necessary for Brad to recover his voice. He discussed the possible risks and benefits of surgery with Dr. Misono and decided to proceed.
Surgery and successful recovery
Phonomicrosurgery – the name for this type of surgery on vocal folds – requires special tools and expertise. Vocal folds are about the length of your little fingernail. So, the surgical site is extremely small and very delicate. A long slender tube was inserted in Brad’s throat and Dr. Misono viewed the vocal folds through a microscope at the other end. Using very small surgical micro-instruments on long, thin handles, Dr. Misono carefully cut through the vocal fold surface, removed the polyp and excess tissue, and replaced the flap of skin over the vocal fold.
After his surgery, Brad was on complete vocal rest for seven days and then gradually increased activity over the following weeks, following a customized care plan and continuing voice therapy with Dr Michael. By three months, he was singing again and prepared a Mozart aria for his follow-up visit with Drs. Misono and Michael.
“After the surgery, Brad had new positive energy,” says Dr. Misono. “It was very moving to hear him sing, knowing how important it was to him. He also told us his kids said they hadn’t heard him sing so much in years. He was able to start a new chapter in his life – we hear that from many of our patients.”
“I have made a total recovery. I am now preparing for auditions, considering parts I wouldn’t have in the past,” says Brad. “And, talking normally is awesome.”