The voice and the role it plays in our quality of life often is overlooked — until something goes wrong, says Gerald S. Berke, MD, founding director of the UCLA Voice Center for Medicine and the Arts and chair emeritus of the UCLA Department of Head and Neck Surgery. “The expression of our self-identity really lies in our voice. When that changes, it can make a tremendous difference in our ability to interface at work and with our family and friends, as well as in the way we are perceived by others,” Dr. Berke says.
The UCLA Voice Center for Medicine and the Arts is a national resource for treating patients with any type of voice problem, from common benign disorders such as vocal nodules, polyps and papillomas to more complex disorders such as spasmodic dysphonia, airway stenosis and laryngeal cancer. The center consists of a multidisciplinary team of experts — including laryngologists, voice scientists, speech pathologists and voice therapists — who work closely with referring physicians to optimize voice function tailored to the individual patient’s needs.
The most common cause of voice deterioration is stomach acid resulting from GERD. “A lot of patients think they know how to treat it, but they haven’t really dealt with the problem the way they should,” Dr. Berke says. Such patients are typically treated through dietary and other lifestyle changes, as well as medicines to help control the acid, he notes.
Other patients present with benign lesions on their vocal cords — often from misuse or overuse. Patients can have functional disorders, typically developed through poor habits in the use of their voice, for which they are treated by a speech pathologist. Neurogenic causes of hoarseness can involve a paralysis or weakness of the vocal cords, often resulting from surgery or a viral illness. Patients with neurological disorders, such as Parkinson’s disease or more rare forms of dystonia, can experience spasms that affect the vocal cords. The center also sees patients with serious swallowing problems, most commonly following radiation therapy or from neurogenic causes. Finally, premalignant lesions that can cause vocal changes, as well as more serious vocal cord malignancies, are treated in the least invasive way possible after a consensus is reached through a multidisciplinary tumor board.
The center offers a number of innovative procedures for voice and swallowing disorders, including office laser therapy, digital video endoscopy and Botox injections to the vocal cords — a minimally invasive treatment pioneered at UCLA. “People with severe hoarseness for more than a month that isn’t getting better with changes in the diet or voice rest should let a professional take a look at their vocal cords to see what’s happening,” Dr. Berke says. Patients with persistent swallowing problems or who find lumps or bumps in their neck should also visit a specialty center such as UCLA’s, he adds.
The department is also launching the Professional Voice Clinic Program for people whose work depends on their voice. “This is not only for professionals in the entertainment industry, but also for those who use their voice on a constant basis, such as teachers, lawyers and salespeople,” says Dinesh Chhetri, MD, a professor and laryngologist in the department whose practice is devoted to voice, breathing and swallowing disorders, and who is running the series of clinics. “Our focus will be on educating these individuals about how the voice works, how injuries occur and how they can be prevented.”