What this leaflet tells you This leaflet explains what to expect after the Epley (canalith repositioning) manoeuvre for posterior-canal BPPV, what you should and shouldn’t do, and when to seek help. 1. Quick summary — what the Epley did The manoeuvre moves tiny particles (otoconia) out of the balance canal of your inner ear and back into a place where they don’t cause spinning (vertigo). Most people feel much better after one or a few treatments. However BPPV can come back (recurrence is common). 2. How you may feel immediately afterwards You may feel dizzy or off-balance for a few minutes to a few hours; nausea is possible. Some people feel better straightaway; others get gradual improvement over days. Rarely ,you may have brief recurrences of vertigo — this does not always mean the manoeuvre failed. 3. Activity and posture — what the evidence says Good news: High-quality studies and recent guidelines show that strict he...
Most professional voice users can be regarded as vocal gymnasts. They need to have the good vocal calibre to match their demanding needs. For this reason, they are more prone to develop disorders of the voice. It is needless to emphasise that their existence is centred around their voice and hence the substantial psychological impact on them at the subtlest aberration.
How do I care for my voice? How can I stay away from voice problems?
Good vocal health can be ensured by adhering to principles of vocal hygiene. Good voicing techniques, warm-ups and cool-downs, avoiding unwanted strain like shouting and cheerleading adequate hydration and rest, regular diet and sleep are essential for good vocal health.
Who will be able to answer all my concerns and help me?
Otolaryngologists with a special interest in professional voice can help you sort issues relating to voice. They work in close association with voice therapists(SALT with a special interest in voice), Vocologists and voice coaches. They have access to osteopaths and other medical voice experts (psychologist, respiratory physician endocrinologist, with a special interest in professional voice).
I am gifted and can perform well. Is it mandatory that I undergo voice training?
Voice is like a pebble rock in the bosom of a river. It is subject to constant changes, age being the most expected factor in both genders alike. One cannot stress the importance of vocal training when it comes to choosing that as a person's career.
I am a trained voice user. Does it mean I will never get voice issues?
Training only reduces the likelihood of a voice disorder. Anybody can suffer any vocal insult. Even the most trained singer can have a voice problem when he shifts his trainer, or there is an alteration in his routine.
When do I seek medical help if and when I develop a voice problem?
Any sudden voice change needs evaluation. Any voice change persisting beyond three weeks needs investigation. It is good to be aware of some other red-flag symptoms like pain in the throat, difficulty swallowing, breathing difficulty, noisy breathing, weight loss, neck lumps, weight loss.
What can happen if I ignore my symptoms?
Ignoring the symptoms can result in permanent alteration in one's voice. If there is a delay, it may warrant prolonged voice therapy sessions. It is much easier to correct a new symptom when the technique is faulty. Submucosal haemorrhages can get organised and take a long course to recover if not treated soon enough.
Can an endoscopic exam of larynx harm my voice?
This is a total myth. It is an invaluable tool in assessing a person's voice. The specialist may ask you to elaborate your vocal activity before and while doing the endoscopic assessment. You may need to go up and down the scale, sing some easy and challenging songs to assess your technique. Also while you do this, the specialist gets to assess your posture, breath support, voice projection and other technicalities to ensure proper execution.
Are there special tests to precisely identify my voice problem?
Voice disorder may be associated with structural problems in the voice box or the singer/voice user has an entirely normal voice box. In the vast majority of cases, the larynx looks normal, and it is the functioning which is abnormal.
Endoscopic exam aids greatly in looking for structural problems (nodules, cysts, polyps) and enables dynamic assessment of voice to assess if they function normally.
(Can elaborate on Flexible nasal endoscopy, 70-degree telescope, stroboscopy, voice analysis software) to measure pitch, loudness, formants.
My voice box looks completely normal, yet my voice sounds horrendous. Is it a common occurrence?
Yes, it is common. For example, imagine a person with a sprain in the right ankle. When you look at him when he is seated on a chair, he will look quite alright. If instructed to walk, he would limp. Even though his feet are structurally normal, they function abnormally(limp).
My speaking voice is normal but things go terribly wrong when I sing. How do you explain that?
Dysodia is a condition where specific vocal tasks are affected. The speaking voice can be normal with a faulty singing voice.
What is Voice Therapy? Can SALT help me with therapy always?
Voice therapy consists of a series of tasks to address posture, relaxation, breathing, voicing and voice projection.
Depending on the severity of the voice problem, the faults can be identified and corrected at specific levels or the person needs to learn to voice if there are faults at most of the levels.
It is ideal to work with a voice therapist, who is a SALT member who has specialised in voice. They should be able to help you almost always but will also require input from the voice psychologist, voice coach and the surgeon if need be.
Does voice rest always help? What if it can be detrimental to my career?
Voice rest is very crucial for a healthy voice. The microscopic structure of the vocal cord reveals a complex, layered structure of fibres in the deeper portion. When we talk, they vibrate. Any resultant disruption heals by itself if we allow time between vocal activity. One hour of talking requires two hours of rest. Judicious use of voice rest helps maintain a good voice.
Long periods of voice rest unless essential, should not be advised to professional voice users as it can negatively influence their career.
How does reflux affect my voice?
When we look at the vocal cords in professional users,it is as though we are looking at the skin which glows on a beauty pageant. The glow is the indicator of absolute skin health, and similarly, vocal cords have a mucus layer which is disrupted by vocal abuse, allergy, infections and reflux. They cause subtle irregularities in the lining and make secretions and phlegm clingy on the surface. Once the mucus layer is lost, the vocal cords dry up more often, and this can cause the voice sound scratchy.
This is the mildest change described when there are no apparent changes like swelling or redness. That is how reflux affects one's voice.
My ENT specialist feels I need to have an operation in my voicebox to remove a non-cancerous growth which makes my voice quite rough. Will it damage my voice forever?
Surgical treatment is the last option for a voice professional for fear of the scarring. However, if need be, it is resorted to. There are special surgical techniques to minimise the structural damage and a special team to take the artist through the phases with adequate care.
Helping Patients with Specialist Expertise and Kindness
Mr Gaurav Kumar
Consultant Ear Nose Throat Surgeon
Book Appointment
entsurgeonclinic@gmail.com
07494914140
Disclaimer: For general information only, always seek expert advice from treating consultant.
