Ageing population, greater awareness of treatments possible reasons for demand
WHEN Mrs Jarita Yeo failed to hit the high notes at her weekly choir practice, she sought out a voice clinic. The 69-year-old retiree, who has been singing recreationally for over 10 years, said: “I used to be able to hit a high C, but one day, I just could not reach it. I also noticed I would lose my voice whenever I got too excited or if I lost my temper.” She is among a growing group of people going to the voice clinics in hospitals.
Singapore General Hospital (SGH), Changi General Hospital (CGH) and Tan Tock Seng Hospital (TTSH) report between 20 per cent and more than 100 per cent more patients at their voice clinics in the last five years. At TTSH, for example, the number of patients ballooned from 180 in 2006 to 493 last year; at CGH’s Voice and Swallowing Clinic, the number of patients has risen 50 per cent in the past five years. Voice clinics are led by ear, nose and throat (ENT) specialists and speech therapists, who diagnose and treat those with voice disorders. An ageing population and greater awareness of treatments available could explain the increased case load, said Ms Francoise Lim, the principal speech therapist at TTSH’s ENT department.
Dr David Lau, a senior consultant at SGH’s department of otolaryngology, explained that as a person ages, the muscles of the vocal folds can atrophy, which leads to the voice weakening. Having an operation for a heart problem can also cause vocal fold paralysis, which is when one or both the patient’s vocal cords become unable to move. This can also affect the voice.
Doctors at the National University Hospital’s department of otolaryngology say their patient numbers have been fairly stable, but more people now have voice problems unrelated to the usual risk factors such as smoking and drinking. Dr Peter Lu of CGH’s ENT department said vocal cords can be damaged by severe coughing, forceful throat clearing or inefficient use of the voice, and by inflammation, infections and tumours of the voice box.
The bulk of the patients at voice clinics are those who use their voice for work, such as teachers, salesmen, and managers; hawkers also figure among patients because they inhale large amounts of cooking fumes. ENT doctors advise a person to seek help if there is a noticeable change in one’s voice, such as when it becomes hoarse and rough. TTSH’s Ms Lim said speaking sentences that trail off into a whisper, pitch breaks as well as squeaks during speech are also possible signs of a voice disorder. She said: “Hoarseness is never normal. Very often, you hear people say, ‘Others think I sound sexy.’ But the hoarseness can worsen to a point when it becomes an effort to speak.”
Mrs Yeo is undergoing multipronged treatment. She sees a speech therapist every three months to have her voice assessed; at home, she does exercises the therapist taught her, and takes medication for acid reflux, one of the causes of vocal cord damage. She also avoids fried, spicy and sour foods. Prevention is still key to avoiding voice disorders. Lifestyle factors such as avoiding cigarettes and alcohol, not shouting and whispering, and drinking plenty of water can help. Those who have to speak a lot on the job should also consider using a microphone when addressing crowds.
On Yam Ah Mee’s voice...
THE Returning Officer of the recent General Election, Mr Yam Ah Mee (below), endeared himself to Internet and television audiences with his monotonous delivery of the election results. He later told reporters that his robotic delivery was the result of a throat operation he had when he was young. Two types of surgery can change a person’s voice. One is the kind carried out on the voice box, or larynx, to improve a person’s voice. The other kind of surgery, done to remove a tumour, for example, can have the reverse effect. This was the case with Broadway star Julie Andrews, who had benign vocal cord nodules removed in the 1990s. Her singing voice was never the same again.
Dr David Lau, a senior consultant at Singapore General Hospital’s department of otolaryngology, said one’s voice can also be affected indirectly as a result of injury to the nerves controlling the voice box, which makes the person sound breathy and weak. This can occur in certain types of surgery in the neck or chest.
Dr Christopher Hobbs, a consultant at Tan Tock Seng Hospital’s ear, nose and throat department, said an individual with “reduced dynamic range” will sound rather monotonous and robotic. Sometimes, this has its roots in what the person picked up while learning to talk, rather than a medical problem. “In this case, it’s vocal misuse – not using the voice to its full potential. For example, if your father speaks monotonally, you’re brought up to speak that way too,” he said.
Insufficient use of inflection – changes in pitch or loudness – is also a form of vocal misuse. Dr Lau said speech therapy may help reduce the monotony of a person’s speaking voice, though this would depend on why it became that way in the first place. In most cases, surgery will not help, Dr Hobbs said.