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Losing your voice is often inconvenient, especially if you rely on talking and your voice to make a living. For actors, singers, teachers, lawyers—anyone who communicates in a professional capacity—the ability to speak with clarity and without pain, is essential.

Hoarseness may have many causes, and if not improving after a cold or infection, you should be evaluated by an otolaryngologist or ENT (ear, nose and throat doctor). If your symptoms continue to persist after several days or weeks), your hoarseness could be a sign of a voice disorder, also known as a dysphonia to determine the exact reason for the hoarseness.

If you suspect you might have a voice disorder, the good news is, there are a number of treatment options available. Once you have been seen by an ENT, you will need to then be evaluated by a speech-language pathologist who has experience with a variety of voice disorders, preferably one certified in orofacial myology.

To help you prepare for a discussion of your symptoms with an ENT and a speech language pathologist, here’s a break down some of the most common voice disorders seen with people who use their voice frequently for their work or their past time, along with some of the different treatment options out there, so you can understand what might be causing your hoarseness and get your voice back to its full capacity.

Getting to the Root of Your Hoarseness
A few of the most common hoarseness-causing voice disorders due to voice overuse, incorrect breathing and vocal strain are vocal cord nodules and muscle tension dysphonia, often due to vocal hyperfunction also known as phonotrauma.

Vocal cord nodules are benign, callus-like growths that tend to arise as a result of muscle overuse, usually following activities like singing, yelling or talking a lot with strain. They occur on the tissue of the vocal cords and are usually symmetrical, that may go away with proper therapy. If not, they become harder and more difficult to reduce and may require a surgical option.

Vocal hyperfunction is caused by muscle overuse—in this case, the laryngeal muscles—and often goes hand-in-hand with muscle tension dysphonia (MTD), a common disorder in which the laryngeal muscles become so tight that it may cause inflammation in the surrounding tissue and prevent easy muscle movements to produce voice from occurring.

Breathing is an important factor to consider in using your voice well. Breathing through the mouth causes cool, dry air to enter the body and allow more bacteria and germs than through nasal breathing. Many people will have more upper respiratory infections and allergies when they breathe through their mouth. The negative effect of mouth breathing on the voice, is often drying to the mucosa lining of the vocal cords, which results in more voice difficulties.

A tight or short attachment under the tongue might contribute to muscle tension dysphonia (MTD) by putting strain on the muscles of the larynx. This condition, also known as ankyloglossia, is able to be identified by a voice therapist who is also a certified orofacial myologist.

Treating Your Voice Disorder
Voice therapy can help identify and eliminate any environmental factors that may be contributing to your voice disorder, while improving your vocal habits, breathing efficiency, muscle use, projection and more. Depending on your specific condition, your voice therapist will choose the appropriate treatment methods and techniques, including vocal function exercises meant to restore strength and balance, resonant voice therapy, breathing exercises including Buteyko Breathing and Laynee Restorative Breathing Method™ and more dynamic methods like myofascial release therapy (MFR) or VoiceGym.

Breathless
Identifying breathing dysfunction is a large part of voice dysfunction. Helping speakers develop better nasal breathing, especially when not talking, makes a big impact on vocal health.

In Pain? You’ll Love Myofascial Release
For muscle tension causing pain in addition to hoarseness, myofascial release therapy can bring fast, often enduring relief. Myofascial release is a hands on, manual technique in which sustained pressure is applied to the soft tissue in and around the neck where the larynx or voice box is located and surrounding regions until the tension melts away. Patients often have lessened pain for several days following a session.

Hit the (Voice) Gym
VoiceGym is an exercise program that was developed by a vocal coach, Angela Caine in the early 1990s to help maintain “the coordination and efficiency of voice, body and brain.” The technique was designed to help people like singers, professional communicators and exercise instructors maintain the power and resonance of their voices while performing physical activity. VoiceGym involves a combination of functional anatomy, Pilates and similar exercises, and is often used with patients who have orofacial myofunctional disorders such as tongue thrusting and restricted tongue movement, by changing the placement of the tongue and the hyoid bone that is attached by muscle, also attached by muscle to the laryngeal structures where voice is produced.

Articulate Your Symptoms and Yourself
Whether you rely on your voice professionally or socially, trying to communicate while dealing with hoarseness can be frustrating at best and painful at worst. At Alliance Speech & Language Center, we work closely with laryngologists and ENTs specializing in voice disorders to identify whether the cause of your hoarseness is in fact a voice disorder and, if so, develop the right treatment plan for you.

To learn more about our experience treating singers, actors and other professional speakers with voice disorders, or to schedule an appointment, please contact us.

For most of us, mealtime is a rewarding and enjoyable time of the day. We look forward to both the food and the social interaction. Imagine walking into your home and smelling fresh cookies baking or soup simmering. You hear the clanking of pots and pans and the whirl of the food processor. You ay associate the sounds and sells with familiar food and start to salivate. Your first thought may be, “How long until dinner?” For many of the clients we work with, mealtimes are frightening and challenging rather than enjoyable. Over the years, I have received countless numbers of referrals for children who reportedly had “behavioral feeding aversions. The vast majority of these clients have feeding aversions or “behavioral feeding issues. In some cases, well meaning families or therapists have actually created these aversions. Strict behavioral intervention programs may not recognize or treat the sensory or motor etiology of feeding disorders.

Consider the cases outlined below:
Jason is a five year old boy with a diagnosis of pervasive developmental delay. He is extremely hyper-sensitive to high pitched sounds. As his mother begins the preparations or dinner, Jason puts his fingers in his ears and begins rocking back and forth. The hum of the microwave and the buzz of the blender increase the intensity of Jason’s protests. Jason screams as his parents try to put him in a chair for dinner. Jason’s pediatrician suggests that he has behavioral issues. A more accurate assessment of Jason’s feeding aversion may be that his hearing sensitivities are so significant that the kitchen has become an unpleasant place for him to be.

Sarah is a ten-month-old baby girl. Initially she had trouble with bottle feedings which required several nipple and formula changes. She has a history of gastrointestinal reflux, which was addressed with position changes, thickened formula and eventually resolve with medication. She was also a difficult to calm baby who required complicated routines for bath time, dressing/undressing and bedtime. At six months of age, rice cereal was introduced. Sarah gagged and spit up. Her parents tried a variety of baby cereals, fruits and vegetables over the next few months. Sarah’s reaction was generally the same. She turned her head, pushed the food away and gagged on anything her parents were able to get into he mouth. Her parents were advised to ‘give her time and sell get used to food.” Her doctor was not overly concerned because he weight was staying on the charts due to her formula intake. Her parents were frantic. Through a sensory diet program we discovered that Sarah’s reaction to baby applesauce was very different if we put it in the freezer for fifteen minutes prior to a meal. She actually became an active participant in the mealtime experience! While dining in an Italian restaurant, her mother discovered that “Penne ala Vodka” was her favorite food. The bland taste of baby food and lukewarm temperature did not give Sarah enough information to be able to handle food successfully. In addition, her early bout with reflux made feeding an uncomfortable time of the day. Addressing underlying medical concerns improved her ability to handle feeding. A sensor diet which respected Sarah’s need for increased information made food considerably more enjoyable.

Alexandra is a two-year-old girl with a diagnosis of Down Syndrome. She reportedly did “fine” on a bottle and with pureed foods. When solid foods were introduced at approximately nine months of age, Alexandra had repeated incidents of gagging and choking. Initially, she would try any solid foods presented, but she reportedly became a “picky eater.” By fifteen months of age, she would only eat pureed foods or crunchy, salty foods, such as Goldfish and crackers. She will sometimes put a solid food she deem acceptable into her mouth, suck on it and push it out with her tongue. As I observe Alexandra eating, I note her primary pattern continues to be a suckle with both pureed foods and solid foods. Her mother has been told that Alexandra only eats purees because he “gets away with it.” I suspect Alexandra is afraid to eat solid foods. Due to low muscle tone, reduced strength and mobility in her jaw, lips, cheeks and tongue, she does not have the motor skills to chew food effectively. She is willing o eat highly salted snacks which will break down easily in her mouth. Other high tasty foods may be explored to experience the flavor and then pushed out the oral cavity using an infantile suckle pattern. As Alexandra has learned to chew, other food textures have become safe and acceptable to her.

In all of these case presentations, sensory and motor limitations contributed significantly to the “feeding aversion.” Families and therapists frequently give children with special needs foods that they do not have motor skills to handle or foods that do not address their sensory deficits. The response is often gagging, choking and throwing up. The subsequent learned reaction is to refuse to eat these food textures or tastes when they are presented. Sell meaning therapists and families are so concerned with nutrition that they miss the underlying issues which limit a child’s ability or willingness to eat. The practice of “force feeding” clients is another factor which contributes to behavioral feeding problems. The message we give children is, “I bigger thank you and I can make you eat.” The result is a lack of trust the child has for the therapist or caretaker. Our clients cannot always communicate their needs effectively, and we may miss subtle communication attempts. The diagnosis of feeding aversion or behavioral feeding problem does not always adequately represent the issues.

A comprehensive feeding evaluation must include assessment of both motor and sensory skills. Adequate respiration and postural stability are your first considerations, as stability in the body will support mobility in the mouth. Then, oral phase skills such as lip closure, tongue retraction tongue bowling, tongue lateralization and tongue tip elevation should be assessed. A five-day baseline diet, analyzed in terms of taste, texture and temperature should serve as an initial exploration of a client’s sensory preferences. Your therapy plan should focus on facilitating the motor skills required to handle feeding. Exploration of taste, texture and temperature variables should be done slowly, with only one change made at a time. Use sensory variables, such as taste and temperature, to facilitate changes in motor skills. (For example, in Sarah’s case, the addition of cold temperature to her applesauce gave her more information and encouraged increased lip closure on the spoon and more effective tongue retraction to move the bolus back in the oral cavity.) As changes are noted in motor development, a client will be better ale to handle an increased variety of textures; the client will have been an active participant in sensory exploration in the feeding interaction. Improved feeding skills will b supported by the development of trust in the caretaker/client or therapist/client relationship. For clients with underlying sensory and motor issues, behavior management approaches should be considered as secondary to sensory/motor goals.

Babies with Down Syndrome commonly have developing difficulties with speech and swallowing which may be addressed very early. Your baby is likely to have low oral tone including the muscles of the oral cavity. The lips and tongue are especially at risk to develop less strength that is needed as your baby grows, necessary for breast or bottle feeding, eating and speech. Because of the low tone, the tongue appears oversized, flaccid with a rounded tip and frequently at rest between the gums.

The tongue is very important in feeding. The soft palate or roof of the mouth is a soft spot growth plate like the fontanelles on he head, which eventually close as your baby grows. The stimulation of sucking the tongue against the palate is important to stimulate this closure. There is also a connection with fluid in the ears, another common problem in babies with Down Syndrome. It is critical that she sits upright to feed, with her ears higher than the mouth, to reduce the likelihood of ear fluid. Place the nipple lower than your baby’s mouth. If the tongue stimulates the palate during sucking adequately, which will also occur with proper positioning, the palate will develop in a smooth, arched manner. If her mouth is closed, her tongue is in an active phase of toning against the palate. If not, a high narrow palatal vault with a bony notch will develop. If fed in a reclined posture, your baby is susceptible to ear infections. Reclined feeding may encourage mouth breathing thereby generating more mucous in the nose which would the drain to the ear by way of the Eustachian tube.

For young infants, use a Playtex Nurser with the bag liners. Take the baby’s lead. When he sucks, press the bag to increase the volume of liquid drawn in by the tongue. He will exercise his tongue every time you press. Don’t press if the baby stops to breathe or swallow. Let the baby rest when he needs to because his endurance may be poor. Your baby will be exercising his tongue every time you press, and increase the strength of his tongue.

Babies over 8 months may be ready to use a straw which will exercise their tongue by sucking through it. It will help her retract or pull back her tongue while pursing he lips. The first straw should be straight and short, and the baby may need to tae a large amount of the straw in her mouth. As the baby increases her tongue strength, allow les and less of the straw to go into her mouth, so the tongue can be further challenged. As the baby improves her ability to use only” of a straw into her mouth to suck, give her a longer straw. The Party stores sell all kinds of straws with twists and turns that are colorful and attractive. Gradually add more complex straws as your child is able to use each one.

This is a quick look at how tongue ties and upper lip ties may affect function in a variety of ways through the course of one's life. This animated video is recommended as the first place to look for a good overview about how this common anomaly can cause potentially serious health conditions.

Nicole Archambault Besson, a Speech Language Pathologist in California, is one of the best known researchers and clinicians on the speech pathologist’s role in disordered breathing. Difficulties with nasal breathing, during wakefulness and sleep affect many people of all ages and related to Orofacial Myofunctional disorders. It is within the scope of practice of a Speech Language Pathologist with specialized training, to understand how difficulties with nasal breathing affect development and functions such as speech, swallowing and breathing, including sleep disordered breathing. This article describes what red flags indicate disordered breathing as well as the SLP’s role in treating patients with these issues.

There's a silent epidemic in western civilization, and it is right under our noses. Our jaws are getting smaller and our teeth crooked and crowded, creating not only aesthetic challenges but also difficulties with breathing. Modern orthodontics has persuaded us that braces and oral devices can correct these problems. While teeth can certainly be straightened, what about the underlying causes of this rapid shift in oral evolution and the health risks posed by obstructed airways?

Sandra Kahn and Paul R. Ehrlich, a pioneering orthodontist and a world-renowned evolutionist, respectively, present the biological, dietary, and cultural changes that have driven us toward this major health challenge. They propose simple adjustments that can alleviate this developing crisis, as well as a major alternative to orthodontics that promises more significant long-term relief. Jaws will change your life. Every parent should read this book.

Alliance Speech & Language Center is proud to announce that as a longtime provider of Advanced Brain Technology (ABT) products, including The Listening Program® (TLP), we are able to offer their latest cutting edge technology. ABT develops music-based neuroacoustic products for Sound Brain Fitness for Learning, Communication, Intervention, Wellness and Performance.

Advanced Brain Technology’s newest products include Spectrum, Achieve and Sleep, as well as the latest in Bone Conduction headphone technology, Waves™. ABT now offers a new delivery of their products, through cloud, or streaming the music from most electronic devices including PC, Mac, iTouch, iPhone, iPad, or Android phone and tablets. They also provides on-screen journaling with simple and easy to use graphics for monitoring.

In addition, listeners can choose from monthly or 1 or 2 yearly subscription membership plans, If you are perusing one of the yearly memberships, you can pay the fee as well as your Waves™ headphones in 3 monthly installments as well as take advantage of the membership discount.

Shira Kirsh, M.S., CCC/SLP, Speech Language Pathologist is ready to guide you with TLP online. Go to tlp.advancedbrain.com for more information and start your 7-day free trial. Like us on Facebook at http://facebook.com/AllianceSpeechLanguageCenter and follow us on Twitter @AllianceSpchLng.

I read an article in Toastmaster’s magazine recently about Neuroplasticity. I immediately took interest as I have been reading about and applying the principles of neuroplasticity for years in my work as a SLP. Neuroplasticity is the ability the brain has to change, depending on repeated stimulation or exposure to specific experiences or actions. When you change the wiring in the brain, you create improved associations between activities and increase the processing efficiency of thoughts and actions.

One of the most interesting books I have come across on the subject is by Norman Doidge, “The Brain That Changes Itself”. It explains how spending the amount of time that we do on certain activities, actually changes the neuropathways of our brain – changing the wiring of the brain – producing specific associations, for better or for worse. Neurons that fire together, wire together. Some positive changes might be learning a new language, learning to ballroom dance and improving your memory skills. Some negative changes might mean you develop addictions such as gambling or become desensitized to violence from playing certain video games. The more you are exposed to it, the more you need to create excitement for your brain’s neurons to fire and have release of endorphins which make you feel good. Changes to the brain are possible throughout our lifetime, although it does slow down considerably as we age. But the old adage “you can’t teach an old dog new tricks” is erroneous. However, frequency, intensity and repetition are all important if you are interested in making changes in the brain. So, choose your activities wisely and remember it’s never too late to learn something new.

The tool that I started using fervently in my practice 10 years ago, when I first started reading about neuroplasticity was something most of us really like. Music. Music has the ability to excite neurons, create mood, help us learn, facilitate action. It is used to heal, aid us in prayer, march soldiers and teach young children the alphabet and important facts. Neuroplasticity and the power of music.

Music helps us move – listening to music with a good beat provides the pace and the rhythm for everything from aerobic exercise, to running, to ice-skating, to lifting weights to cardio activities in the water. It usually has a fast, strong bass beat to help ground us and provide us with rhythm, and high tones for increased energy. It can help us be creative and inspire us. High pitch, fast pace makes us want to get up and go – whether it’s to exercise, dance or do something constructive around the house. But it also provides us with improved abstract thought.

Classical music has been particularly helpful in helping us learn. Don Campbell, who wrote “The Mozart Effect”, explains how this particular genre of music mimics language. There is intonation and turn-taking inherent in the composition, especially in Mozart’s music and other classical pieces which have mathematical patterns that are repetitive, and has been scientifically proven to improve the intelligence of young children who are exposed to it on a regular basis. Participants in music education in school perform better on the math and reading sections of the SATs and improve their memory and concentration. The corpus callosum of the brain of musicians is strengthened, bridging the left and right hemispheres of the brain and allowing them to communicate more efficiently. There are middle tones in the music that is facilitating to us for learning and thinking – a great companion to studying.

Music can help us heal – it can help us relax, lower blood pressure, even reduce the number of seizures in epileptics. It improves those recovering from stroke and head injury. With slower pace, fewer beats per minute (bpm), we entrain to the music as our breathing and heart rate slow down to match it, often used in Yoga, for instance. For those of you with insomnia, avoid watching highly stimulating TV late at night and try listening to slow music.

I have used specially engineered music with certain specifications to be used therapeutically, to help clients with auditory processing disorders, ADHD, language disorders, autism spectrum disorders and more. It is produced by Advanced Brain Technologies and is called The Listening Program® or TLP. I have seen huge transformations in my clients who follow certain listening protocols. They typically listen to special music for 30 minutes a day, 5 days a week, for at least 20 weeks. It supplements the therapy they receive. The most powerful delivery of this specially engineered music is via Bone Conduction. Advanced Brain Technologist also produces The Sound Health Series, which is music for various needs: Music for Concentration, Thinking, Learning, Relax, Destress, Inspiration and Motiviation. I also use a variety of music while patients are performing certain exercises; for young children it might be music from popular Disney or Pixar films – “Up”, “Cars” and “Frozen” to name a few. Not only do they keep up a certain pace and rhythm to the exercises they are doing, but they associate the activity with a more positive experience as they are enjoying the music as well.

So whatever your age, if you are in the market to make changes in the way you think, feel, act or heal, consider using music to aid your tasks – and choose the music thoughtfully. Consider bpm for the timing, the pitch range of the music and the mood that the music sets to match your task. Remember this simple idea behind neuroplasticity and the power of music. Neurons that fire together, wire together.

Do you, or someone you know, live with snoring, teeth grinding, poor sleep, aches and pains, chronic fatigue, moodiness, and other seemingly inexplicable symptoms? Your whole body suffers oxygen deficiency from a clogged airway and poor sleep when your mouth is structurally impaired. Six-Foot Tiger, Three-Foot Cage is the first book EVER to connect the dots between your mouth structure and total health. “Six-foot tiger” is the vicious medical, dental, mood, and financial consequences of a “three-foot cage” — a mouth that's too small for the tongue. Dr. Liao shows you if Impaired Mouth is the start of a domino effect of your (or your patients') persistent, escalating, and costly symptoms. Actual cases illustrate how Holistic Mouth Solutions™ can effectively redevelop “three-foot cages” by combining innovative Whole Health approaches with stem-cell-activating oral appliances to produce unexpected and even life-changing improvements. "An Impaired Mouth is the start of a domino effect leading to medical, dental, mental, and financial troubles. Pay attention." - Sally Fallon Morell, President, The Weston A. Price Foundation “Dr. Liao’s 6FT3FC shows ingenious ways to solve snoring, sleep apnea, teeth grinding, chronic pain, and fatigue with his novel-yet-sensible Holistic Mouth Solutions.” - Steven Y. Park, MD, Author of Sleep Interrupted “A must read for all dentists, medical doctors, and patients." - Simon Yu, MD, Author of Accidental Cure

Has your child been diagnosed with sleep apnea? If so, you're not alone. In this comprehensive handbook for parents, pediatric sleep experts provide answers to the most common and difficult questions from parents, including: What is sleep apnea? What causes sleep apnea? How is sleep apnea diagnosed? How do I prepare my child for a sleep study? What are the treatment options? Why take the tonsils and adenoids out? How do I get my child to wear CPAP?