• Dr. Heather Nelson

On the twelfth day of vocal health, my true love gave to me...flexible scopes a-strobing

Have you been to the laryngologist this year for your annual voice check up yet? The last post in this series looks at twelve things to expect during a visit with your laryngologist and reasons why an annual voice check is a good idea for every professional voice user.


1. First, why do this?

If your voice is your livelihood, then keeping it in shape just makes sense. And like every other problem that we might encounter with our bodies, prevention is so much easier than treatment. Keeping the habit of a yearly visit with a laryngologist can both assure you that things are functioning the way they are supposed to, and hopefully catch any changes before they get to be problematic. Plus, if you have a relationship with your laryngologist already, if something crops up during the year, you're likely to get help faster. Every professional athlete has a team of people to help them stay in shape. You, the vocal athlete, also should have your dream team in place and use them to keep you in great vocal shape!


During the appointment


2. A thorough vocal history

Your voice doc will want to know what's going on, even if everything is working well. Keep track of any vocal changes you have during the year, even if things resolve after awhile, and be ready to divulge anything that you have noticed. Often, docs are looking for patterns.


3. A thorough medical history

Besides just how your voice functions when you speak or sing, your voice can be effected by things like allergies, reflux, surgeries, injuries, etc. A complete vocal history will also include any medical issues that could effect the voice. Be sure to include medications you take regularly or frequently.


4. Singing in a really weird environment

A good doc will ask you to speak and sing, and it will be weird. Often they'll ask for vocal slides, repeated notes, snippets of songs, singing in different registers, etc. while you're sitting in an exam chair with a camera either up your nose or poking in the back of your throat. It's going to feel weird, and sound weird, but be assured that they are able to see and hear things even though it will feel completely unnatural to you. Try to relax and just go with it. Speaking of those cameras, scopes can come in two major categories, each with their pros and cons. Often the SLPs or the docs have their preferences, and so they'll use whichever one they think is best. Both types of scopes are fitted with a strobe light and a camera to observe the vocal folds in action.


5. Flexible scope

This one goes through the nose and hangs down in the back of the throat. The SLP or doc will administer some numbing spray into your nose that will taste terrible and drip down the back of your throat, but will make it more comfortable for the camera while it is in place. The pros to this type of scope is that because it is basically freely hanging in your throat, you can sing and speak normally. The cons, besides the obvious of having a foreign object up your nose, is that because it is freely hanging in your throat, it can be tough to get a clear picture of the vocal folds.


6. Rigid scope

This scope is on the end of a long stick, and can be held in place by the doc or SLP. He or she will take a hold of your tongue with some gauze and a gloved hand, and will gently pull it forward so the tongue will be out of the way of the scope. Then you will sing or speak (good luck!) while they are looking at the vocal folds. The pros of this type of scope is that you can more easily get a clear picture of the vocal folds while they are working, while the cons are that it is really difficult to sing or speak in a natural way. My personal laryngologist uses a super tiny rigid scope, so I have found this one to be the best one for me.


7. The scopes will often project to a TV monitor, so you can see your vocal folds!

This, by far, is the coolest part about the visit. If your clinic has it set up, you might be able to not only see your own vocal folds, but get a recording of the scope for later viewing. I think this is super neat and I love, love, love watching those tiny little muscles work. It's super fun! Plus, it's helpful for me as a vocologist to see the voice in action when I'm working with a new client. If you are making your next appointment, ask if the scope can be recorded and if you can receive a copy. That might take a few days after the appointment to get one, so giving them a heads up ahead of time can help to make it easier for them.


What they're looking for


8. Mucosal wave

Remember, these are super tiny muscles that are covered with a skin-like covering (epithelium) and fluid layers vibrating at dozens or hundreds of times per second. The strobe light at the end of the scope "slows down" the motion so that we can perceive more easily what is going on. A good mucosal wave is a steady and even motion of the epithelium from the midline to the lateral edges of the vocal folds. If that motion is uneven or unsteady, that gives a clue that there's something not quite right. That might include cysts below the epithelium, neurological issues that make the vocal folds uneven, muscular issues, etc. There are a lot of reasons, and that's all best left to the medical professionals. But know that if there's good mucosal wave, that's an excellent thing.


9. Any obvious lumps or bumps

If there are physical changes to the vocal folds themselves, be it cysts, nodes, granulomas, etc., they should be visible on a scope. We cannot perceive the difference between these types of pathologies just by hearing, and they have different causes and tissue makeups, so a scope needs to be the way to see what's there.


10. Muscular function

Your doc or SLP will be looking for whether the muscles are underperforming, overperforming, or are in the Baby Bear "just right" zone. He or she will be looking for things like gaps in the closure, overactive false folds, and smoothness as the folds stretch during vocal slides, etc. Overuse is one of the biggest causes of vocal dysfunction, and that can very often be seen clearly on a scope.


11. Neurological function

Some vocal issues have a neuro component to them, and so the doc or SLP will also be looking for things like symmetrical closing of the vocal folds, lagging in the muscular response, and consistency in the muscle response. Patients who have had stroke or other diseases like Parkinson's, spasmodic dysphonia, or an injury from surgery may have neurological side effects that can be monitored through a scope.


Follow up

12. If something changes....

Once you are established with a doc, keep up with the annual visits. (See #1.) If something happens to come up during the year, a good rule of thumb is to make an appointment if there are vocal changes that last longer than two weeks without any direct cause. For instance, if you have a cold and your voice is not better after two weeks, even if the cold itself has resolved, it's time for a check up.


Need help finding a laryngologist in your area? Check for ENTs that are in your insurance coverage, and then research the ones that come up. Look for an ENT that has been fellowship trained in a laryngology program. That will likely be in their online bio. Most major cities will have a fellowship-trained laryngologist, but if you're not terribly close to a major city, you might have to drive to get to one. Trust me, it's worth it to make the drive once a year for a proper check up, instead of visiting an ENT who may be a genius when it comes to the ears, but doesn't know enough about the vocal demands of a professional singer. Your voice is worth it!




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