Eastern Carolina Voice Center

What is the Voice Center?

The Voice Center is composed of six ear, nose, and throat doctors and two speech pathologists. Together as a team a doctor and speech pathologist work to find the cause and offer treatments for voice problems. Although a patient may see only the doctor or the speech pathologist, commonly both the ENT doctor and the speech pathologist will evaluate a treat voice disorders. Click here to learn how to make an appointment in the Voice Center.

Why should I choose a Voice Center?

The Center has been set up to address virtually all disorders of the voice - ranging from fairly simple to very complex problems. By having the speech pathologist and physician under one roof, the communication and coordination are improved. The Center also provides State-of-the-Art evaluations including high-tech Videostrobe testing. A commitment to quality completes the picture of a modern-day voice center. The Voice Center is set up to treat people with voice disorders affecting their everyday life as well as those who use their voice in performances, such as speaking, acting, and singing. Professional voice users may seek care through the Voice Center as well. [link word 'professional' to the professional section below]

What are some common voice problems?

One common cause for a hoarse voice includes swelling of the vocal cords. This can be caused by many factors. For example, heavy use of the voice or misuse of the voice can create swelling of the vocal cords. Another common cause is acid reflux (acid coming up from the stomach). This acid can cause significant irritation of the vocal cords, sometimes causing them to contract (close) too vigorously and can even contribute to spasms (spasmodic dysphonia). Chronic muscle tension can also cause hoarseness. Only a thorough evaluation can successfully uncover these and other causes of voice problems.

What is a Videostrobe Evaluation?

Videostroboscopy is a special test that uses the most up-to-date video and digital imaging technology to examine the voice box as the vocal cords are moving. This state-of-the-art equipment is available at Eastern Carolina ENT.

During the examination, a special strobe light is used to light up the voice box. This rapidly flashing light makes the vocal cords appear to move in slow motion. The speech pathologist and doctor can see small details about motion of the vocal cords, allowing them to diagnosis many different voice problems.

The telescope used for digital Videostrobe exams

A videostroboscopy examination may be recommended by one of the Eastern Carolina ENT physicians to further study the vocal cord appearance and motion. For example, the Videostrobe is very helpful in determining if the edges of the vocal cords are smooth and straight. It also helps determine if the delicate covering of the vocal cords is vibrating properly-this is important in producing a 'normal' sounding voice.

How is a Videostrobe Examination performed?

Videostrobe Equipment

For the exam, a patient is seated upright in a comfortable chair. The patient leans gently forward. Then the speech pathologist uses a thin fiberoptic camera to look into the mouth. This camera has an angled prism at the tip, allowing it to see around the back of the tongue. So without having to go deep in the throat, the speech pathologist can photograph the vocal cords. The exam is well-tolerated and generally not at all painful.

The speech pathologist looks for brief periods, asking the patient to make an "EEE" sound at various pitches with the voice in order to study the vocal cords in action. Rest breaks are included to keep the patient comfortable.

What happens after the Videostrobe Examination?

Afterwards, the whole exam is summarized along with a review of the video and pictures. This gives a more complete understanding of the problem when the patient is able to see the problem in a picture or video. Photos and a detailed report can also be sent to your primary octor, if desired, so that all involved have a good understanding of the problem.

Who performs the Videostrobe evaluations?

An ENT physician or a speech-language pathologist may perform the exam. At Eastern Carolina ENT, stroboscopic exams are most commonly performed by Dana M. Gribble, MS, CCC-SLP. Exams may also be performed by Kathleen T. Cox, PhD, CCC-SLP, a research consultant from East Carolina University.

What is Speech Therapy and when is it used?

Speech therapy first involves educating the patient about their particular voice problem. Then the speech pathologist teaches the patient techniques or exercise to help fix their particular problem. The original and follow-up Videostrobe pictures may be used to demonstrate to a patient the progress that he or she is making.

What are some example of speech therapy techniques?

- Identifying vocal abuse patterns which cause excess strain on the voice
- Learning what the Voice Center calls vocal hygiene (how to take care of your voice)
- Special exercises to maintain enough breath support (getting enough wind behind your words)
- Special exercises to improve strength and endurance of the voice
- Many other techniques as well…

What if my voice needs medical attention?

This is the real beauty of a voice center. Often both the speech pathologist and physician contribute to the care of a particular voice problem. The combined ENT and speech care at Eastern Carolina ENT allow this to be well-coordinated. Sometimes a surgical procedure is recommended; even then, the speech pathologist may be involved in pre- and post-procedure care. The goal is complete management under one roof with state-of-the-art facilities.

How do Professional Singers and Speakers benefit from the Voice Center?

Professional singers and speakers often seek medical intervention to enhance voice quality and performance. They can get baseline pictures of the vocal cords taken. In other words, a documentation of where you are now. This can be useful for later comparison.

The Voice Center provides a team approach to evaluation and treatment of professional voice users. They have the opportunity to receive speech therapy and singing therapy from Dana Gribble, MS who is a speech-language pathologist as well as a classically-trained singer. The Voice Center team prides itself in helping singers out of what they believe to be dire circumstances. The perception among singers is that a voice disorder or vocal cord lesions are career-enders. Very often this is not true, and the problem is treatable. A visit to the Voice Center helps the professional voice user understand that the voice box is not only an 'instrument' but also a system of muscles which can be rehabilitated.

What are the research activities of the Voice Center?

One new program being developed at the Voice Center is the further development of a long-time partnership with the Department of Communication Sciences and Disorders (CSDI) at East Carolina University (ECU). ECU has cutting edge research and academic programs throughout the university that are making news around the world for their innovative and exciting research projects. Dr. Kathleen T. Cox, assistant professor in the Department of CSDI, is a part of that exciting innovation and will be directing a research program within the Voice Center. ECVC is committed to this research effort. Dr Cox's program is designed to ensure that the advancement of knowledge about the voice, voice disorders, and singing occurs through an active research program. Dr. Cox has experience in directing research projects within the areas of voice and swallowing and will be coordinating research experiments, training doctoral students who will be performing research studies, as well as acquiring external funding to enhance ECVC's research capabilities. Research goals include conducting "clinical trials" for new and unique treatments, designing training programs for doctoral students in the CSDI department who are interested in a career in voice and voice care, and disseminating research findings through publications in scholarly research journals.

How do I make an appointment?

If you have already seen an ENT physician, you can make an appointment with Dana Gribble by calling (252) 752-5227 and requesting a stroboscopic or speech evaluation.
If you have not already seen an ENT, you can make an appointment with one of the physicians at the Eastern Carolina Voice Center and the physician will determine if you should be recommended for a stroboscopy.
If you have seen another physician (pulmonologist, allergist, family doctor), and that physician has recommended the examination, then you can call (252) 752-5227 for an appointment with Dana Gribble. Please bring any medical records regarding your voice problem to the appointment.

Dana Gribble, MS, CCC-SLP

Dana Gribble received her undergraduate degree from East Carolina University with a double major in music therapy and music education. She trained as a classical singer during that time. She then went on to teach K-8 music before returning to ECU for her Master's Degree speech-language pathology. During the course of the master's program she completed an internship under the direction of Bernice Klaben, PhD at the Blaine Block Institute of Voice Analysis and Rehabilitation (Joseph Stemple, PhD, Director).

At Eastern Carolina ENT, Ms. Gribble provides evaluation and treatment for voice disorders. She also evaluates and treats swallowing disorders in head and cancer patients and cares for the laryngectomy patients.

Links:
· National Spasmodic Dysphonia Association

· Voice Academy for Teachers

· American Speech-Language and Hearing Association

· The National Association of Teachers of Singing

· The National Center for Voice and Speech

· The Voice Problem Website

· National Organization for Rare Diseases

· American Academy of Otolaryngology

· International Association of Laryngectomees