When you have a fully functioning voice that communicates your wants and needs, expresses you fully without failure, you don’t realize that all that could change in an instant. Having a voice disorder can unexpectedly change your habits with seemingly mundane tasks and whether you are the speaker or the listener, this is an important story.
Voice Disorders:
A voice disorder like a polyp, or vocal nodules, or even vocal paralysis can affect your ability to speak loudly, stay loud for a period of time, or sound clear and resonant. A voice problem we likely all have experienced before is swollen vocal cords from an illness. We call it Laryngitis or Allergies when it happens. We have experienced how difficult it can be to even make a sound, and the feeling of strain when we attempt to voice for even the most simple of voice tasks.
But what if that voice disorder didn’t go away once we recovered from our illness? What if the difficulty remained and began to create a hesitancy loop that we never expected?
When Medicine and Therapy Fail:
My patient has been dealing with a persistent case of vocal cord inflammation for years now. The journey has been inconsistent, some days they can depend on their voice, but other days neither therapy techniques nor medicine makes a difference.
They have become troubled by the inconsistency and developed what they describe as a performance anxiety. They fear vocalizing at all because they don’t know what kind of voice will be there that day or how hard they’ll have to work to get it to happen or to maintain it. Voice tasks that were easy like a quick phone call or a fast chat, are now insurmountable roadblocks. Some days, there’s not enough energy to communicate vocally with anyone.
Take the drive thru order for example. Before their voice disorder, Starbucks or Chick Fil A were easy to navigate. But now, they fear the thought of communicating this way as they drive up for their double shot half caff iced latte. It doesn’t stop them from trying totally, but they remember past times when they had to repeat the same thing 5 or more times, eventually giving up and having to drive forward (or drive away totally). They remember feeling stupid when the worker couldn’t hear/understand and kept asking them to repeat. The voice on the other end of the drive thru speaker can become judgemental and even frightening.
They began to pre-plan…“What is the landscape like at this drive thru? What is the distance from my mouth/car window to the speaker? Is there a speaker or only windows? Is there a way to drive out of the line if it all becomes too overwhelming? What if I get scared? What if I feel stupid again?”
This anxiety and fear that has developed is extremely challenging to navigate because the feelings can become so large inside ourselves, and those feelings are very real and very strong.
This has developed over time with communication failures on part of the drive thru staff and of my patient. A communication failure can be asking someone to repeat, or it can be not understanding the speaker. It can be nodding and smiling giving the speaker false feedback, or it can be aborting the entire exchange. We navigate communication failures daily when we ask “huh” or “could you speak louder please?”
Please Pull Forward for Takeaways:
It’s important to remember that as we give voice therapy, we consider the traumatic events that may develop as a result of the voice disorder persisting, and not just the voice disorder when it occurred. Continued failures in communication can leave us frustrated, sad and anxious because we have memories of interactions like this succeeding in the past, and also we have memories of these same interactions being complete failures since the voice disorder began.
If you are struggling with a voice disorder, keep trying to do these difficult things. Maybe the drive thru window isn’t the most challenging thing for you, but perhaps by reading this it reminded you of YOUR drive thru window story or experience. Voice therapy sessions can help in multiple ways and there is hope because you are not alone in what you’re feeling and experiencing.
Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center, and lectures on voice science nationally. She is a member of ASHA Special Interest Group 3, Voice and Upper Airway Disorders. Knickerbocker continues to develop a line of instantly downloadable voice assessment and voice therapy materials on TPT or her website. Follow her on Pinterest, on Instagram or like her on Facebook. Kristie is a founding member and co-owner of The Confident Clinician Cooperative and mentors on voice and private practice through it at www.confidentclinician.com.
