At the TTSH Ear, Nose & Throat (ENT) Clinic, patients aresometimes reerred to an on-site speech therapist or anassessment o their speech, swallowing or voice problems.Screening can be done or speech related problems suchas articulation imprecision or stuttering. Depending onthe diagnosis, therapy may be ofered subsequently.Occasionally, the patient may be reerred to another serviceprovider that specializes in an area o sub-specialty suchas childhood syndrome disorders or aphasia (acquiredlanguage disorders ater CVA or TBI).Voice problems such as hoarseness, vocal atigue, strainedand painul throat ater a vocal event are common problemsthat the Speech Therapist at TTSH ENT clinic treats.Beore undergoing therapy, the patient’s larynx is examinedusing videostroboscopy. This examination is importantin being able to visualize the integrity o the vocal olds’structure, and more importantly the mucosal wave duringphonation. Treatment plans are then laid out, involvingmedication, surgery, voice therapy, or a combination o anyo these.Voice therapy involves teaching the patient exercisesto mobilize the vocal olds in a more e cient manner toacilitate repair o micro injury and strengthening. Besidesbasic warm-ups like lip trills, patients also have to learnvoice projection techniques. Therapy oten takes an averageo 6 sessions. Results are good especially or unctionallycaused problems like vocal nodules, and muscle tensiondysphonia.For dysphagia or related problems, the patient is rstlyassessed clinically. He may then be reerred or urtherinstrumental procedures such as Videouoroscopy orFibreoptic Endoscopic Evaluation o Swallowing (FEES).I a patient is diagnosed to have swallowing di culties,therapy will begin immediately. All the patients are reerredby doctors rom the ENT clinic, with a high percentageo patients having had treatments or head and neck diseases / conditions.At this clinic, the therapists also rehabilitate patients whorequire voice restoration services. These include counselling,assessment and prescribing / supplying the diferentoptions or voice restoration ater total laryngectomy.
** Our speech therapists accept referrals for the above services through our ENT doctors. If youhave a patient with a voice disorder, you can make the appointment directly with our VoiceClinic, which runs twice a week.
EAR, NOSE & THROAT SERVICES
Figure 1: Laryngoesophageal Reux.Figure 2: Muscle Tension Dysphonia -Note the squeezing o the larynx whenperson phonates.Figure 3: Vocal Nodules.Figure 4: Normal vocal olds at rest.
JULY • 2009
EAR, NOSE & THROAT SERVICESVOICE DISORDERS: SPEAK UP FORTHE HOARSE PATIENTEVENING CLINICS
About Francoise Lim MS,CCC-SLP
Francoise graduated in 1992 from theUniversity of Oregon with a Masterof Science degree in CommunicationDisorders and Sciences. She has worked with both adults and children with speech, languageand swallowing disorders. She has been with an ockSeng Hospital, EN department for the past 11 years,specialising in voice disorders. ogether with an ENdoctor, she runs a weekly Voice Clinic where stroboscopiclaryngeal assessments are conducted. Apart from working directly with patients, Francoise is also involved in voiceeducation through organising and conducting workshops.
About Susan Goh
Susan graduated in Australia and hasbeen in Speech Terapy for more than10 years. She started out working ata special school for a year and a half before switching to a hospital. Herspecial interests include voice rehabilitation and head /neck dysphagia, including post laryngectomy rehab.