Speech & Language Therapists? Sound Engineers? Amplification of voice box?

[KatyMac]

My dad has Lung cancer & he has lost his voice due to pressure on the nerve for his voicebox.

He can whisper & he finds it frustrating

Can he buy a bit of 'kit' that will amplify his voice

My husbands radio mike (for dance teaching) is a bit bulky and plugs into an amplified so wouldn't be very portable - and is several (maybe 5) years old

What could he use?

I don't have cancer, but have a similar problem with my vocal cords. Mine are paralysed on one side and I have real issues with being able to speak above a whisper at times. I was referred to our local ENT consultant and then on to a Speech Therapist who worked with me for some weeks and I have regained quite a lot of function. Occasionally it all goes when I get a bad cold, but I manage to get back to a reasonable state with exercises.

I also bought a machine from Amazon which gave me a bit of extra power.

www.amazon.co.uk/gp/product/B003SP2SFY/ref=oh_aui_detailpage_o08_s00?ie=UTF8&psc=1

That's fairly similar to the ones he is looking at

May I ask - does it change your voice or just amplify it?

My dad is lost without his voice - The ENT consultant said they can't help only shrinking the tumour will increase his voice, no one bothered to say something like the box thingie might work

It was a friend who said why not try it

I'm an adult SLT, my specialism is cancer and voice.

Sorry to hear about your Dad's diagnosis, and the difficulties he's having. I hope his tumour responds well to treatment.

Your Dad shouldn't have to wait long for SLT help at all - given his diagnosis he would be a high priority in most areas, especially as a paralysed vocal cord can also result in swallowing problems. You might well be able to self refer to your local Adult NHS SLT service, particularly as you know exactly what the problem is, so he wouldn't need to go via ENT (little ducks is quite right, for voice disorders, we need to know what we're treating). They may want to see evidence that someone has looked at his voice box, though. If you contact your local hospital, they should be able to put you through, or give you contact details.

If he's having chemo still, they might also not want to offer any active treatment until the outcome is known - the chemo might well shrink the tumour and relieve the pressure on the nerve, for example. Once the outcome is known, his Oncologist will almost certainly refer to ENT if his voice is still a problem, as there are various procedures that can really make a difference.

For private SLT, ASLTiPP (or something similar) are the official organisation, you can contact them via the website of the Royal College, our professional body (www.RCSLT.org.uk).

As far as amplification goes, I've recommended the waistband ones before, though I can't say if they would actually help your Dad. Often, if you only have a whisper, a loud whisper (against amplified background noise) isn't that much more audible. If he can try your husband's one, that'll give you an idea of whether it's likely to be successful.

Some people are dead against the idea, but if your Dad's au fiat with computers or mobile phones, there are some excellent, and very cheap, text to speech apps available. He would type in a message, and it reads it aloud for him.

I hope some of that is useful.

Sympathies to you op. I lost my voice after traumatic surgery once couldnt even whisper.. I understand how he must be feeling. Its taken a very long time to recover. xx

An amplifier will only amplify his voice, not change it, so as I say, he'll get a loud whisper.

OP, the microphone just amplifies the sound. But even that might help your Dad a bit. I know how totally frustrating it is and it must be driving him mad. You can also help with things like not calling him from another room, trying not to talk over him, working out some hand signals for when he needs you to listen, maybe a bell for if he needs to get your attention from another room, turning the volume on the TV to mute when he wants to speak.

All of these things sound obvious, but it is amazing how people just don't do them. I found that I lost my temper a lot with the simple frustration of making myself heard above a typical noisy household.

Thanks Flipper

It just seems so unfair he lost his voice about 4 weeks before diagnosis we are now about 6 weeks post diagnosis - so that's 10 weeks

Another 16 until they decide whether or not to do anything, means he is 6 months without an effective voice

I felt awful asking him to email rather than phone me as with normal household noise I just can't hear him

Unfortunately, the amplifier probably won't help on the telephone.
If he's got a smartphone, check out the apps. You'll have to wait for him to type the message in, but it can be really effective.

Vocal cord palsies don't generally respond quickly to therapy, unfortunately, so other than checking that he can communicate effectively (which might include assessment/recommendation for any suitable aid), and making sure that his swallow is ok, there may not be much that the SLT can do in the short term.

He is stubborn - I know nothing can really be done

If the tumour shrinks he will have his voice back for a bit - maybe

But it will grow again

If having another appointment & a bit of kit gives him some hope of talking _ I'll make him that appointment & drive him

If he doesn't get his voice back, or it goes again and the damage is permanent, there are still options. He may be suitable for a vocal cord medialisation procedure, which is technically surgical, but can be done under local anaesthetic. Our consultants tend to favour them in cases like your Dad's, because they're quick and effective. They aren't always long lasting, but that has to be weighed up against quality of life. It wouldn't be at all suitable until after treatment, however.

Of course, it's not suitable for everyone. I wouldn't want to give you the idea that there is a miracle around the corner, but it might give your dad some motivation, if he knew that there are still options.

They have said nothing will help his voice except the shrinking of the tumour - so I don't think that's an option (I don't know why, but I was there when the Doctor said ENT wouldn't be able to do anything at all for his voice & that shrinking was the only option......)

But thank you

Oh, I'm sorry to hear that. Might be worth asking for an ENT referral after treatment anyway? Ask the GP if the oncologist won't do it. At least then you'd know you'd tried everything.

Please also ask your Dad to tell someone if he starts coughing when he's drinking or eating.

When he had the broncoscopy they were a bit shocked he was eating ok, mind you the oncologist was shocked he was managing stairs - my Dad didn't like to say he'd just refurbished a boat & launched it the week before or that she was racing his boat that weekend.

I don't think they realised how fit he was before. But it's all about quality of life now & he sees his voice as a big part of that.

He knows we don't have a long-term option - so short-term is important

He sounds quite formidable, your Dad!

The broncoscopy won't have told them much about swallowing or vocal fold function during the swallow, other than the basics. It's amazing how our bodies can compensate.

I would definitely push for that ENT referral at the end of treatment. They might not do anything until then, but I'd want to hear it from the horse's mouth at that point, so to speak. It's hard to imagine, because I always assume that all doctors know what each other can do, but you'd be surprised what they don't know about other specialities.

As you can probably tell, I'm a wordy cow, so I can't imagine what I'd be like without a voice. Your Dad has my full sympathy.

A voice is a big part of a person's character, I only ever deal with S&L in children with emergent language so ve never seen it like this (work in a nursery)

He asked for an ENT to be present for the broncoscopy but they said it wasn't protocol; then during it they said the ENT would want to do another later on - he was not a happy bunny

Ah well our hospital doesn't seem to have a voice/S&L department so that might be why it's not possible - I may ring MacMillian nurses to see if it's our area that means he can't have help or his condition

There may not be one based at your hospital, Katy, but he will still be eligible for a service from wherever provides it locally. It will be the ongoing treatment that's a barrier.

16 weeks does sound like a ridiculously long time to be without a voice, but hopefully, as treatment progresses, there'll be some improvement.

The problem with the medialisation procedures for vocal cord palsy is that they narrow the airway by bulking up the the paralysed vocal cord, so that it reaches the middle of the voice box, and the other vocal cord can then meet it again. If they do that, and then the nerve recovers because of the treatment, that bulked up vocal cord will be trying to move across the voice box, which will compromise the airway. That's likely to be why they won't do anything until after treatment.

The best thing to do in the meantime is ensure that your Dad has an effective way of communicating, through amplification or an alternative means of communication.

Thanks - I've passed on all the info to him

At the moment all I do are phone calls so I'll let him decide how he proceeds

Hi
I'm a SaLT and work with Voice disorders.
His GP can refer him to the ENT or SaLT team and they should prioritise referrals so shouldn't wait more than a few days. Some hospitals accept self referrals.
For this scenario there are two main options, ENTs can perform vocal cord medialisation which is a quick procedure that should allow voice to return. It is very frequently done in cases of terminal lung cancer to allow phonation in the end stage of the disease.
The second option is to use a voice amplifier. Most SaLT departments will be able to quickly provide one on loan. But if your father currently only has a whisper they may not be very useful. A transdermal microphone sometimes helps but not always.
Therapy (exercises) does not usually help. It does in paralysis caused for other reasons but not when a tumour is compressing the nerve.
Hope that helps

Just read comment above, there are two ways to medialise, one by injection one surgically moving the paralysed cord towards the midline. They would choose the best option for each candidate, preserving the airway is always the main priority.

thanks - I'll pass this info on