Posts Tagged ‘ENT’

Setting and Delivering Standards in Vocal Health

Tuesday, May 8th, 2018

The singing industry is completely unregulated, meaning anyone can call themselves a singing teacher, vocal coach or even vocal rehabilitation coach regardless of training, experience or lack of clinical supervision. At BAPAM, we have many calls from actors and singers with voice problems and we have been aware of an inconsistent approach to care.

Working with a group of vocal health specialists established by our Medical Committee, comprising Ear Nose and Throat specialist doctors, speech and language therapists, physiotherapists and vocal rehabilitation coaches from across the country, we have set standards for our vocal health advice, and competencies for Vocal Rehabilitation Coaches. We are also funding sessions for specialist clinics to have a Vocal Rehabilitation Coach for a pilot period so we can evaluate the impact.

We hope this will be a major step forward improving the quality of care for vocalists who present with problems in healthcare. It will enable them to get a rapid assessment by the right professionals to accelerate the right treatment. It will also provide a set of standards for singing practitioners in the UK who wish to work with a Voice Clinic and provides an improved level of protection and quality assurance for organisations supporting arts professionals accessing specialist health care.

The literature on dysphonia demonstrates that singers presenting with voice disorders are most likely to have Muscle Tension Imbalance (MTI). General ENT Surgeons tend to look for organic pathology or structural abnormality and do not always diagnose MTI.  Diagnosis of MTI in speech is usually made by a Speech and Language Therapist with experience and training in assessing the muscular function of the whole larynx and vocal tract via nasendoscopy.  MTI in singing is being assessed in a few leading clinics by a Vocal Rehabilitation Coach with experience and training in the assessment of the larynx and vocal tract in a wide range of singing styles, also diagnosed via nasendoscopy.  Only specialist Voice Clinics have access to equipment and personnel qualified to deal with this type of problem in professional singers.  Treatment of MTI in singers is carried out by Speech and Language Therapists and Vocal Rehabilitation Coaches, jointly or in succession.

The BAPAM Vocal Health Working Group recommends multidisciplinary clinics with a surgeon and specialist speech therapist using high definition cameras with stroboscopic or high speed videos to analyse the vocal folds as standard of care. BAPAM has adopted this standard for the advice we give to patients.

BAPAM’s advice for GPs is to refer to a specialist Voice Clinic when patients with the following characteristics present with a voice problem:

Patient population

  1. Elite Performers (professional singers, actors, broadcasters, etc)
  2. Studying Performers (FE, Undergraduate and Postgraduate singers and actors)
  3. Quality of Life Performers (singers whose singing is their primary means of socialising like older local choir members)

Presenting Voice Problems

  1. Loss of range, power, flexibility
  2. Pain, fatigue, hoarseness
  3. Gaps in range, delayed onset of phonation
  4. Increased recovery or warm-up time
  5. Chronic throat-clearing, sensation of lump in throat (globus)

Referrals

A referral to a specialist Voice Clinics should be made for:

  1. Any vocal symptom lasting more than 2-3 weeks
  2. Any vocal symptom lasting more than 2 weeks following resolution of a bacterial/viral infection

Advantages of a Specialist Voice Clinic

  1. Stroboscopy to view vocal fold vibration is only available in these clinics
  2. EGG and other specialist equipment for accurate measurements
  3. Expertise in muscular function and dysfunction of the vocal tract
  4. More accurate diagnosis, improving management and decreasing patient recovery time (P.S. Phillips 2005)

The large clinic team enables a multidisciplinary assessment because performance voice problems are likely to be multifactorial and more likely to be muscular with musculoskeletal and/or psychogenic causes. Staffing includes:

  1. Voice Specialist Laryngologist*
  2. Voice Specialist Speech and Language Therapist
  3. Vocal Rehabilitation Coach (Singing Voice Specialist)
  4. Performance Specialist Osteopath/Physiotherapist (in some clinics)

*Some Specialist Clinics are SLT-led with Laryngologist review

Accurate diagnosis and specialist treatments speed up recovery times and save money in the long run.

(see British Voice Association leaflet on Multidisciplinary Voice Clinics)

Patient Outcomes

  1. If organic lesions are present they may be listed for surgery immediately or referred for Speech Therapy then reviewed
  2. Functional disorders will be referred for Speech and Language Therapy and/or Vocal Rehabilitation
  3. Musculoskeletal disorder will be referred for Osteopathy/Physiotherapy
  4. Psychogenic disorders will be referred to Speech and Language Therapy and onwards to access Psychology/Talking therapies as appropriate (for Psychotherapy and/or Speech Therapy)
  5. Most patients will be referred to more than one of the above

Vocal Advice

BAPAM offers 90 minute small group vocal health advice workshops to performers who have concerns about their vocal health once they have received a referral to a Specialist Voice Clinic and been put on the waiting list.

The sessions will be run by a Vocal Rehabilitation Coach with experience working with performers in Specialist Voice Clinics. Participants will receive general advice on how to look after their voice, gentle stretching to release vocal tract tension, exercises to release tension in the breathing mechanism, and information on what to expect in their Specialist Voice Clinic appointment.

These sessions are educational, not diagnostic, and are not a replacement for an appointment in a Specialist Voice Clinic.

To find our more or book a place at a BAPAM vocal health advice workshop please call us on 020 7404 8444.

The Vocal Rehabilitation Coach

In late 2017, BAPAM’s Vocal Health Working Group approved competencies for Vocal Rehabilitation Coaches to set a standard of practice in this important area. Vocal Rehabilitation Coaches on the BAPAM Directory of Practitioners must meet the following competency criteria:

  1. Hold or have previously held a contract with an NHS specialist Voice Clinic including a job description. Verified by contract document. Where an informal but significant relationship with a Voice Clinic exists or has existed in the absence of a contract, a letter from the Voice Clinic may be accepted.
  2. Have spent at least 10 years practicing as a singing teacher/vocal coach within an educational institution or in private practice. Verified by contract document or evidence of proven track record.
  3. Work under supervision from both voice specialist laryngologist and speech therapist (as appropriate) as part of a clinic team with all clients.
  4. Undertake at least 10 hours of Voice Clinic observation per year. Verified by letter from Voice Clinic.
  5. Have completed relevant anatomy/physiology training formally or in-house. Verified by attendance certificate or letter from Voice Clinic.
  6. Have completed endoscopic interpretation of singing physiology training. Verified by attendance certificate or letter from Voice Clinic.
  7. Have both basic counselling and palpation training, formal or in-house. Verified by attendance certificate or letter from Voice Clinic.
  8. Adhere to data protection standards when keeping client records.
  9. Have current appropriate liability and indemnity insurance policies. Verified by documents.
  10. Provide at least two references, one from a specialist Voice Clinic, one from a reputable professional performance-related company (ex: university or production company).
  11. Adhere to all BAPAM professional practice standards at all times.

Applicants will be included on the directory for a term of three years before needing to revalidate their application.

Information about applying to join the Directory can be found here.

We look forward to reviewing and reporting on our pilot project to support specialist Voice Clinics by funding a Vocal Rehabilitation Coach.

Vocal rehabilitation is a truly multidisciplinary endeavour, with crucial contributions from laryngologists and speech therapists.  A central member of this team is the Vocal Rehabilitation Coach who is uniquely placed between the medical clinicians and the performers to carry the scientific aspects of vocal treatment into the performance practice.  It is critical that these coaches are well schooled in vocal anatomy, physiology, pathology and rehabilitation; this schooling should be assessed with a series of measurable competencies to ensure that they are providing the best possible care. Mr. Declan Costello – Consultant Laryngologist

Following treatment for any vocal problem, like any injury one might sustain during physical exercise, a patient must rehabilitate appropriately with the aim of getting back to their pre-morbid state; to allow them to sing and speak again. In the same way you must learn to walk before you can run, one must set up the larynx correctly before trying to push its limits. Speech therapy achieves this but translating this laryngeal work into the singing voice requires a vocal rehabilitation expert. The expert vocal rehabilitation practitioner will help the performer take their correct setup into their performing voice before returning to their genre specific vocal coach. It can be seen that this is an essential part of the recovery process and having trained, competent and expert help is a comfort to patients.To this end, having the appropriate knowledge and having been assessed as reaching a standard level of expertise means that you know your patient will be in good hands.  Mr Nicholas Gibbins - Consultant Laryngologist

BAPAM Vocal Health Working Group

Mr. Nicholas Gibbins ENT

Mr. Declan Costello ENT

Ms. Tori Burnay SLT

Dr. Ron Morris SLT

Ms. Linda Hutchison VRC

Mr. Dane Chalfin VRC

Mr. Ed Blake Phys.

BAPAM Training Day: The Professional Voice User in Trouble

Monday, September 4th, 2017

Our November 2017 Training Day brings a multidisciplinary focus to bear on vocal health issues affecting professional voice users. Presented in collaboration with voice care experts at the forefront of the field, this event is ideal for medical professionals and students, voice coaches, professional voice users, teachers, healthcare practitioners, and all those engaged in wellbeing in the creative arts, who want to develop specialist knowledge and skills. BAPAM Training Days are also a great opportunity for discussion, sharing insights with peers, making new connections and growing our performing arts medicine network.

Book your place here

Our timetable for the day will be confirmed shortly. Presentations include:

Mr Nick Gibbins, Laryngologist
The Surgeon’s Perspective

Nick Gibbins will take us through the types of vocal injuries and disorders that face professional performers including musculoskeletal issues, inflammatory problems, and organic lesions of the vocal folds. The laryngologist’s role in the multidisciplinary voice clinic will be explored including diagnosis and surgical intervention.

Tori Burnay, Voice Specialist Speech and Language Therapist
The Therapist’s Perspective

Tori Burnay will show us the therapist’s side of endoscopic examination including the muscular behaviour of the larynx and vocal tract in healthy and disordered speech. Muscle tension issues, vocal hygiene, workload management and potential therapy plans will be discussed.

Dr Carol Chapman, Counselling Psychologist and Performance Coach

Dr Jane Oakland, Music Psychologist and Singer
Psychological Perspectives

Examining the difference in presentation, conceptualisation and treatment between professional voice users who have a medical diagnosis and those for whom no diagnosis has emerged and whose problems appear to have a purely psychogenic origin. Discussing the psychological and social/career impact of having voice problems in these circumstances and at different stages during a performing career. Using illustrations from client work, suggesting what clinicians should look out for. Illustrating techniques for rehabilitation and coping.

Prof. Dane Chalfin, Vocal Rehabilitation Coach
The Singing Perspective

Dane Chalfin will guide us through the Vocal Rehabilitation Coach’s role in the interpretation of the laryngopharyngeal gestures in healthy and disordered singing in various styles. Muscle tension issues in the singing voice and rehabilitative pedagogy will be discussed. This will also include a live scoping session where Mr Nick Gibbins will perform nasendoscopy on Professor Chalfin live in front of the audience. We will be inviting attendees to submit requests for singing gestures they would like to see in situ.

Ed Blake, Physiotherapist
The Physiotherapist’s Perspective

Ed Blake presents on physiotherapy treatment for professional voice users suffering voice related symptoms.

Event Report: BVA Rock & Pop Day, September 2015

Wednesday, September 30th, 2015

BAPAM Clinician, Dr Shareen Chua, reports from the British Voice Association (BVA) Interactive Rock & Pop Day, London, 13th September 2015. 

A quiet Sunday morning on Chiswick High Street – one man on his morning run, a dog with a tennis ball in its mouth and a woman driving an empty double decker bus. Through the entrance of a pub, empty tables, a smiling bartender, but beyond its courtyard, a large chattering crowd was audible. Vocal coaches, singers, songwriters, voice specialist Speech and Language Therapists, instrumentalists, voice rehabilitation specialists, voice researchers, performance coaches and consultant laryngologists, amongst all present at this event organised by the BVA. Also in attendance from BAPAM were Dr Frances Carter, Dr Miranda Godfrey & I.

At the start of the programme, Canadian singer songwriter, Selena Evangeline  took to stage to demonstrate the range and variety of vocal effects available to a solo live performer, in her case using vocal audio equipment by TC-Helicon.

Kim Chandler (vocal coach & lecturer) got our vocal cords going by getting us to attempt various vocal onsets, characterising them and offering suggestions on alternative ways of achieving particular sounds and reducing glottal stops.

Hearing loss associated with onstage noise was thereafter explored by John Rubin (Consultant ENT Surgeon, Royal National Throat, Nose and Ear Hospital). He spoke about various sound levels encountered within the music industry, covering a variety of sound monitors and hearing protection.

Two singers were subsequently brought on stage. In a live setting, Dane Chalfin, current President of the BVA, used song interpretation and emotion to offer them solutions that improved their technique and performance.

Tom Harris (Consultant Otolaryngologist) & Sara Harris (Speech and Language Therapist), no strangers to the realms of vocal health, engaged the audience in their talk about vocal nodules, with Sara Harris sharing several strategies and exercises that might be helpful in such an instance.

Applying the Primal Sound Model to an instantly familiar Pharrell Williams number, Craig Lees got everyone on our feet creating various vocal sounds, forming a Pop Choral group thus concluding the day’s programme – on a high note!

Although the BVA holds their Interactive Rock & Pop Day every two years, their Voice Clinics Forum will take place on Friday, 23 October 2015 at St Thomas’ Hospital, London SE1. The October event will cover topics such as the role of Voice Clinics in the NHS, training in laryngology for ENT surgeons, training for singing teachers involved with Voice Clinics and a discussion of ongoing research & audit papers on the aspect of voice or voice care in the UK.

BAPAM and the BVA are actively exploring opportunities to collaborate on future projects. Suggestions are welcome!

BVA Study Day – Management of the Young Voice

Wednesday, May 20th, 2015

Sunday, 5th July 2015
Baden Powell House, 65-67 Queen’s Gate, London SW7 5JS

AGM: 9.30am – 10.15am
Study Day: 10.30am – 4.45pm

This study day from the British Voice Association will explore the management, training and therapy of the young voice. It will incorporate identifying problems, handling the changing voice and will look at potential routes to therapy where necessary. It will address issues for both female and male adolescent singers as well as children and will extend into the realms of hearing and speech therapy.

Full information and booking:
http://www.britishvoiceassociation.org.uk/events.htm

Speakers Include:

Stuart Barr (chair of the panel) Conductor and Singing Coach
Lesley Cavalli Joint Head of Speech and Language Therapy Services Team Leader for SLT-ENT Related Services, Great Ormond Street Hospital
Nicola Gorb Highly Specialist Speech and Language Therapist ENT/Voice, Great Ormond Street Hospital
Ruth Hansford Author, BBC Noise Guides
Graham Welch Professor and Chair of Music Education at UCL Institute of Education
Jenevora Williams Singing Teacher
Emma Winscom Singer, Composer and Singing Teacher

 

BAPAM Training Day, Sunday May 17, Cambridge

Thursday, March 5th, 2015

Anglia Ruskin University, Cambridge
9.30 – 4.30 

Turning an expert eye on the health impact of touring, ENT/reflux and specific issues around piano playing, our programme includes:

Travel health for performers – presentation by Dr Charlie Easmon.

Pianists’ performance issues – presentations by:  Dr Hara Trouli, BAPAM Musculoskeletal physician; Sarah Upjohn, BAPAM and Purcell School physiotherapist. Demonstrations by pianists and keyboard students.

Gastric reflux and the voice – ENT Consultant, Mrs Jan Panesar, and speech therapist speakers to be confirmed.

Lunch is included in the ticket price.

Cancellations prior to 3 May will be fully refunded.

Booking is now open here: http://bapamtraining2015a.eventbrite.co.uk

If you’re not already a Friend of BAPAM, please consider becoming one. Friends have the opportunity to book Early Bird tickets to BAPAM events, with considerable savings on the usual price (Early Bird bookings are now closed for this event). Please note, if you’re already in ‘Price Band A’, you won’t save more by becoming a Friend, but your support will help us deliver our services and keep the performing arts in good health.

This event is part of our regular series of training days for health professionals, researchers, practitioners and others engaged in performing arts healthcare, welfare and education.

We are grateful to Anglia Ruskin University Music Department for providing a free venue for this event and for supporting us as members of the BAPAM Student Advocate Scheme.

Event Report: British Tinnitus Association Conference September 2014

Tuesday, December 23rd, 2014

Dr Anita Nathan, NHS GP and BAPAM Clinician reports from the BTA conference 2014 

The British Tinnitus Association (BTA) is the leading source of information about tinnitus in the UK. All patients contacting BAPAM with concerns about the condition are advised to contact the BTA and investigate their many excellent publications. BAPAM’s recently updated Factsheet on hearing, Don’t Lose the Music, also highlights the BTA as a vital resource.

I attended their fascinating conference, held in September 2014 at the British Library Conference Centre in London. This short report summarises a few key points of particular interest to BAPAM clinicians and performing arts medicine specialists.

In an overview of the highlights of recent research into tinnitus, we heard about a trial of MDMA assisted psychotherapy for tinnitus, investigations into neural plasticity and multisensory processing, ‘residual inhibition’ (a brief suppression of tinnitus sounds after an offset (i.e. a presentation) of an external sound), and the way that sound therapy depends on the degree of hearing loss associated with tinnitus.

Investigations have been made into the effects of amplification with hearing aids in tinnitus patients with a co-existing mild to moderate hearing loss. One trial found that a hearing aid had an equal effect to a sound generator. Hearing aids can act as both noise generators and amplifiers for tinnitus treatment. Some early trial results suggest positive results from low level input from hearing aids for tinnitus sufferers without any hearing loss.

Some research suggests that stress may be a more significant factor in tinnitus than other causes (such as hearing loss and noise exposure). Cortisol, which is a marker for stress, affects hearing. Trials are ongoing into mindfulness based stress reduction approaches to managing tinnitus.

People with severe tinnitus have chronically higher basal cortisol levels than those with less severe symptoms and people without tinnitus.

A number of systematic reviews have shown the efficacy of CBT (Cognitive Behavioural Therapy).

Both avoidant coping and active coping mechanisms can seem to worsen tinnitus so it is necessary to find a balance. Increasing age is associated with increasing tinnitus annoyance.

GPs and assessing clinicians need to be aware that the first contact with someone suffering from tinnitus is very important. Catastrophic thinking worsens tinnitus so think carefully about giving the advice ‘learn to live with it’. Audiology-led tinnitus services seem to be the way forward, with an ENT opinion sought afterwards if necessary. There are shorter waiting times, less anxiety for the patient, and all initial investigations can be done by the audiology team.

All tinnitus patients should be given a hearing test to find out if they have hearing loss.

The BTA’s own Conference Reports from 2010 – 2013 can be found on their website here: http://tinnitus.org.uk/conference-reports.

Collaborative Working : BVA Study Day

Monday, December 1st, 2014

Collaborative Working - flyer

 

Sunday, 25th January, 2015. Baden Powell House, Queen’s Gate, London. SW7 5JS

This study day, organised by the British Voice Association, looks at the value of collaborative working between professions. It is suitable for all those working in the field of voice.

Working Psychologically with Voice (10am – 1pm)
Peter Butcher B.A.(Hons), M.Psychol: Clinical Psychologist – Specialist in CBT
Annie Elias, MRCSLT: Speech and Language Therapist – Specialist in Voice

This session explores the value of collaborative working between clinical psychology and speech and language therapy in helping to understand and free the voice from underlying psychological stresses. The session will include:

  • Cognitive Behaviour Therapy – a brief summary
  • Psychogenic Voice Disorder – what it means
  • The value of CBT in Voice Therapy
  • A model for joint working
  • Practical tips, case study and role play illustration of using CBT to help treat voice disorders, including with singers.

Whose Body Is It Anyway?

Sally Burgess, ARCM, FRCM, Mezzo, Teacher, Mentor, Director.
Fiona Bryan GGSM.Dip RAM.MSTAT, Musician, Alexander Teacher, Arranger, Artist

Sally Burgess (Singing Teacher) and Fiona Bryan (Alexander Teacher) began working together by chance 4 years ago. Although from very different backgrounds they discovered a common interest underpinning their teaching techniques – the importance and potential of mind-body awareness.

They decided to explore this more deeply via a series of workshops for singers combining their respective areas of expertise and were subsequently asked by “Live Music Now” to work with groups of wind and string players.

They are delighted to have this opportunity to share their experiences with you. They will describe in detail their collaborative teaching methods and put them into action with the aid of some (brave) singing volunteers.

Adobe Acrobat - icon Download a provisional Programme

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BAPAM Training Day at Leeds College of Music, May 17th

Tuesday, April 29th, 2014

Wind Instruments – Playing & Problems
Dance and Fitness – The Art & Science

We’re delighted to announce details of our forthcoming Training Day which takes place on Saturday May 17th 2014, 09:30 – 16:45, at Leeds College of Music.

The full programme can be viewed and downloaded here: BAPAM Training Day Programme 17 May 2014

BAPAM Training Days are designed for medics, health care practitioners, and all those concerned with performers’ wellbeing.

Our events provide in-depth explorations of key areas of Performing Arts Medicine and unique insights into aspects of performers’ health and wellbeing. We present performers’ perspectives as well as the expertise of experienced medical practitioners.

The sessions are also a great opportunity to network with colleagues.

Venue: Leeds College of Music, 3 Quarry Hill, Leeds, LS2 7PD

£80 – Full Day
£50 – Students

To book your place or for more information please return this booking form by post or email Clare Hicks, our Office and Clinics Manager –  clare@bapam.org.uk

For those of you who are GPs, BAPAM training days should qualify for CPD credits under the RCGP CPD credits scheme (please check this with them directly).

Study Days from the British Voice Association

Wednesday, February 19th, 2014

Forthcoming symposia from the British Voice Association, include My Tongue Goes Where? at the Royal Conservatoire of Scotland, Glasgow, a chance to hear Dr Ron Morris, (Speech and Language Therapist and Professional Countertenor), explore the anatomy and physiology of the articulators, how tongue tension and articulatory disorders can impact on speech and singing and practical techniques to deal with these difficulties. Saturday, 29th March 2014.

Recovering Voices: The Transition from ‘injured’ to ‘well’, on July 6th, addresses what is meant by vocal injury, and how this affects professional voice users physically, professionally and emotionally.

Further information and booking

And don’t forget World Voice Day, celebrated annually on 16th April. The idea began in Brazil and then spread to the USA. The idea is to celebrate healthy voices and highlight the importance of voice at work and in society. Find out more about World Voice Day.

 

BVA Course: Irritant Issues: Reflux, Allergy and the Voice

Tuesday, November 19th, 2013

This event, organised by the British Voice Association, takes place in London on Sunday, 12th January, 2014 9.30am – 4.30pm.

A multidisciplinary study day suitable for all professionals working with the voice. Subjects to be addressed will include how reflux and allergies can affect the vocal tract and how they can be managed through medication and diet.

Speakers agreed at this time:

Dr Rehab Awad, Voice Specialist Speech and Language Therapist
Mr Tomm Coles, Nutritional Therapist, Paget & Coles Ltd, London
Dr Gavin Jarvis, Lecturer in Pharmacology, Selwyn College, Cambridge
Professor Stephen O’Hickey, Consultant in Respiratory Medicine, Worcestershire Royal Hospital, Professor National Pollen and Aerobiology Unit, Worcester University.

For further information and booking click here.