用按摩治疗唤回了声音

MARY LOUISE KELLY, host:

This is MORNING EDITION, from NPR News. I'm Mary Louise Kelly.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

Today in Your Health, the power of speech and the story of a woman who lost her voice to the point where she could only speak in a strained whisper. Then she got it back in a surprising way. Here's Gretchen Cuda of member station WCPN in Cleveland.

GRETCHEN CUDA: I met Julie Treible at the Cleveland Clinic in mid-May. In that forced whisper, she tells me that six weeks earlier, she got laryngitis. At least that's what she thought. But Treible hadn't been able to speak in her normal voice since then.

Ms. JULIE TREIBLE: April 1st I got a cold, and this part never got better.

CUDA: Without her full voice, Treible had to stop working her job at the meat counter at the local grocery store because she couldn't be understood by the customers. In fact, she says it affected pretty much every aspect of her life.

Ms. TREIBLE: I can't talk on the phone. I can't order food at a restaurant because people don't understand me. My son had a hockey party, and all the parents were sitting around, and nobody talked to me. They just sat there. And I know it's because I can't talk back, but I really didn't feel a part of anything.

CUDA: Scopes of her throat, CAT scans, an MRI and visits to various specialists yielded no answers. But today, in the waiting room of the Cleveland Clinic Head and Neck Institute, she's hopeful that will change.

She has an appointment to see Claudio Milstein, a voice specialist who's optimistic he can send Treible home today able to speak.

Dr. CLAUDIO MILSTEIN (voice Specialist): I'm going to try first some techniques where, basically, I'm going to be using my hands on your shoulders, your back and your neck. OK? I am going to ask you to make some sounds while I work with you, but no speaking. OK?

CUDA: Dr. Milstein begins by manipulating the muscles in Treible's throat with his fingers.

Dr. MILSTEIN: I'm going to stretch the muscles around your voice box. Those cracks, you hear that? OK. Those are normal, so don't be concerned.

CUDA: She winces slightly as he presses against her voice box. He turns her head from side to side, and then presses down on her shoulders.

Dr. MILSTEIN: So you lean forward and drop your head all the way down.

CUDA: To the casual observer, it looks something like a chair massage.

Dr. MILSTEIN: OK. We're going to start working with your voice now. We're going to have you make a sound like eeee, without strain. OK, so long eeees.

Ms. TREIBLE: Eeee.

Dr. MILSTEIN: Chin down a little bit. Keep going, long...

Ms. TREIBLE: Eeee.

CUDA: He continues to work, massaging her shoulders, neck and throat. And within minutes, the raspy whisper begins to disappear.

Dr. MILSTEIN: Lean forward, shoulder up, drop your head. Go ahead. One, one really loud.

Ms. TREIBLE: One, one, one, one, one, one.

Dr. MILSTEIN: There's your voice. Again.

Ms. TREIBLE: One, one, one, one, one, one.

Dr. MILSTEIN: Louder.

Ms. TREIBLE: One, one, one, one, one, one.

Dr. MILSTEIN: One, two, three, four, five.

Ms. TREIBLE: One, two, three, four, five.

Dr. MILSTEIN: There's your voice. Say hello, how are you?

Ms. TREIBLE: Hello, how are you?

Dr. MILSTEIN: You can talk now.

Ms. TREIBLE: I can talk now.

Dr. Milstein: Yes.

Ms. TREIBLE: That's amazing.

Dr. MILSTEIN: Does that sound pretty much like your normal voice?

Ms. TREIBLE: Just about.

CUDA: Milstein says Treible's condition, something called functional dysphonia, is caused when the muscles that control the vocal cords tighten up and lock. It took him just under seven minutes to release them and allow her to speak again.

Dr. MILSTEIN: In order to produce voice, you need to have a very good balance of muscle tone in a lot of different muscles that are involved in voice production. So an intervention like this, where basically you manipulate those muscles and try to restore the internal balance, is very effective.

CUDA: The problem, it turns out, is fairly common. Milstein estimates he sees about 10 patients like Julie Treible every month.

Dr. MILSTEIN: Sometimes these patients have been without a voice up to two to three years.

CUDA: One reason for this, he says, is that things like cancer, infection, acid reflux and neurological problems need to be ruled out first, and that may involve multiple doctors, medications and expensive tests. Another is that it takes a speech pathologist to diagnose and treat the problem.

Nelson Roy is a professor of speech language pathology at the University of Utah.

Professor NELSON ROY (Speech Language Pathology, University of Utah): If I look at the larynx and there might be a little bit of redness, but the patient sounds like this, you have to be able to say the inflammation I'm seeing is insufficient to produce that kind of voice problem.

CUDA: Roy says no one really understands the underlying cause of functional dysphonia, and that led many doctors to believe the disorder is psychological in nature.

Prof. ROY: These are complicated cases. You're really straddling that territory between mind and body, and that's the territory that medicine has a difficult time with.

CUDA: Yet psychological and stress management therapies are rarely effective alone, says Roy, and are best combined with a hands-on treatment or therapy where the patient learns how to use their voice differently.

There's plenty of clinical evidence showing that physical manipulations of the voice box and voice therapy can be extraordinarily effective, but few controlled studies have compared treatments or studied their long-term effectiveness.

Milstein says that in his hands, most patients have a permanent recovery. He demonstrates a set of vocal exercises for Treible, but today she has just one piece of homework.

Mr. MILSTEIN: For the rest of the day today, you have to talk nonstop. Talk and talk and talk.

(Soundbite of laughter)

CUDA: No problem, right?

Ms. TREIBLE: No.

(Soundbite of laughter)

CUDA: For NPR News, I'm Gretchen Cuda.