May 1, 2013 Departments

Inbox: May 2013

Where to Find Member Information

Once upon a time, the Membership Directory, which is available online only to ASHA members, was a valuable resource that included educational, professional and contact data. Now, however, someone in the association has removed all the information, perhaps under the belief that providing data to ASHA members invades privacy. Or, more likely, the ruining of the directory was undertaken to ensure that the association can make more money by selling mailing lists. Meantime, the directory has become worthless.

Jerry V. Tobias
Ledyard, Conn.

Treatment for Children With Benign Vocal Lesions

As SLPs specializing in pediatric voice, we were happy to see a pediatric voice article, "Strike the Right Cord" (March, 2013). The authors brought up the very important point that pediatric hoarseness needs to be fully evaluated, especially due to the possibility of being caused by something life-threatening. What we fear was missed in this article, though, was a discussion of direct, behavioral voice therapy for children with nodules in combination with a vocal hygiene program.

We are concerned that this article might lead speech-language pathologists to the conclusion that behavioral voice therapy beyond vocal hygiene is not needed, or even beneficial, for children with benign lesions. The negative impact of impaired voice quality on children's quality of life has been documented in children as young as 4 years old (Connor et al., 2008). Studies done in children have shown improvements in voice quality and in some cases reduction or elimination of nodules with direct behavioral voice therapy (for example, Lee & Son, 2005; Tezcaner et al., 2009; Trani et al., 2007; Valadez et al., 2012).

While, as the authors point out, we cannot assume that all pediatric hoarseness is due to nodules, we also cannot assume that children with nodules need only vocal hygiene. Children are able to change their manner of voice production, and in order for voice therapy to have long-term meaningful effects, children need to be taught what to do, and not only what not to do.

Maia Braden, MS, CCC-SLP; Sarah Blakeslee, MA, CCC-SLP;
Shannon Theis, PhD, CCC-SLP
Madison, Wis.

Conflicting Voice Interventions?

A patient reading two of your recent voice interest articles would surely raise an eyebrow at opposing intervention strategies for the same pathology (Roy and Tanner, "All Talked Out" and Law, "Healing the Hitmakers"). The protocol Law described for a "top-billed celebrity" presenting with a unilateral true vocal fold polyp was complete voice rest, polypoid resection and postsurgical voice therapy. In contrast, Roy and Tanner noted successful intervention for a unilateral polyp through voice therapy alone; very small supporting before-and-after endoscopic images were included in the article sidebar. Differential diagnosis for the pictured left TVF lesion could include granuloma, a lesion typically more responsive to voice therapy.

In the same Leader issue, it may be important to note that the oft-quoted recommendation for drinking "(up to) 64 ounces of water per day" is simply not supported by research (Kelchner and Brehm, "Strike the Right Cord"). The National Academy of Science's Committee and Institute of Medicine stated in 2005 that an estimated average requirement for water intake "based on data is not possible." Also, "The Role of Hydration in Vocal Fold Physiology" (Sivasankar and Leydon, 2010) noted "these clinical recommendations are based largely on anecdotal reports of the beneficial effects of hydration on voice function." Other widely publicized myth-busting articles indicate that the seminal, hypothetical, 1945 recommendation for high daily water intake included both liquids and foods. Animals drink only when thirsty, and humans in a "prehydration era" did just fine when following the same instinct.

Martin L. Spencer
Columbus, Ohio

Successful Haiti Mission

I cannot tell you how excited I was to read Diane Paul's article on Haiti in the February ASHA Leader! It sounds like her mission was a huge success! I was on a mission in Haiti this past July/August; I was also there during the summer of 2004. We traveled mostly to Borel, Dessalines and Goniaves. Haitian teachers receive very little training, so I joined a mission to train more than 500 teachers through various workshops. I hope to go again this summer.

Again, I was delighted to hear another SLP volunteering in the country

I fell in love with ... way back in 2004. I'm very proud of Diane Paul and her mission!

Jenny Dinelli
South Wilmington, Ill.


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