Wednesday, December 14, 2005

the stroboscopy experience

On Tuesday, I drove up to Phoenix for my video stroboscopy. My ENT, the wonderful Dr. O, had noticed chemical erosion on my throat structures, and was concerned there was some weirdness in my vocal folds. He 'scoped me at my last appointment, and saw enough to warrant doing the stroboscopy, so we set it up.

First off, it doesn't hurt, and it's only mildly uncomfortable. The equipment used by the voice therapist who did my exam uses a tiny digital camera at the end of a silver tube, about the diameter of a pen, maybe a little wider, and somewhat flattened. Basically: the camera is slid back along your tongue until it can see down your throat.

The reality is a bit more tricky than that, but nothing too horrible -- at least for me. I'm lucky in that I don't have a psychologically-triggered gag reflex. The one time she did tag my uvula, I had to cough, but it only happened once during the entire exam.

I've been through a number of procedures that visited various levels of indignities upon me. It's medicine, it's impersonal, I know that, and I can usually keep myself from thinking things like, I look ridiculous! Usually.

But doing the stroboscopy requires that the patient:
1) hold a stethoscope-like disk against the throat with one hand (this allows the timing of the strobelight to be adjusted to the vibration rate of the vocal structures, the therapist explained to me)
2) stick out the tongue and firmly hold it out and down, with the other hand (the tongue is held by a piece of gauze so your hand doesn't get slimy and the tongue won't slip out of your grasp)
3) lean forward, tip the head back, and jut the chin out simultaneously.

If you can imagine this position, you'll know how downright silly it sounds, before the therapist even starts the examination procedure. So, I did all these things and it's all I can do not to laugh, and then...

The procedure starts. The therapist slides the camera wand in to the back of my mouth, just so it peers down my throat. This is tremendously distracting because facing the chair I'm sitting in is a big screen flat-panel TV that's live-broadcasting the camera's signal. It's so cool!

But now the real fun begins: Say "E", the therapist says. I try to say "E" but it comes out more like "A" -- well, really, it sounds like a wounded animal vocalizing its pain. Smile big, the therapist encourages me, and I push up the corners of my mouth -- Ah, there it is, "E". Now we're cooking, I thought.

It turns out "E" was the least of my problems. I had to do low Es and high Es, and other sounds, too. My biggest problem? I was acutely conscious of how ridiculous I looked and how silly I sounded! I had to really clamp down on that feeling otherwise I would've been laughing throughout. As it went I had to pause 2 or 3 times just to compose myself.

That was it for the exam -- I'd say the camera was in there maybe 15 minutes at most. There's a lot of setting up and figuring out how things will work, etc, but the procedure itself is short and painless -- if you can keep from gagging or cracking up.

In spite of my giggles, the therapist said I did very well. Dr. O will review the recording, of course, but she told me that I do have some paralysis/weakness in the right vocal folds, which are muscles inside the neck. This makes complete sense given that I'm still suffering from numbness on the outside of my neck, and I've been working for nearly 8 weeks to restore the strength and control to my right shoulder, arm, wrist, and hand that the surgery whacked. She recommended voice therapy, because she could hear the tightness in my voice (I hear it too), and because I probably am aspirating stomach acid because the folds are not closing properly. (She did say that the increased dosage of Prilosec seems to be helping with that as well -- there was evidence of past erosion, but it seems to be healing now.)

In the meantime, she gave me an exercise I'm supposed to do for 2 to 3 minutes, 2x/day for 4 weeks: sirens. You start low and support with your breath, make an "O" sound and increase both the pitch and volume, sliding up, then decreasing both pitch and volume sliding back down. She and I practiced 3 or 4 times.

I can't do it. I find myself singing discreet notes which is not what I'm supposed to do. I also feel like a complete idiot! It really does sound like caterwauling, and to do it for 3 whole minutes? Yikes!

Well, I'll try -- I want a strong, flexible voice! But I'm going to have to search for a siren recording that I can imitate, because doing it on my own is just not working.

* * *

Part of me wants to say No more tests, ever! because every time I have a diagnostic test, it finds something. So far all the "somethings" have been correctable, but it is getting old. The results from the stroboscopy were to be expected, really -- there was so much work done in my neck that it would be rather a miracle if there were not any nerve problems. Since my overall recovery has been fantastic, I think I'll be satisfied with that one miracle -- no need to get greedy and ask for another.

I'll just add "vocal fold paralysis; needs therapy" to my ever-growing list of "stuff that can't be ignored or I will be very, very sorry later." Better to deal with it now.

3 comments:

ws said...

Thanks for posting your experience having the stroboscopy. I;m scheduled for one next week in Boston and like to know what I'm getting myself into.

Jackie said...

I am having one in the morning. I feel more comfortable about the time and procedure. It's interesting being the patient. I am retired from the O.R.

Sam said...

Interesting website, I found it Googling "Stroboscopy", I'm scheduled for one next week in Boston.... because my larynnx is doing crazy things, and my voice gets so hoarse I can't talk. I just wonder what the therapy will accomplish...... can anyone tell me it helped them?