Hi everyone.

Well Dr Kim looked at my vocal chord video and came up with the following comments. He seems decidedly cool on doing VFS for me and I'm not sure if he sees any benefit. What do you think? Any help decoding what this analysis really means would be much appreciated!

Thank you,

Sarah.

Please refer to Dr.Kim's comment below.

"Vocal folds assymetry along with muscle tension discrepancy are observed on your vocal folds. The contact of vocal folds is unstable and vocal tremor and voice break are at present.

This indicates that you have hypofunctional voice due to againg process and presbylaryngis. However, other organic voice disorders are not observed.
At the moment, you can have VFS surgery, however, post-operatively a long-term botox treatment through injection and medication are required.
Vocal function exercise must be accompanied continuously to adapt to using your new vocal folds.
Please take all this into consideration and make a decision."

Well, most of it is standard, although it reads like you may have some longer period to get your results.
all the diagnosis are present in many of the patients of him who have written about it here. not everyone has all of them, but they are common. Thus he almost always treats with Botox and medication, although usually it is 3-4 months Botox and then medication for up to 4 months. He told me however that it may be that I need another Botox injection because I may have too much tension and tremor.
Doing the exercises is always important and voice rehabilitation therapy certainly is beneficial after VFS. so nothing new there either.
The only difference I see to his common diagnosis is that he strongly emphasizes these points, which means you man need to do a bit more to get your voice than some of the others - maybe several Botox injections and strictly following the voice exercises.

the aging of the vocal folds may cause some issues. A perception some have made is that voice surgery of this kind is less effective  and/or takes a longer time to reach the goal in older women than in younger women. So age and also aging of the vocal folds may play a role there.

I would say you probably can do it, but be careful not to expect to have a voice like Jenny had after 4-6 weeks already - it may take more time and more exercises and maybe more botox to get there. Thats what I read from this.

Thanks Anja, and sorry to have posted this on the other thread as well.

Oddly, the video showed I was getting up to 296 Hz with a sustained note, and yet I have these male sounding undertones which make it impossible for me to sing, scream, sneeze or cough in a female way, and I so want to sing again... I suppose if I go ahead I'll have to get botox injections in the UK, if that's possible. I can't keep going back to Korea just for injections.

Is there any value in me posting my vocal chord video anywhere? If so, where? The frequency measurement is on-screen and you can hear the note as well.

Sarah.

Well - the pitch you have there is not relevant really. Usually they ask you to do a high, medium and low pitch sound to see how the vocal chords react in these registers. It has however not much to do with your speaking frequency, this is assessed by reading a text and recording it and then analyzing for the pitch.
Pitch alone is not all there is, it is just one piece in the puzzle. Undertones, Resonance , Prodosy are some of the others. I can only speak of limited experience now regarding the surgery, since I dont know how much is the Botox, the post op hoarseness and how much is the desired result of the surgery, but so far, the low and male sounding undertones are gone for me, lower voice limit is at 130 Hz and I dont have the undertones that would come from below that. Coughing and Sneezing and all that is still off limits for me if I can avoid it, so I am not sure how much change is to be expected there, but I think those sounds depend to a large degree on the resonance chamber? For singing , I guess resonance is important. I find it is pretty easy right now to use different resonances for me and I dont have a voice break really. Again, I am not sure which parts are because of the Botox, I expect some of the bad things to come back later on and I will have to deal with them somehow. From what I heard from the others, it is much easier to manage resonance and voice break compared to pre op though.

Dr Kim thinks that tremor can be treated with one or few Botox injections and medications. Apparently the thought is that the brain then unlearns these bad muscle use patterns (contracting the vocal muscles while using the voice) and adapts to the new, more balanced voice that can be used in a relaxed way, so no need to tense the muscles all the time. However if it is really a stronger variant of "spasmodic dysphonia" which basically is what the name of this condition really is, a more regular treatment has to be done. In severe cases this has to be continuously treated with Botox, but listen to the examples of people with this condition who get this sort of treatment and judge if this is you - I find this is a very different thing - they basically have gaps in their speech and sound totally damaged. I doungt that this is the case for you.

Dr Kim said if the post op examination (I will go to a local ENT and get an endoscopic video done again) and voice recording 2-4 months post op still shows signs of the tremor, he can give me adresses in Germany to get the Botox, but he apparently things that it will be enough to use the medication and then phase that out. But he seems to know doctors around the world who do Botox treatments.

Thanks Anja.

I never understood the need for botox before but if it is as you say to allow the brain to change the way it controls the voice I can see how it might be necessary, and why someone who has controlled their voice for a very long time (like me) would need longer. I'll email Jessie and see if she knows of doctors in my country who might be able to give the extra injections. I think my problem in not sounding totally female is due to undertones, not my fundamental frequency. You're talking again now? I'd love to hear your post voice somehow although I can understand you not wanting to post to a public forum. Could you describe the improvement? Were you ever mistakenly identified on the phone before?

Gosh, you know a lot about this subject now. I'm just going off to look up 'prodosy' and 'voice break'!

Best wishes,

Sarah.

LOL, Yes I was sucked into that topic I guess. The part about the Botox is from Dr Kim since I asked him about the Botox and the need for it. He also told me why he does not use it right at the surgery date but 7 days later - the shot would be partially ineffective because Botox could leech into the wound and then exit the body eventually.

Quote from: Teslagirl on April 01, 2015, 01:34:32 PM
I'll email Jessie and see if she knows of doctors in my country who might be able to give the extra injections.

I think Dr Kim can tell you about them if the need arises, which I dont really think will be the case. He probably first will want to make a diagnosis in his clinic - In my case he said he will tell me the adresses if my post op examination shows that I need another Botox. So I think he probably does not think it will be needed and only seek out adresses in case I really need it.

QuoteI think my problem in not sounding totally female is due to undertones, not my fundamental frequency.

Yes, that was part for me too. And this definitely seems to have changed to a good part.

QuoteYou're talking again now? I'd love to hear your post voice somehow although I can understand you not wanting to post to a public forum. Could you describe the improvement? Were you ever mistakenly identified on the phone before?

I try to put updates in my thread on my "voice journey". I will post an audio in some time, but I want to get rid of the initial hoarseness a bit and find out which pitch now really is comfortable. I seem to tend to use a too low pitch - near my new lower limit - but its straining actually. So its not really you do the surgery and then just talk away and the pitch is up, the brain has to adjust and actually find the new pitch that is comfortable now. I want to at least have some general idea about this and do a proper recording then. Also it is kind of annoying to be able to say only a few sentences and then get hoarse already. Maybe in 2 weeks or so.

I was misidentified a lot on the phone, yes. Especially when I had to go down in pitch because I developed voice issues eventually. It will take time to get to know if this is gone now.

I also kind of expect some change maybe to the negative a bit when the Botox wears off. I may have more roughness in the voice again at this point. Now it kind of sounds like padded in cotton

Main effects I noticed - my lowest pitch is no 130 instead of 80 Hz, lowest average pitch when talking rather low is about 150 Hz, up from around 110 maybe. The Undertones have changed, there is a more feminine quality to the voice. It is far easier now to use upper pitches - I cannot feel a voice break right now, although I guess this is going to come back with the end of Botox. The downsides - I get hoarse really fast, then have soreness in the throat for a while, the voice is very soft and low in volume.