Finding Her Voice

Lisa Aucoin enjoys reading to students again, thanks to having her voice restored by GHS’ Voice Center.

As a media specialist at Summit Drive Elementary School in Greenville, Lisa Aucoin spends seven hours a day interacting with kids and reading aloud. A year ago, her students kept asking her what was wrong. “You sound funny,” they would tell her. “Are you sick?”

She wasn’t sick, though she kept getting laryngitis. After treating her with steroids, antacids and vocal exercises, doctors at Greenville Ear Nose and Throat (ENT), part of Greenville Health System (GHS), found a polyp on her right vocal cord, and she became one of the first patients of Robert Eller, MD, who directs the Greenville Voice Center.

The Voice Center’s state-of-the-art equipment includes high-definition endoscopes and laryngeal videostroboscopy that allows close evaluation of the structure and function of the larynx. “Akin to high speed video,” Dr. Eller explained, “videostroboscopy slows down the vibration of the vocal cords, which is too fast to appreciate with the naked eye. Frame-by-frame anaylsis lets us see what’s preventing the voice from sounding right.”

Patients with continuing or recurring voice problems may go to their primary care doctor or an ENT doctor who may not have specialized equipment. “If people have had examinations but no improvement, we may be able to help,” Dr. Eller said. “We have the extra expertise and extra equipment to detect what others may have missed.”

Speech-language pathologist Alissa Yeargin and Robert Eller, MD, director of Greenville Voice Center, help patients with a range of voice problems.

Dr. Eller graduated from the U.S. Air Force Academy and Vanderbilt University School of Medicine before training in otolaryngology–head and neck surgery at the University of Alabama at Birmingham, followed by a fellowship in laryngology at the American Institute for Voice and Ear Research in Philadelphia. He also founded and directed the U.S. Air Force and Army Voice and Swallowing Center in San Antonio, and was deployed to Iraq in 2008, where he performed more than 700 procedures.

He moved to Greenville in summer 2017 and began seeing patients in August. Many area residents previously had to travel to Charleston or out of state for specialty treatment, so Dr. Eller’s arrival at GHS has increased convenience for many local residents while offering an option for out-of-town people from Georgia, North Carolina and Virginia.

Aucoin waited several months so she could have the surgery with Dr. Eller in Greenville. After her procedure November 15, 2017, she spent two weeks on complete vocal rest, gradually increasing the amount she spoke. She returned to work on January 15.

A Team Approach

When patients like Aucoin need surgery, the Voice Center’s speech pathology team works with them before and after the procedure to make the treatment even more effective. Lisa Barksdale, Emily Manny and Alissa Yeargin, speech-language pathologists, work with Dr. Eller, offering voice therapy and other services to patients whether or not they require surgery.

“When we see patients together as a team, we provide a higher level of care with more efficiency,” Dr. Eller pointed out. “Patients leave with a better understanding of what’s needed to improve, and they really buy into the therapy. That can reduce the amount of surgery required.”

Yeargin said her team can teach patients better habits that help recovery and prevent similar problems from occurring. While she works with many singers and those who speak a lot in their work, like lawyers and teachers, “we see the whole gamut,” she commented. “Some people just want to project to teach Sunday School class or order at the drive-thru.”

The Voice Center can assess anyone with a voice, swallowing or upper airway problem, including a change in singing voice, swallowing problems or the voice simply wearing out.

Many people don’t know when to seek help, as allergies, colds and coughs are common and often affect the voice, so Dr. Eller suggests seeking help if problems continue beyond one month.

The Voice Center works closely with doctors at the GHS Cancer Institute for patients fighting cancers of the head and neck, offering customized treatment plans to preserve or restore speaking and swallowing. They also team up with pulmonary, neurology, allergy, GI doctors, or others whose patients have voice or airway issues.

Support groups for different patient populations allow people to confide in and compare issues with those facing similar problems. For example, the Voice Center runs a group for spasmodic dysphonia, a relatively rare disorder in which the muscles that generate voice have periods of spasm. This group provides a forum for patients to talk about what treatments work best, including holistic approaches.

“They can get tips, and we’ve heard experts from the field,” Yeargin noted, “and also from Scott Adams, creator of the Dilbert comic strip, who has spasmodic dysphonia.”

The Voice Center also is reaching out to the community by speaking to schools and organizations about vocal health, supporting a table at the Greenville Drive’s healthcare career night, and speaking at high school and college chorus classes. “We want to educate people about taking care of their voices, and we also want to talk about our profession,” Yeargin said. “There is high demand for speech pathologists, and we’re always trying to educate young folks about this.”

A Storybook Ending

For Aucoin, working with speech pathologists and completing vocal exercises were key parts of her journey. Before finding the polyp, she worked with therapists and performed exercises that she thought weren’t working, but she later found that they reduced swelling, which allowed Dr. Eller to use a minimally invasive laser technique to treat her polyp instead of having to cut it out.

She then spent two weeks not saying a word—except for one lapse when she accidentally told her husband “Bless you” after he sneezed.

While the recovery was difficult, she found ways to get around talking, such as texting with her husband while in the same room and writing notes at Thanksgiving that family members would then act out. She soon was talking for 15 minutes a day, then 30 and slowly progressed back to a normal amount of speaking.

“I did everything they told me,” she recalled. “If I didn’t, it wouldn’t have turned out as well.”

One big perk of the Voice Center was the supportive staff who prepared her for each step of the journey. “They helped me anticipate the challenges of vocal rest,” Aucoin observed. They gave her email addresses and responded quickly to her emailed questions, since vocal rest meant she was unable to call.

Voice therapy also helped Aucoin realize how she had been using other muscles to compensate for her vocal cords, and she was expending extra effort to talk and read to children. Though she doesn’t sing, reading aloud and storytelling require similar range, pitch and vocalization. “Now it’s effortless,” she marveled.

Aucoin learned that just like other parts of her body, she has to take care of her voice to keep it healthy. She now uses a portable microphone while reading aloud, as the library at her school is large, and she hadn’t realized how much she was straining to be heard.

“I make sure to hydrate, amplify with a microphone, and I force myself to take vocal breaks throughout the day,” she said. During summer break, she faithfully performed her exercises, preparing for her added vocal load in the new school year.

Dr. Eller said many people don’t realize how much having a voice problem reduces quality of life. “People can’t do their jobs or talk on the phone. After treatment, their relationships are restored. It’s fun to see that.”

Yeargin added, “Or when you don’t sound like yourself, it can affect your career and your life in so many ways. Our voice is a big part of our identity.”

When Aucoin returned to work in January, the children were happy to have her—and her voice—back. “They don’t tell me I sound funny anymore,” she reported. “This was my 26th year, and I was worried I might not be able to continue.”

As she enters another year of introducing children to the joys of reading, Aucoin’s advice to those experiencing throat or voice issues is simple: Get help. “People think the problem will go away, but if you think there is something wrong, go,” she urged.

Dr. Eller agreed. “We’re here to help you find your voice again.”