Kate loves to sing. It’s her greatest passion and an important part of her identity. She acts and sings in musical theater and would like to make a career in the performing arts. So, when she experienced bouts of losing her voice at age 16, she was scared.

“I was worried that I had a vocal injury,” Kate recalls. Her voice would be fine for a week or two, then it would disappear. She cut way back on her singing, excusing herself from her school’s chorus at times. Even with more rest for her vocal folds, when she did sing her voice was weak — not what she knew it could be. Consultation with an ear, nose and throat (ENT) specialist didn’t bring relief. She tried the treatments suggested, but the bouts of voice loss continued.

Help from CHOP’s Voice Program

“I realized I needed someone who specializes in singers,” Kate says. With the help of her family doctor, she found Karen B. Zur, MD, and Paula Barson, MA, CCC-SLP, at the Pediatric Voice Program at Children’s Hospital of Philadelphia (CHOP). Dr. Zur, Chief of the Division of Otolaryngology, is Director of the program. Barson is a speech-language pathologist who provides voice therapy.

In her first appointment with Dr. Zur and Barson, Kate received welcome news and important insights into the way she was using her voice, both of which pointed to solutions.

First, Dr. Zur identified a medical issue that was contributing to her voice problems, and it wasn’t an injury to her vocal folds or an issue with vocal fold nodules, as Kate had feared. Instead, Dr. Zur found that she had significant acid reflux, which was causing irritation in her throat and inflaming her vocal folds. “I had never realized that before,” Kate says, “and I was so relieved to find out that it was an easy problem to bring under control.”

Second, Barson, after listening carefully to her speech and singing, noticed that Kate was dropping into “vocal fry” at the end of her phrases. Vocal fry is the lowest register of the voice, and can come out as a raspy or creaky sound. On its own, vocal fry wouldn’t cause Kate to lose her voice, but together with her acid reflux and how hard she was pushing herself, it was adding additional stress on her vocal cord and would be a factor to work into the treatment plan.

Diet changes and voice exercises

Dr. Zur advised Kate on her diet to control the acidity and reduce regurgitation. Barson showed Kate some exercises to reduce the stress to her vocal folds and build their resilience, and ways to massage her neck and throat to reduce tension.

By avoiding acidic foods, drinking a special alkaline water and paying attention to when she ate (avoiding food at bedtime) and modifying other aspects of her eating habits, Kate soon brought her reflux under control, ending that source of irritation. Following Barson’s suggestions, Kate did vocal exercises, practiced massage, and paced her singing to allow her voice to rest and recover.

Six months after her appointment, Kate returned for a follow-up visit with Dr. Zur and Barson, at which she was delighted to sing for them — “Not for the Life of Me” from Thoroughly Modern Millie. She sounded wonderful. Both told her she had a completely different voice, clearer and stronger, with more range and confidence.

‘Moving forward with my passion’

“I’m so grateful to Dr. Zur and Paula Barson for everything they did for me,” Kate says. “I came in as a little kid, worried about my singing voice — so, so scared that I had injured it. When I found out that it was just acid getting into my throat, it changed everything. It took away the fear. They helped me build new habits — to take a step back sometimes and take care of my voice. Because of them, I’m moving forward with my passion for singing.”

Kate, 18, is in college now, in a musical theater degree program where she performs regularly and is learning from professionals in the field.

“I feel so blessed,” she says.