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Have You Lost Your Voice?

Douglas Hicks helps people, including famous performers, get their voices back.

By Linda Formichelli

Douglas Hicks, PhD, has a great appreciation for the human voice: He’s seen how a voice problem can shatter a person’s self-image and shut down a social life. As Director of the Voice Center at Cleveland Clinic, he helps ordinary citizens and famous performers get their voices back.

Here are Dr. Hicks' answers to some common questions about restoring patients' voices.

»What are some medical causes of voice problems?

There are many organic explanations: injuries, illnesses and diseases that can affect the larynx, or voice box. But there are also non-organic causes that have to do with bad habits of voice use, like bad technique or too much tension, that make the voice box operate inefficiently.

»What are some clues that you might have a voice problem?

Any changes in quality, pitch (how high or low the voice is), resonance (how nasal it is) or loudness are signals that something’s wrong. For example, if you’re suddenly unable to speak as loudly as you would normally speak, if your pitch starts to go really low, or if your quality is off, like you have hoarseness — that could be a problem.

»Can you tell us about the Voice Center?

The Voice Center has two major components: speech-language pathology; and ear, nose and throat, or otolaryngology. We deal with voice disorders, which have to do with quality, pitch, loudness and resonance. While caring for the professional and the performing voice is one of the specialties of the Voice Center, our typical patient is the average person struggling with a voice disorder.

Our approach is to do a very careful evaluation so we can match the problem with the best treatment. The four treatment options for any voice disorder are surgical, medical, behavioral voice therapy or a combination of those three.

»What makes a good voice?

The expression “It’s in the ear of the beholder,” as opposed to “the eye of the beholder,” is relevant here. The criteria for a good voice vary by the individual, their culture and where they live. For example, in Western culture, a low pitch is viewed as more desirable. But in Asian culture, a slightly higher pitch is valued more. However, there are standards across cultures; if you’re too far outside the norm in quality, pitch, loudness or resonance, that would trigger a reaction in people that something is wrong.

»How can voice problems affect a person’s life?

Voice is key to an individual’s self-concept and self-confidence. It’s the way we present ourselves to the listening world. When we have problems with our voice, our image in the world, our ability to carry on our professional requirements, and even our social and recreational activities are all affected. For example, if you’re a sports fan, you need to be able to talk over a crowd, and if you’re into martial arts, you need to be able to yell.

»So it’s not just an issue for performers?

There are lots of non-entertainment, non-celebrity occupations that rely heavily on speaking, like teachers, preachers, telephone operators, telemarketers, salesmen, police dispatchers, and on and on. When they get into voice trouble, all of a sudden they’re caught in a world that they don’t understand. It’s frightening and disorienting. That’s why they seek help.

»Can you tell us about a celebrity you treated at the Voice Clinic?

We treated Tom Hamilton [who completed his 21st season of calling Cleveland Indians baseball games on the radio in 2010]. He’s in a very high-demand voice situation, and there are times that his voice has given him trouble. He has been very generous with his compliments about working with the voice team. For International World Voice Day on April 16, Mr. Hamilton interviewed me in the booth during a night game.

»How about a case involving a nonperformer?

Our phone is ringing off the hook because of a recent story about my partner, Dr. Claudio Milstein, who was interviewed on NPR. We had a patient who had so much tension in her neck and voice box that she could hardly produce any voice at all. This isn’t as uncommon as you’d think: Some people carry their stress in the neck, which is the home of the voice box. In less than 10 minutes, using some tension-unloading techniques that are like massage or muscle manipulation in the neck and upper shoulder area, she regained her voice completely. The patient said that Dr. Milstein returned not just her voice, but her life.

»You have a very deep and rich voice. Were you born with it, or did you have to work on it?

It’s more heredity. An individual’s voice is in some ways like a fingerprint. You didn’t cultivate your fingerprint. You can take care of your hands, you can take care of the skin, but you still have to deal with what you were given.

»Does that mean there’s no hope for you if you aren’t born with a good voice?

Some people’s instrument is different from the masses. For example, Pavarotti had an unusually large breathing capacity that contributed to his unique performance. However, you can take an average person and make them sound much better through training. That’s why there’s training in broadcasting, classical singing, popular singing and theater.

»Who do you think has the best voice?

It wouldn’t be good for a voice professional to pick favorites. Plus, there isn’t one standard of what makes a good voice. But one routinely viewed as good is James Earl Jones. He has a wonderfully rich, robust, resonant, deep voice that carries whatever message he’s trying to communicate, whether he’s doing a radio spot, an advertisement or Darth Vader. He carries this incredible impact to the listener.

Published December 2010