News and Events

News:       New Treatment for TMJ (temportomandibular) Disorders

If you or one of your family members is having pain, headaches and/or clicking of your jaw, we are presently conducting an FDA approved study for treating TMD under the direction of Andrew Blitzer, M.D., D.D.S.  The new study is investigating local injections of BOTOX, which is a neurotoxin that weakens muscles and therefore decreases or eliminates muscle spasm and pain.  BOTOX is an already approved drug for stabismus, blepharospasm, cervical dystonia, hemifacial spasm, and spasticity.  It will soon be approved for cosmetic indications.  This trial is to evaluate the drugs efficacy for TMD.

If you are interested in obtaining more information or participating in the trial, please call Terry, Study Coordinator, at 212-262-4444

The Doctor's Corner:
Hydration, High Notes and Humibid
by Anthony F. Jahn, MD, FACS
(Reprinted from The New York Opera Newsletter)

Hydration, High Notes and Humibid

by Anthony F. Jahn, MD, FACS
(Reprinted from The New York Opera Newsletter)

Most of the singers we see have, at some time taken a drug called Humibid. Some swear by it and are chronic "Humibid habituŽs" while others notice no benefit whatsoever.

What exactly is Humibid, and what does it do and do you really need it? Humibid is a brand name for the medication guaifenesin. This substance is found in many different compounds which are prescribed for colds, congestion and allergies. These include Guiafed, Entex PSE, Deconasal and, more recently, Organidin.

Guaifenesin is a medication which thins mucus. By decreasing the viscosity of mucus, it can diminish the symptoms of post-nasal drip, chronic throat-clearing and vocal difficulties due to "mucus on the cords". As already mentioned, some singers note a dramatic improvement, while others experience no change. Rarely, the medication can have side-effects.

In addition to guaifenesin, other "mucolytic" medication should be mentioned. The enzymes papase and ananase (from papaya and pineapple, respectively) are no longer available on prescription in the USA although you may find them in health food stores, or (more Naturally) in the fruits themselves. An adequate intake of calcium is believed by some to be important. Another drug, acetyl cysteine,, breaks up the bonds that hold viscous mucus together. While in the US this is only available in an unpleasant nebulizer formulation (and used mostly for cystic fibrosis), many singers who perform in Europe have found acetyl cysteine in a "user-friendly" effervescent tablet, which is readily prescribed by local laryngologists.

The real solution to thick, dry mucus, however, lies in the instruction that accompanies any of these prescription: "Increase your intake of water."

Hydration is important for good, safe and reliable voice production. The vocal folds need water in two different ways. Internal hydration of the tissues allows the muscle and mucous membrane of the vocal fold to maintain their tone. the same way that drinking water is good for your skin, it is good for all the tissues of the body. The muscle of the vocal fold and it covering membrane are separated by a microscopic layer of a gelatinous fluid. For proper singing the mucous layer must slide freely, as if on a bed of ball bearings. If the folds become dehydrated, they can not stretch and vibrate reliably.

In addition to this internal hydration, the surface of the vocal fold needs constant lubrication. Drying air rushes past the vocal folds (at up to 70 mph during coughing). The folds need to be constantly moistened to allow flexibility and accurate approximation. Hundreds of glands above the vocal folds (in the ventricle) secrete a thin layer of mucus which coats the vibrating surface. This thin layer is essential, somewhat like the thin layer of mucus that covers the surface of the eye. During soft singing in high head voice, the folds are stretched and thinned and this layer of mucus plays a critical role.

If the secretions decrease or thicken, clumps of mucus will accumulate on the vocal folds and the voice becomes unfocused of rattly. Dry vocal folds are also more likely to be injured by the prolonged and repeated contact (hundreds of times per second!) needed for singing and for sustaining higher notes. So, while guaifenesin can decrease the viscosity of mucus, it is hydration which will increase the quantity of this essential vocal lubricant.

Can you substitute milk, juice, soda, coffee or a beer for water? The answer is "No". Milk and diary products themselves produce thick mucus and if you wish to drink milk, we suggest skim. Sugar (in juice, soda), caffeine (in coffee and non-herbal tea) and alcohol are all diuretics. They actually enhance the elimination of water, rather then achieve the goal of high hydration. Although you need no avoid these other drinks (in moderation), only water and herbal tea will do the job,. We suggest 6 - 8 glasses per day: most singers agree that a few extra visits to the bathroom are a small price to pay for a voice that is strong, clear and reliable.

It should finally be mentioned that mucus is not always the culprit. If you experience persistent vocal difficulties due to "excess mucus," you should see your laryngologist to make sure there are not other factors which interfere with your voice.