Voicing your concerns
Dr Vijeta Jambaulikar, Goa’s very own voice correction surgeon and swallowing specialist speaks to The Goan on the rising medical conditions in ENT field including voice change and swallowing problems
10th February 2019, 03:25 Hrs
She was only 11 when she decided that she would embrace medical profession and be an ENT surgeon and there’s a reason why she chose to do specialisation in swallowing rehabilitation. Seeing her grandfather, late Sadanand Jambaulikar, a renowned teacher from Margao suffer from throat cancer and survive on just 200 ml liquid diet per day, which too was difficult for him to swallow in the last six months of his life, little Vijeta was emotionally very disturbed. She wanted to do something to relieve his pain and suffering, extend his life if she could and make his last days joyful until she loses him. When she grew up a bit, Vijeta zeroed on becoming an ENT surgeon with specialisation in voice and swallowing. She says, 75 percent teachers have experienced a voice problem during their career and 20-35 percent elderly may suffer from difficulty in swallowing.
Today, at 30 Dr Vijeta is living her dream, stealing the credit to offer Goa its first Laryngologist and Voice Correction surgeon. Her parents feel proud that their daughter, Dr Vijeta Jambaulikar who has specialised in the upcoming medical field of Laryngology, is one of the select few who have been trained under Dr Nupur Kapoor and Dr Jaikumar Menon, both of who are believed to be the top two Laryngologists in India.
A MS (ENT), with fellowship in Laryngology, Dr Vijeta is trained at Bombay Hospital and Medical Research Centre, Mumbai and Kerala Institute of Medical Sciences and is also the member of Association of Phonosurgeons of India.
Categorising laryngology into two parts – voice and swallowing, Dr Vijeta explains the reasons why voice changes - “Those who use their voice excessively due to their professions (teachers, singers, DJs, RJs, politicians, speakers, those who work in noisy factories etc) experience a change in the pitch of their voice after too much of abusing it.
Voice can change after accidents, neck injuries, operations, cancer/thyroid treatments, lung/heart operations, paralysis or stroke. Smokers, alcoholics and tobacco addicts also experience a change in their voice as the asthma patients who use inhalers and tuberculosis patients.”
When the voice changes due to overuse, it’s a serious problem and many times people are compelled to change their professions. There are two ways to solve the problem – therapy or surgery. Gold standard test is Stroboscopy which helps to detect the extent of damage to the vocal folds (chords). If voice changes due to accidents or injury we do Flexible Laryngoscopy. Correction can be made by therapy or surgery (Thyroplasty or Injection Laryngoplasty).
When voice changes due to smoking, drinking or tobacco the person needs early diagnosis of cancer and if detected go for endoscopic cancer treatment while trying to preserve a serviceable voice. Long term cancer surveillance and follow-up is required for five years.
Antibiotics TB treatment for tuberculosis and antifungal treatment for asthma is offered to give relief. For long term dry cough, chronic throat pain or foreign body sensation, lifestyle change is the solution. Exercise helps a lot in reducing obesity and allergy both, which affect voice to certain extent. If both the voice folds get paralysed and the person cannot breathe on his own, he has to take help of Tracheostomy tube.
There is a common belief that it is risky to remove this tube, once fitted as the person may not be able to breathe and choke to death. “But these bilateral vocal fold paralysis patients can also have their own breathing space by opening out the airway,” smiles Dr Vijeta.
Trained in the skill to do voice change surgeries, Dr Vijeta mentions that these are done for pathological reasons. If a person wants to change his or her voice due to reasons other than pathological, then there are medico-legal aspects that have to be taken care of, she maintains.
The second part of Laryngology is those who have problems in swallowing. This can be due to multiple reasons – Parkinson’s, stroke, Myasthenia Gravis, accidents, head or spinal injury, spinal surgery, cancer and post-cancer surgery, post-radiology therapy etc.
Those who have severe problem in swallowing have to be fed liquid diet through a nasal tube. Problem in swallowing is a common cause for aspiration pneumonia.
“My goal is to improve the lives of such patients by letting them have oral feeds while avoiding aspiration, which happens when food goes in the wind pipe. Tasting food by tongue is a pleasure which they miss totally, and we can help them by Fibre-optic Endoscopic Evaluation of Swallowing (FEES),” states Dr Vijeta who has this facility at her clinic in Margao to serve people as she witnessed many Goans travelling to other places for treatment.
n Drink enough water
n Regularise meal times
n Keep mouth open while singing
n Sleep for 8 hours
n Excessive oily, spicy food
n Abuse of voice
n Smoking, alcohol, tobacco
n Immediate lying down after meals