About Us and Services		Hoarseness
	David R. Foushee, M.A., CCC-SLP		Vocal Problems
	Ericka L. Olsen, M.A., CCC-SLP		Videostroboscopy
	Jodi M. Miyasaki, M.A., CCC-SLP		pH Probe Testing
	Q & A about Speech & Language		Appointments
	Stuttering

Speech and Language Department

Speech Pathology Services

Central California Ear, Nose & Throat Medical Group is dedicated to providing speech/language pathology services to people with communicative difficulties. We offer a full range of services to include:

• Diagnostic evaluations including laryngeal videostroboscopy
• Treatment/therapy services
• Consultations
• Parent/Family training

Disorders of communication may negatively affect the quality of life, interfere with learning, reduce job effectiveness, and impair social interaction. These problems can occur from early infancy through adult life. Some of these disorders include:

• Articulation Disorders (Speech)
• Language Disorders (Disorders of Expression or Comprehension)
• Stuttering
• Voice Disorders

We offer specialized diagnostic and treatment services for the Professional Voice. The KayPentax computerized laryngeal videostroboscopy system ensures the most advanced diagnostic technology for our patients. Our voice care professionals have received additional training to meet your needs.

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	About David R. Foushee, M.A., CCC-SLP
	Ericka L. Olsen, M.A., CCC-SLP
	Jodi M. Miyasaki, M.A., CCC-SLP
	Appointments

David R. Foushee, M.A., CCC-SLP

Speech/Language Pathologist Graduate School: California State University, Fresno American Speech-Language-Hearing Association: Certificate of Clinical Competence; Speech Pathology, 1975 Licensed: California Speech Pathologist, 1975 Previous experience: public school clinician with orthopedically impaired/infant programs; Director, Language, Hearing and Speech Clinic at CSU Fresno, and private practice at Northwest Speech and Hearing Center.

David R. Foushee, M.A., CCC-SP, Speech/Language Pathologist brings 36 years of clinical practice to Central California Ear, Nose & Throat Medical Group. He has provided clinical service in a variety of settings to include: public schools with orthopedically handicapped and at-risk infants; as the Director, Language, Hearing and Speech Clinic, California State University, Fresno; and in private practice as co-owner/speech pathologist at Northwest Speech and Hearing Center.

He has published and presented papers at state and national conventions on such subjects as Moebius, Williams, Cri du Chat, and Prader Willi Syndromes. Clinical interests and specialties include the professional voice, neurologically-based speech and language disorders, Verbal Apraxia, and Language Processing Disorders in ADD/ADHD children.

• Master of Arts with Distinction, California State University, Fresno in 1975
• Certificate of Clinical Competence, Speech Pathology- American Speech-Language-Hearing Association, 1975
• Licensed Speech Pathologist, State of California, Board of Medical Examiners, 1975
• Member, California Speech-Language-Hearing Association
• Member, American Speech-Language-Hearing Association

Ericka Olsen, M.A., CCC-SLP

Speech-Language Pathologist Graduate School: California State University, Fresno American Speech-Language-Hearing Association: Certificate of Clinical Competence; Speech Pathology, 2008 Licensed: California Speech Pathologist, 2007

Ericka Olsen, M.A., CCC-SLP, Speech-Language Pathologist has provided intervention for a variety of speech and language disorders for both children and adults. She has provided speech, language, and swallowing intervention in a variety of settings including public schools, private clinics, and home health services in the community.

She currently specializes in performing laryngeal videostroboscopy and providing vocal rehabilitation for individuals with voice disorders. She has additional clinical experience in treatment of Fluency Disorders (stuttering), Language Disorders, and Articulation Disorders. Other professional interests include diagnostic and treatment services for Verbal Apraxia, Language Processing Disorders, and language intervention for patients with Autism Spectrum Disorders.

• Master of Arts with Distinction, California State University, Fresno in 2007
  
• Certificate of Clinical Competence, Speech Pathology- American Speech-Language-Hearing Association, 2008
  
• Licensed Speech Pathologist, State of California, Board of Medical Examiners, 2007
  
• Member, American Speech-Language-Hearing Association
  
• Member, California Speech-Language-Hearing Association

Jodi Megumi Miyasaki, M.A., CCC-SLP

Speech-Language Pathologist Graduate School: California State University, Fresno American Speech-Language-Hearing Association: Certificate of Clinical Competence; Speech Pathology, 2011 Licensed: California Speech Pathologist, 2011

Jodi Miyasaki, M.A., CCC-SLP, Speech-Language Pathologist has provided clinical intervention in a variety of settings, including private clinics, public schools, inpatient rehabilitation, outpatient rehabilitation, and a senior nursing facility. Specific areas of interest include early intervention diagnostic and treatment services for children 18-months to 4 years of age.

Jodi has diagnostic and treatment experience in Articulation Disorders, Expressive and Receptive Language Disorders, Fluency Disorders, Voice Disorders, and Autism Spectrum Disorders. She also specializes in performing laryngeal videostroboscopy and providing vocal rehabilitation for individuals diagnosed with voice disorders.

• Master of Arts with Distinction, California State University, Fresno in 2010
  
• Certificate of Clinical Competence, Speech Pathology- American Speech-Language-Hearing Association, 2011
  
• Licensed Speech Pathologist, State of California, Board of Medical Examiners, 2010

Common Questions About Speech and Language Disorders

What are Speech and Language Disorders?

Speech and language disorders affect the way people talk and understand spoken or written language. These disorders may range from simple speech sound substitutions (Speech Disorder) to not being able to understand or produce language (Language Disorder) in a normal manner. Specific types of speech and language disorders are:

Disorders of Speech:

Articulation disorders occur when speech sounds are produced or put together incorrectly or in a way which makes it difficult to understand the spoken word,
Stuttering is an interruption in the rhythm of speech characterized by excessive stopping and/or repeating sounds, words, syllables, words or phrases.
Voice Disorders include inappropriate pitch, quality or loudness, or a loss of voice.

Disorders of Language:

Language Disorders may include difficulty in the comprehension or meaning of words or sentences, difficulty in remaining focused on conversational language, or in learning to express thoughts, learning to place words in the right order, or in the use of appropriate grammar.
Aphasia is the loss of speech and/or language abilities secondary to a stroke or head injury.

What Causes Speech and Language Disorders?

Speech and language disorders can be caused by a variety of factors or a combination of several factors. the most common causes are: hearing loss, brain dysfunction and other nerve or muscle disorders, structural abnormalities, nodules or growths on the vocal cords due to improper use of the voice, laryngectomy, brain damage, head injury, certain drugs, poor role models for speaking and the use of language, and emotional disorders.  Some speech and language disorders may be of unknown origin.

What are the Signs of a Communicative Disorder?

A speech and language disorder may be present if the communicative skills are very different from those of the same age, sex, or ethnic group; when a person is hard to understand; when a person is overly concerned about how they speak or understand communication; or when a person avoids communicating with others. Anyone at any age may have a speech or language problem. The earlier the problem is diagnosed and treatment is begun, he more likely the communicative difficulty may be treated successfully.

What is a Speech/Language Pathologist and How Will They Help?

A Speech/Language Pathologist is a professional educated in the study of human communication, normal and abnormal development, and they many disorders. They are trained to evaluate or diagnose speech and language problems. They provide treatment plans and provide individual or group therapy to correct or modify a variety of communicative difficulties. A speech/language pathologist also counsels individuals and family members to assist with the treatment program. They are often members of a health car team which may include physicians, orthodontists, psychologists, educators, or social workers.

Stuttering: A Communicative Disorder Which Affects Children and Adults

Stuttering is a communicative disorder which is characterized by an interruption in the normal flow of speech. These "breaks" in speech may be a total interruption or "block" in which the air flow is stopped; they may be sound, syllable, word, or phrase repetitions (ssssay, roo roo roo ster, my my my , can I see, can I see, can I see the picture), or prolongations of words or syllables ("sssssay"). Secondary characteristics such as facial grimacing, arm or hand movements or unnecessary body movements may occur at the time of stuttering. The person stuttering often is unaware of these accompanying gestures.

Stuttering most frequently appears in children between the ages of two and six years, will occasionally develop in school age or older children, and is quite uncommon to begin in adulthood. Statistics suggest that about 3-5% of preschool to school age children will exhibit the fluency disorder called stuttering. It is more common for boys to stutter than girls; a ratio of 3 or 4 to 1.

Many children display periods of normal "nonfluency" as they begin to develop speech and language skills. These times are generally short in duration, from a few days to a few weeks, and are characterized by easy interjections such as "um" or "uh." A complete disruption of the speech flow (blocking), the presence of unnecessary facial or body movements at the moment of speech, or the presence of additional stuttering behaviors would be reason for concern. Not all children who stutter continue to do so as adults. In other words, some children recover from stuttering spontaneously.

The dilemma for parents and speech- language pathologists charged with therapeutic intervention is to predict who will spontaneously recover and who will not. Therefore, the prudent choice is to seek the professional advice, consultation, and diagnostic expertise of a speech- language pathologist who has specialized expertise in the area of stuttering. A speech - language pathologist will determine whether treatment is necessary or if a period of watchful waiting with consultation is recommended.

Researchers and clinicians continue to seek the answer to the cause of stuttering. No definitive answer is available at the present time but most experts suggest that stuttering is caused by many factors to include genetic and environmental influences as well as psycho-social-behavioral issues.

While the answer to the cause of stuttering is not available, treatment programs are often successful for children and adults. Early intervention programs are strongly suggested for young children and are often completely successful. Whether stuttering can be cured is debated by clinicians and researchers.

The goal for all treatment is to achieve the most normal flow of speech without the emotional, psychological, or academic / learning consequences of stuttering. An untreated fluency disorder may lead to years of negative feedback from strangers or peers. Adult stutterers often report long-term social and vocational problems which have altered lifestyles dramatically.

The best advice for a concerned parent of a child who is dysfluent is to schedule a consultation with a speech-language pathologist who specializes in the diagnosis and treatment of adults and children who stutter.   Early intervention may prevent the development of stuttering which could otherwise advance into the school years.

Hoarseness

Hoarseness is a non-specific word which indicates that the voice is abnormal. Hoarseness may take several forms, including breathiness, raspiness, strain of the voice, or changes in loudness or the tone of the voice. Such changes that are noted are usually a result of some sort of disorder affecting the vocal folds (cords).  The vocal folds remain apart while breathing as the voice box (larynx) is the gateway into the windpipe. However, when speaking or singing, the vocal folds are brought together, essentially narrowing the air flow, vibrating, and producing sound (voice).  When swelling or some sort of mass occurs on the vocal fold, it prevents the vocal folds from coming together properly, which can cause a change in the voice.

Hoarseness may result as a consequence of several different disorders. In most cases, the causes are not of serious nature and will be of short duration, usually disappearing without any treatment whatsoever. Certainly the most common cause of hoarseness is acute laryngitis, which occurs usually as a result of a virus infection and may be associated with a cold or other respiratory tract infection. Acute laryngitis may also occur as a result of injury, such as excessive vocal use. Prolonged misuse of the voice may result in chronic laryngitis which would be of longer duration.  If hoarseness is prolonged and improper vocal habits are persistent, vocal fold nodules or other pathologies may occur.

One of the most prevalent causes of hoarseness, especially in adults, is Laryngopharyngeal Reflux (LPR). In this condition, stomach acid comes up from the stomach through the esophagus and into the throat, irritating the vocal folds and the larynx. Interestingly enough, many patients who have significant reflux do not have symptoms of heartburn, but may have a feeling of a lump sensation in the throat or a sense of mucus or postnasal drainage. Such irritation leads to excessive throat clearing, which prolongs the irritation and the hoarseness.

Of course, everyone knows that smoking is a major cause of hoarseness. It is also a major factor in the development of throat cancer and if prolonged hoarseness occurs in one who smokes, evaluation should be sought.

There are other causes of hoarseness and among them are those associated with advancing age, hormonal changes, allergies, thyroid problems, nerve disorders, and injury. Most hoarseness does not require treatment and in such cases modified vocal rest is sufficient. However, when hoarseness lasts more than a few weeks, it should be evaluated by a throat specialist. Some hoarseness may be of complex origin and treatment of the hoarseness may require any one of several professionals, including an otolaryngologist, a speech pathologist, or a vocal coach.

It is generally believed that if hoarseness lasts longer than a few weeks or is associated with pain, difficulty swallowing, coughing up of blood, or a lump in the neck, specialist evaluation is imperative.
The diagnosis of the condition which may be resulting in hoarseness is generally accomplished by painless office techniques which allow for visualization of the vocal folds. Specialized analysis, such as laryngeal videostroboscopy, may be necessary in some patients. Central California Ear, Nose and Throat Medical Group is a center where this specialized testing is offered.

Treatment is dependent upon the diagnosis, and in some cases vocal rest or modification of vocal usage is the treatment of choice. If one smokes, discontinuation of smoking is advised. Dehydration should be avoided, and adequate amounts of water should be consumed. Humidification, dietary control (avoiding spicy foods, caffeine and alcohol) and the avoidance of abusive vocal behavior (shouting, screaming, singing, and excessive throat clearing) can be very effective.  In some cases, specific medical or even surgical treatment is necessary.

The otolaryngologist (ear, nose and throat specialist) is the specialist physician specialist most capable of evaluating and treating disorders which result in hoarseness.

Vocal Problems

The importance of human voice cannot be overstated. It is the primary instrument with which we project our personalities and influence others. Professional voice users are continuing to increase in our population. Their need for expert care has inspired new research and interest in understanding the function and dysfunction of the human voice. Professional voice users provide new challenges and responsibilities for the otolaryngologist and related health care professionals.

Professional Voice Care

Laryngeal Videostroboscopy is a high tech method of examining the larynx (voice box) which uses the latest technology to assist the physician and speech pathologist with your medical care. Video equipment, a rapid flashing light source (stroboscope), and endoscope are combined with a computer as the basic tools to perform the examination. A slow motion effect is created by the video examination which is not possible by direct examination with the naked eye. The procedure provides valuable information about the presence or absence of abnormal tissue (pathology), the fine patterns and movements of vocal fold vibration, and the structural characteristics of the larynx. The video recording provides a permanent record of the examination which can be reviewed by the physician and speech pathologist.

The value of videostroboscopy has been clearly established across the past several years. The diagnosis and treatment of voice disorders has been improved significantly through the use of this improved technology. With this more accurate diagnostic tool, the physician is able to recommend needed laryngeal surgery, plan comprehensive medical treatment programs, and refer for vocal rehabilitation therapy.

Laryngeal videostroboscopy is an essential tool in the diagnosis and treatment of voice disorders. Careful examination of the recorded movements of the vocal folds may determine the cause of an abnormal voice, define the severity of the problem, and assist with planning a treatment program. Video recordings before and after medical management or voice treatment programs document changes in movement patterns of the vocal folds. Many patients find that by directly viewing their larynx and vocal folds, videostroboscopy becomes a valuable educational and treatment tool. A greater understanding of the way the voice is produced; the nature and extent of the voice disorder, and how to change laryngeal movement patterns will enhance recovery from surgery and facilitate a voice therapy program.

Who are professional voice users? They are those who use their voice to make a living, including:

• Singers and actors
• Attorneys
• Teachers
• Politicians
• Clergy
• Educators
• Receptionists (telephone/non telephone)
• Insurance agents and brokers
• Salespersons

Voice problems may arise from various local and systemic diseases, trauma, or improper use. Some of the most common causes of voice dysfunction:

• Common cold (upper respiratory tract infection)
• Irritation from excessive voice use (i.e. screaming)
• Smoking
• Allergies
• Acid reflux

Interdisciplinary research has resulted in new technology and understanding of voice dysfunction. The Central California Ear, Nose & Throat Medical Group has developed a state-of-the-art voice lab that uses an interdisciplinary approach to diagnosis and treatment of vocal dysfunction. The interdisciplinary team includes:

• Otolaryngologist
• Speech-Language Pathologist
• Singing Teacher
• Voice Trainer

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