This Cleveland Doctor Makes a Living by Giving People Their Voices Back

Dr. Nelson at work Credit: Courtesy Photo

Dr. Rebecca Nelson still hasn’t received the call from a singer who lost their voice touring through Cleveland, but she’s not waiting around for that. Her passion has been helping normal Clevelanders find their voice — like Mark, father of four, teacher, and grade-school basketball coach.

If it weren’t obvious enough, he’s basically always talking (or yelling). When Dr. Nelson first met him, he was losing his voice by the end of the school day, making basketball practice and home life a practice of patience for him. The first thing he said to her with his weak and raspy voice was, “I have basketball playoffs in a couple months, and I’m going to need my voice back by then.”

The vocal cords consist of two vibrating ligaments — suspended in the windpipe — so special in their composition that no prosthetic to date can mimic them. Dr. Nelson explains this material as “like the silver skin of a tenderloin,” atop which sits a jelly-like material that vibrates, generating the quality of someone’s voice. Surrounding these cords is a piece of cartilage called the larynx. (The Adam’s apple, and yes, women also have Adam’s apples.)

It is here, through the nose and down the throat, where Dr. Nelson, using her laryngoscope, looked right at Mark’s vocal cords and found a polyp sitting on the left chord. It could have been many things causing his waning voice, like damage to the nerve that supplies the vocal chord muscles, inflammation and swelling of the chords, nodules, or cancer. Instead, this polyp was weakening Mark’s voice.

Dr. Nelson is accustomed to bizarre pathologies in the larynx. Just this year she performed a surgery to repair a voice box that split in half…because the guy sneezed. Now he has a metal plate for an Adam’s apple. Even still, Dr. Nelson holds her sneezes in but jokes, “maybe I won’t anymore.”

Dr. Nelson also reconstructs tracheas in people who have a tracheostomy (the hole created in the neck going directly into the lungs), which steals someone’s voice from them. The air that usually would travel past the vocal cords instead is redirected in and out of that hole. And when Dr. Nelson reconstructs the trachea, the air is sent where it naturally ought to go, over the vocal cords, returning people’s voices in oftentimes emotional moments in clinic. Other injections that she performs can return a voice back to someone in the office immediately. “These are very satisfying,” she says.

While Mark may not have had the sneeze of death, or complications from an intubation necessitating a tracheostomy, Dr. Nelson helped quell Mark and his wife’s concerns. He will get his voice back. In fact, she’s never not given someone their voice back who lost it and came to see her.

But what caused the polyp? Dr. Nelson works with voice therapists, akin to physical therapists working on sports injuries. These therapists are specialists on the sophisticated coordination and complications of producing the voice. Oftentimes, voice rest and voice therapy is what the doctor orders. Like the concerned actors she sees from Playhouse Square, or the local musicians trying to optimize their voice care, her multidisciplinary team provides what most people with weakened voices need. “I couldn’t do my job without them,” Dr. Nelson said reflecting on importance of voice therapy.

For Mark’s floppy polyp, she planned to snip it and inject a steroid to decrease inflammation in the chord. It all went well, and when the polyp was analyzed under a microscope, the culprit was clear, “He got it from all of the voice strain he was doing,” said Dr. Nelson.

After the surgery, she met Mark and his wife in her office. She sent him to voice therapy, and gave a quick orientation of what was to follow: a period of silence for him. The directions were clear: “No whispering, no humming, nothing comes out of your mouth for four days. It’s very difficult for parents with young children,” noted Dr. Nelson. Of course, plenty of patient’s partners are tempted to seize this opportunity and slip Dr. Nelson some cash in exchange for longer periods of mandated voice rest, always making for a good laugh.

After his bout of silence, breaking directions only once to reprimand one of his kids, he spoke for the first time after surgery in the doctor’s office.

“He was really happy [with the result],” said Dr. Nelson. He had a newfound respect for being quieter and he was given a voice amplifier (a small microphone and speaker attached to his hip) to use in class for the following weeks. He also invested in a megaphone for basketball practice and is well on his way to coaching his team in the upcoming tournament.

The randomness in medicine and disease means that people who don’t seem to depend on their voice as much as Adele do in fact need a local voice doctor. The way Dr. Nelson sees it, everyone’s voice matters.

Dr. Corey Meador is a practicing family medicine physician in Cleveland who has written for PBS NewsHour and The Washington Post. He obtained degrees from Loyola Marymount University School of Film & Television in Los Angeles and Drexel University College of Medicine.

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