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The Nottingham Voice Disorders Service
According to a survey conducted by the British Voice Association in 2004, there are more than 96 voice clinics in the UK, although as yet no prescribed standards regarding assessment or examination protocols. The BVA is now striving to achieve national voice clinic standards to ensure equity of service, with this year's annual Voice Clinic Forum being hosted by the Derby Voice Clinic Team on November 24th.
In Nottingham, the well-established joint Voice Clinic – now celebrating its 10th anniversary – is part of a broader Voice Disorders Service encompassing a number of specialist diagnostic and treatment clinics. Team members are leading UK Laryngologist Julian McGlashan, and Specialist Voice Therapy SLT team – Fiona Robinson, Suzanne Slade and Katherine Behenna. This service is also one of the very few nationally to benefit from close working relationships with local singing teachers – specialists Lynne Wayman and Jane McDouall attend clinics on a consultative basis, and contribute to training.
The team continues to run a busy weekly Joint Voice Clinic. Traditionally, new patients, particularly professional voice users such as elite singers and actors as well as teachers, lawyers, and call-centre workers, were triaged by letter to the clinic. Under the new 'Choose and Book' system, 40% of new referrals to the voice clinic are booked directly by GPs, with the remainder triaged by letter by non-voice clinic personnel. Approximately 12% of patients seen in this clinic are tertiary referrals from other centres, both regionally and nationally, requesting a second opinion. Complex cases requiring review are also brought back for joint consultation. Each patient undergoes rigorous assessment, ELG/acoustic analysis and laryngostroboscopic examination. Patients may be offered further specialist diagnostic services such as a 24-hour pH with impedance study to assess for episodes of laryngo-pharyngeal reflux, or laryngeal EMG in the 6-weekly neurolaryngology clinic run by Julian McGlashan.
In addition, the voice therapy team also run an autonomous weekly SLT led endoscopy clinic using both rigid and flexible scopes to review laryngeal status and trial therapy manoeuvres. Audited clinical benefits have been improved diagnostic and therapeutic outcomes, reduced waiting times and increased patient insight and motivation through the use of biofeedback.
Voice disordered patients in Nottingham benefit from a range of specialist treatment services. We are fortunate to have a Consultant Clinical Psychologist with a special interest in voice problems, and members of the voice therapy team each take a clinical lead in different areas of specialism, such as professional voice, transgender voice, and vocal fold paralysis.
Professional voice users in Nottingham also benefit from the programme of 'Professional voice users' workshops' run by the voice therapy team – interactive group sessions which focus on advanced voice development and projection skills required in the classroom or for performance.
In collaboration with the BVA, the Nottingham team host the annual 'Nottingham Voice Days' - a national training course providing a forum for UK voice practitioners to discuss voice clinic assessment methods and current best practice.
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