GEORGE NEWS -  This vital organ, located in the throat behind the “Adam's apple”, is essential for breathing and swallowing as well as for the production of voice.

Dilys Jones, George speech-language therapist, writes about the ordeal of George resident, Melanie van der Merwe, who is someone who has first-hand understanding of the importance of the voice box.

In 2015, she underwent surgery to remove her thyroid gland because of a cancerous tumour. The surgery was successful, but the nerves controlling the vocal cords in the larynx were unfortunately damaged. 

As a result, her vocal cords could close to produce some voice, but not open properly to allow good breathing. In the early days after her surgery, she had no voice and battled to swallow. 

This gradually improved but her breathing became increasingly difficult. This culminated in her being admitted to the intensive care unit to be placed on a ventilator for a short time and it was thought that she would need a permanent tracheostomy – a surgical opening of the airway directly from the outside of the neck.

Eventually in 2021 she was referred to a laryngologist (an ENT surgeon specialising in the treatment of voice and larynx disorders) in Johannesburg. There she was offered the option of having part of one of her vocal cords removed in order to create a bigger airway. 

This would improve her breathing, but unfortunately permanently damage her voice. As Melanie says now, she did not really have a choice! She underwent successful surgery at the end of last year, with immediate improvement in her breathing, tolerance of physical activity and quality of life. 

Initially she had difficulty swallowing, but has learned to compensate for this. She also had no voice at all in the beginning, even a whisper, but after much hard work and perseverance she is able to talk again. 

Her voice is soft and hoarse, but after twice experiencing not having any voice, she values it as a precious gift.

People with voice difficulties, like Melanie, often experience negative reactions when trying to communicate - some people become irritated when they cannot speak louder; people tend to want to try and help by offering advice, but in reality, voice disorders may be complicated and difficult conditions to treat and traditional remedies are not effective. 

Because the vocal cords are damaged, the voice can sound monotonous, and this might make people assume that the person is depressed or angry when this is not the case.

Some people even think that a person with a soft voice must be hard of hearing. What is a better way of responding to someone with a voice problem? 

Melanie suggests trying to make the environment easier by switching off music, reducing background noise, maintaining eye contact and concentrating on listening to the person. Also be aware that text messages and emails are a much easier way of communicating for many people with speech and voice disorders.

Although Melanie's breathing, swallowing and voice problems resulted from life-saving surgery, and are, fortunately, a very rare complication, many people experience other problems with the larynx/voice box. Some of these are preventable, such as exposure to irritants like cigarette smoke. 

Many people also abuse their voices by too much shouting and screaming, poor singing technique or habitual throat-clearing and coughing. These activities can cause serious injury to the delicate tissue and muscles of the vocal cords.

Anyone who notices a change in their breathing, swallowing or voice should consult with their clinic or GP so that a referral can be made to an Ear, nose and throat (ENT) specialist if necessary. Once a medical diagnosis has been made, a Speech Therapist can also help with treating voice and swallowing disorders and helping people with vocal abuse to use their voices more effectively.

Melanie van der Merwe with her husband Willie and daughter Emma.

'We bring you the latest George, Garden Route news'