You might call the Voice Institute of West Texas a case of “If you build it, they will come”—even if they have to come to Abilene. What else could explain the success of a clinic that treats afflictions like spasmodic dysphonia and mutational falsetto and does it out there in what locals call Big Country but the rest of us call the middle of nowhere? “No question about it, we’re much better known in Europe than we are here in Texas,” says Austin King, an otolaryngologist and a head and neck surgeon who is one of the institute’s founders. “In fact, it’s kind of funny. When I’m at a voice conference in, say, Stockholm to deliver a research paper, the program will say, ‘So-and-so, Berlin. So-and-so, Paris.’ And then, ‘Austin King— Abilene!’”
The institute, the state’s first voice disorder clinic, was founded in 1985 on the campus of Abilene Christian University by King and his two partners, ACU speech-language pathology professor Jon Ashby and classical singer and voice instructor Charles Nelson (who also happens to be the younger brother of golfing legend Byron Nelson and was then the university’s artist-in-residence). On a recent Wednesday afternoon, eight patients are scheduled to be seen in the modest suite of offices. While the sky outside turns greenish with a spring thunderstorm, the three partners try to explain to a middle-aged woman that the reason her voice sounds like a marble rattling around in a garbage disposal is because she has a paralyzed vocal cord.
“What?” she croaks incredulously.
“You have a paralyzed vocal cord,” repeats King, a slender 51-year-old with a soft, reassuring voice. He consults the image of her vocal cords that was transmitted to a TV screen by the tiny fiber-optic cable, or laryngoscope, that he had threaded through one of her nostrils and down the back of her throat. “For some reason, the nerve that powers that cord is not firing.”
The clinic is open only one afternoon a week, and the three partners treat uninsured patients for free (the institute is supported by grants from two West Texas foundations). “You have to understand,” says King. “This wasn’t about money or work. The voice was a real passion.” In a specialty where patients are routinely shuffled from ear-nose-throat (ENT) doctors to allergists to speech pathologists and back again, the clinic offers one-stop shopping: All three partners participate in every diagnosis and treatment plan. There are young singers with nodules, cysts, or polyps on their overworked vocal cords and people whose voices are breathy, squeaky, or choked for causes that are sometimes unknown.
“The voice is probably the most abused and neglected organ in the body,” says King. The vocal cords (also called vocal folds) are part of the larynx, a mass of muscle and cartilage that sits atop the trachea (or windpipe) in the throat and serves both as the vital door between the mouth and the lungs and as the initiating instrument of human speech. Sound is generated by the larynx when air is forced up through the closed vocal cords, causing them to vibrate as the air pushes them open. This vibration is commonly thought to be like that of a plucked guitar string but is actually a more complex movement, a kind of coordinated undulation involving all three layers of tissue that make up the cords: the underlying muscle; the lamina propria, which covers it; and the epithelium, or outer skin. The monotonic hum produced by this wave is then further amplified and articulated by reverberating off the walls of the pharynx (the throat) and then the tongue, the hard and soft palates, the teeth, and finally the walls of the nasal sinuses to produce the actual voice, which is as distinctive in each person as his or her fingerprint.
Most people can live their entire lives and have no vocal problems worse than a case of laryngitis. But about 6 percent of the population suffers from more-chronic and debilitating pathologies of the voice. It was this largely ignored patient population that intrigued King as early as his ENT residency at Houston’s Baylor College of Medicine in the late seventies. An opera buff, he had always been interested in the workings of the trained singing voice—an interest that was further encouraged by the work of a favorite professor, Van Lawrence, a fellow opera lover who treated Houston Grand Opera singers and was a pioneer in the use of fiber-optic technology to provide diagnostic images of the throat. While serving a residency rotation at the Houston VA hospital, King was reminded of just how indispensable the voice is. “Here you had these proud war veterans who didn’t have much left of their manhood but the ability to talk about it,” he remembers. “And they’d come down with cancer of the larynx and we had to take the whole thing out. They just changed overnight when they couldn’t speak. It was like castrating them.”
So when he finished his education and returned to his hometown of Abilene to hang out his shingle, he planned to pursue the study and treatment of the voice. Abilene being something of a small town then, he soon bumped into Nelson and Ashby, who shared his enthusiasm for the subject. The three began getting together informally to exchange research and discuss their pet theories, and soon enough they found themselves opening the voice-disorder clinic.
Though there were plenty of otolaryngologists around the state who treated voice and ear problems, there wasn’t a clinic dedicated solely to the voice, not to mention one staffed by three experts who could cover the gamut of vocal dysfunction. “Oddly, the vocal cords are the last thing a lot of people—including doctors—think of when someone starts speaking abnormally,” says King. “They think allergies or viral infection. And even if a voice disorder is recognized, there’s the widespread feeling that nothing can—or should—be done about it. You’re supposed to live with it. We felt some people were suffering unnecessarily.”