edie hapner, ph.d., ccc-slp
Published on July 16, 2016
Pleased to post an interview with Edie Hapner, Ph.D., CCC-SLP. Along with Dr. Michael Johns, she founded and developed the Emory Voice Center into a world class multidisciplinary voice program. Now Los Angeles is lucky to have her at USC! Please credit The Voice Forum when you share our content. http://www.keckmedicine.org/the-keck-effect-more-volume/ #fellowshipofthelarynx
TVF: Where do you currently practice/teach?
EH: I currently practice at the USC Voice Center
Tina and Rick Caruso Department of Otolaryngology
University of Southern California, Los Angeles
TVF: Where did you complete your education/training in voice?
EH: My undergrad was from University of Missouri-Columbia
My master’s from Fontbonne College (now University)-St. Louis
My PhD from Vanderbilt University-Nashville, TN
TVF: What motivated you to dedicate yourself to the field of voice?
EH: Our voices are a mirror to our souls so working with voice connects you to others in a very deep and personal way whether patients, students, or colleagues.
TVF: What comes to your mind as one of the most pressing issues in voice disorders?
EH: Collaboration and education. There are many myths about voice care that are propagated by those with limited exposure to current voice science and study. These myths impacts the way our patients are cared for and ultimately impact the way physicians, other professionals and the public view voice therapy. Through collaboration and education I believe that we are making in roads into care guided by good clinical judgment and evidence. But, not everyone believes they need to collaborate, nor continue to expand their current knowledge base. This scares me the most right now.
TVF: Do you think this is an international issue or specific to your country?
EH: I suspect it is an international issue given the exchanges I have had with colleagues from outside the US.
TVF: Do you have research interests?
EH: I have two primary areas of research.
One is adherence to voice therapy and what makes people want to make changes to improve the health or vitality of their voices. I have worked for over 10 years with several colleagues, specifically Carissa Maira, to study attendance in voice therapy. It sort of goes without saying that if you don’t attend therapy, it just might be a bit harder to benefit from the treatment. Our work continues and the best news is that we have seen a positive change in attendance and now others are studying how the change impacts outcomes and the financial burden of therapy.
My second area of research interest is in aging voice. The older I get, the more interested I am in the natural changes to one’s voice as we age and the impact of a “ life well lived” on aging voice. I have worked with Aaron Ziegler on an exuberant voice therapy for treating the impact of aging on vocal loudness and vocal endurance called PhoRTE. Aaron recently received the CPRI award from ASHA and we are continuing our inquiry into dosing. How much therapy do you need to make the change?
TVF: Which vocal myth would you like to dispel?
EH: Can I do two??? First I want to say that I am so thankful to work with Dr. Michael Johns for so many years with his keen sense of good and reasonable patient care. Now with Dr. Lindsay Reder and Dr. Karla O'Dell, I am thrilled to be part of team that dispels myth one and myth two. They just get it!
One, reflux is the cause of every voice disorder and you should have 3-6 months of reflux medication as a sole treatment before you are sent for additional tests or voice therapy. I see lots of patients from physicians who have treated everything from nodules to RRP with reflux medication only. Where did this all start?
Two, voice therapy is easy. Voice therapy looks easy but there are lots of calculations going on in the trained therapist’s head as we work with a patient. What to do next given what they just vocally presented? How to act nonchalant when they make sound for the first time in months or years so you can get more and shape it. Leave the therapy up to the therapist.
TVF: Your most memorable voice case?
EH: I think we all want to write about our successes to look good to our colleagues on your FB page but the ones that haunt me are not the success. I saw a lady in 1991 when I was working in a university clinic. She came in with an olive pit between her teeth as she discovered it was the only way to stabilize her jaw. She had seen multiple physicians and had OMF surgery (not a small deal) and still the erratic movements of her jaw continued. Everyone thought she was crazy of course. I missed it too. I did not have the kind of exposures afforded me at Vanderbilt or Emory and now USC at that time. You all know it was most likely a dystonia and I missed it. That one haunts me.
Then there are the (few but still present) primary muscle tension dysphonia patients that don’t get better. I know in my head that it’s more than just the muscle imbalance but it is still hard not to help them get their lives back.
TVF: Do you have a vocal pet peeve?
EH: Before I started preparing for my ASHA panel discussion on vocal fry this year, I would have said that vocal fry bothered me but it actually doesn’t bother me anymore. Maybe the move to Los Angeles made it all the more prevalent for me? I actually understand it is quite an accepted vocal form by millennials. Since it doesn’t cause pathology, voice fatigue maybe but the jury is still out on that one, I am less bothered by it.
I guess if the truth is told, it would be that “ affected” voice. Remember, I think the voice tells us about the person and when it is ramped up and not a true descriptor of the person, I am turned off.
TVF: As a voice pathologist/educator/researcher, what keeps you on your toes?
EH: My students, interns, residents, and fellows keep me on my toes for sure. Goodness, they are so smart, ask amazing questions, and making truly insightful suggestions that often I did not even fathom before they commented. I owe it to them to keep up and to at least be able to point them in the right direction to get their answers.
TVF: You are a dedicate advocate for Head and Neck cancer screening in NASCAR events. (right?) Can you tell us more about that? What symptoms/signs were you looking for during screening?
EH: Chrissy, how much time do you have? Anyone who knows me knows that once I start talking about NASCAR, it’s hard to get me to stop.
For many years I participated in OHNCAW (Oral Head and Neck Cancer Awareness Week) and every year it frustrated me doing our “ screenings” in the mall or the basement of Emory. We were not making an impact at all. My husband said to me after one particularly frustrating year, why don’t you go where the people need you? Go to NASCAR. So we did! Of course it was not that easy but my husband had NASCAR corporate connections and the collaboration blossomed.
From 2006 to 2014 about 112 volunteers each year went with us to Atlanta Motor Speedway to set up a screening tent and provide “ mouth and throat” screenings to about 500 people per weekend. Soon Tennessee and Kentucky joined us. We have screened over 5000 people and our results have been published and presented in several peer reviewed journals and national meetings. We educated the people who attended the screening while we were screening as it may be the only time they ever heard about the signs and symptoms of mouth and throat cancer (the term we use at the screenings so it is less nebulous to the public).
I am hoping to recreate this screening on the west coast. I have people contact me weekly about setting up screenings and I am happy to say that our non-profit group, A VOICE FOR HOPE, has helped many facilities develop community-based screenings.
TVF: What were some of the obstacles?
EH: What are the obstacles? Two primarily:
TVF: What do you think the next steps are in growing the field of laryngology/Vocology?
EH: Figuring this singing voice specialist thing out. Maybe not one person is best for this role? Enough talking, it is time for action. I am lucky enough to have some great connections with the Thornton School of Music at USC and a connection with Lynn Helding, one of our Voice Foundation and PAVA greats. She and I have had wonderful discussions and we are working together to at least figure out something that works for us. Maybe there are several models. But as I said before, collaboration and education are the keys. Without them, we will spend the next 40 years without an answer.
TVF: What advice would you like to give to the general populace about voice care? How about to the professional voice users?
EH: General public- Your voice walks in the room at the same time your appearance walks in. Take as much care of your voice as you do your appearance. We know you have 15 seconds or less to make a good first impression. If your voice needs care, there are people who understand the voice and vocal health. Find the right people to care for your voice. Find a laryngologist, speech pathologist team.
Professional Voice User –Again, find the right people to care for your voice. Go to a Laryngologist and a Speech Pathologist who understand voice. Loop in your voice teacher.
TVF: Who are your favorite singers?
EH: Ok, those who know will expect me to say Steven Tyler. But, people it’s not his voice that makes me say he’s my “boyfriend”. So I had to put that to rest.
Singers-I like singers who speak to my soul
Cantor Steven Weiss (formerly Atlanta now Boston) and Cantor Nancy Kassell of Atlanta
TVF: What sparks “joy” for you as a person?
EH: My family.
I have the most amazing husband in the world and anyone who knows him will agree.
My two adult daughters. I am constantly amazed by their accomplishments.
My 5 dogs bring me incredible joy and love.
Being at the Moose (our cabin in the mountains of Georgia) brings we peace and joy.
My time with so many of our colleagues who energize me every time we are together. These friendships are so deep and I am so lucky to learn and laugh with them often.