Published on November 28, 2018
With much gratitude on this Thanksgiving day, I am reposting an interview with Dr. Joseph Stemple who taught me how to be an empathetic clinician, not a technician. He has contributed immensely to the field of voice pathology as a kind, patient and generous teacher, clinician, leader and scientist.
#fellowshipofthelarynx #voicetherapy #vocalfunctionexercises #physiologicalvoicetherapy
Dr. Stemple joined the faculty in the UK Division of Communication Sciences and Disorders in 2005 following a 30-year clinical career as founder and director of the Blaine Block Institute for Voice Analysis and Rehabilitation, Dayton, OH, and the Professional Voice Center of Greater Cincinnati. Dr. Stemple is the author of the texts Voice Therapy: Clinical Studies (4th ed) and Clinical Voice Pathology: Theory and Management (5th ed) (Plural Publishing, Inc, 2014) as well as research articles and text chapters related to clinical voice disorders. Dr. Stemple is an active national and international speaker and lecturer on topics related to evaluation and management of voice disorders. He is a Fellow of the American Speech-Language-Hearing Association.
TVF: Dr. Stemple, where do you currently practice/teach?
JS: I currently teach and do research in the Division of Communication Sciences and Disorders, Department of Rehabilitation Sciences, College of Health Sciences at the University of Kentucky.
TVF: Where did you complete your Ph.D.?
JS: I received my Ph.D. from the Department of Communication Sciences and Disorders, University of Cincinnati. My CFY was completed at the University of Cincinnati Medical Center in the Department of Otolaryngology where I was supervised by Robert Peppard in the Head and Neck Cancer clinic.
TVF: How/why did you come to choose voice pathology?
JS: I was active in music and theater throughout high school and college and saw speech-language pathology as a profession where I could meld a passion with a profession. I specialized in voice disorders before it was a specialty. It was a great choice.
TVF: What comes to your mind as one of the most pressing issues in contemporary voice disorders?
JS: One of the most pressing issues in contemporary voice disorders is the need to improve the quality of patient care across all settings. The most consistently high level of care appears to be given in interdisciplinary settings where laryngologists and speech-language pathologists closely collaborate in patient care. However, many generalists in both otolaryngology and speech-language pathology also treat voice disorders individually. While there are many fine practitioners in independent settings, some lack the specialized skills necessary to provide the highest level of care. As otolaryngology has developed Fellow-trained laryngologists, I believe that we have reached the point where specialty recognition in voice disorders should be considered in speech-language pathology.
TVF: What is/are your research interest(s)?
JS: I am most interested in understanding the aging voice. Why do some older individuals develop presbyphonia while others do not? We still don’t have a good knowledge of the actual prevalence, risk factors, and consequences of voice disorders in this population. What are the most appropriate treatments for presbyphonia? Using an animal model, we are also trying to determine the effects of vocal exercise on aging laryngeal muscles.
TVF: In your opinion, what poses the greatest challenge in care of voice disorders?
JS: I believe that there are actually many more individuals that suffer with voice disorders than actually seek treatment. Most of our prevalence data comes from treatment seeking individuals, which, of course, omits those who do not seek treatment. Many individuals seen in clinical practice indicate that they were not aware that voice could be improved through therapy. This begs the question, how many do not seek treatment? An extension of this issue is related to retaining individuals in therapy to the completion of treatment. We need to get a better understanding of the reasons for the high level of no-shows and dropouts.
Also, I believe that another great challenge to the advancement of patient care is the lack of available research support in our field. We have many talented researchers who want to study important aspects of our field and, as with most disciplines, a lack of funding limits the advancements that I believe we could be making. A commitment to enhanced funding would be refreshing.
TVF: What is your vocal pet peeve?
JS: Besides glottal fry? When I was growing up in this field 40 years ago, puzzling diagnoses were almost always attributed to postnasal drip. Yesterday’s postnasal drip is today’s laryngeal pharyngeal reflux. Enough already!
TVF: Which vocal myth would you like to dispel?
JS: That serious vocal professionals should avoid all caffeine.
TVF: Your most memorable voice case?
JS: My most memorable case actually came after I left my clinical practice in Ohio and started teaching in Kentucky. The case demonstrates the love of a mother and the commitment to her child. I was consulting with the UK ENT Clinic and was asked to see an 11-year-old girl who had been without voice for two years following hospitalization for a severe asthma exacerbation. She had previously been seen by two general otolaryngologists and two SLPs in a different city and diagnosed with functional aphonia. Therapy had not proven successful and she was referred to a psychologist without improvement. The mother was given my name as a possible referral, but since I had moved to Lexington, she did not follow through. After her daughter had been aphonic for 18 months, the mother called UK ENT Clinic for an appointment, but was told that her insurance would not cover evaluation and treatment in Kentucky. Six months later, I received the consult and confirmed the functional nature of the voice disorder. Therapy was successful in returning the voice. The remarkable part of the story, and most memorable, was the extent to which the mother went to receive services. In the six months between the mother’s initial contact with UK ENT and the time of the consult, she had moved her family of three children to Lexington and secured a job at the University of Kentucky to make sure that her daughter could receive the covered services. My wish was that she had just contacted me directly….
TVF: As a pedagogue, what keeps you on your toes?
JS: My students who are often much more intelligent than I.
TVF: In your opinion, what are some of the challenges in care of voice disorders?
JS: Affordability. While ACA has expanded coverage to more individuals, coverage for voice services remains problematic and copays and deductibles are often difficult for individuals who require voice care to manage. Another challenge is making sure that the service delivery is of consistent high quality across clinicians and settings. This is true for all discipline providers of voice care.
TVF: What do you think the next steps are in growing the field of voice pathology?
JS: I believe that the next step in voice care may be to more intentionally customize voice therapy. We know that individuals compensate for the same pathology in individual ways. Should we not personalize/customize care based on the compensations?
TVF: What is your advice in mentoring future voice pathologists?
JS: First and foremost, invest in your patients. Don’t just listen to them, but actually hear them. You are not treating a disorder or a pathology, you are treating a person. SLPs have the unique opportunity to be the one healthcare provider who has the time and expertise to really invest in the care of the entire person. Second, voice care should be a team sport with the SLP, laryngologist, and patient. The best care is provided by this model.
TVF: What advice would you like to give to the general populace about voice care? How about to the professional voice users?
JS: There is a continued need to make people aware that they need not just “live” with a voice problem. We have not educated the population to be aware of the rehabilitation available through voice care teams.
TVF: Who are your favorite singers?
JS: Josh Groban and Michael W. Smith seem to be the ones that top my personal playlist.
TVF: What sparks “joy” for you as a person?
JS: Beautiful sunrises and sunsets, bodies of water, and my wife Terri.