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Helping patients find their voice

BUSINESS PROFILE: St. Cloud ENT - Speech Language Pathology

Speech Language Pathologist at St. Cloud ENT specializes in voice and swallowing issues

By Jim Palmer

Speaking and swallowing are two important everyday functions that most people are lucky not to give much thought to. But when one of these functions isn’t working properly, it can be truly life-altering.

Kari Krein, M.S., CCC-SLP, a Speech-Language Pathologist (SLP) at St. Cloud ENT, specializes in evaluating, diagnosing, treating, and educating patients with voice and swallowing ailments. Krein joined the St. Cloud ENT team about three years ago, bringing 20 years of experience. She previously served at the Mayo Clinic in both Rochester, Minnesota, and Scottsdale, Arizona.

Kari Krein (left), MS, a Speech Language Pathologist at St. Cloud ENT, along with Eileen Dauer, MD, show a patient an image of her larynx during an exam. Contributed photo

Speech & Voice

Many of Krein’s cases revolve around vocal strain or hoarseness, symptoms that can be mild irritants or can have a major impact on a person’s day-to-day life.

“Our voice is a huge part of our personality, and frequently, people are bothered if their voice changes,” she said. “If a person’s voice changes, people often ask them to repeat themselves. Or they ask them if they have a cold. It ends up making people feel uncomfortable because they receive too much attention. The big thing is they just don’t feel like themselves.”

And depending on the person’s occupation, voice changes can have a huge effect on their career and fulfilling certain work requirements.

“If a patient is a singer or performer, or someone who needs a strong, healthy voice for their job, a change in their voice can be a big issue,” said Krein.

One common symptom is hoarseness, and there are a variety of reasons why a person’s voice will become hoarse over time.

“It could be voice overuse or voice misuse,” she said. “It could be yelling too much, or it can even be just talking a lot. We see customer service reps who are on the phone eight or nine hours a day who are getting muscle strain, hoarseness, or voice fatigue.”

Krein said that hoarseness is normal for those who are working their way through a virus or acute illness, but if that hoarseness continues, they should get it checked out.

“It could be benign—vocal overuse or strain—that can be treated with voice therapy. There could be acid reflux involved. It could be caused by structural damage, like polyps, nodules or cysts on the vocal cords, which may require surgery. Alternatively, symptoms can stem from something cancerous, like a mass or tumor on the vocal cords, which requires further medical treatment. Hoarseness can also be caused by something like weakness of the vocal cords.”

Kari Krein, MS, CCC-SLP, has been at St. Cloud for about three years. She specializes in diagnosing and treating voice and swallowing ailments. Contributed photo

Krein said identifying the reason for the voice change is the first step. Once the cause is determined, treatment methods are discussed and implemented. One of those treatments can be voice therapy.

“The goal of voice therapy is to change or alter behaviors that caused the change in the first place,” said Krein. “We want the patient to change habits. For example, that might include drinking more water and drinking less caffeine to try to reduce or stop habitual throat clearing.”

There are also different voice exercises that can be used to treat the symptoms.

“We work on relaxed voice use techniques to try to get the respiratory and phonatory systems in a better balance. We want to get the most effective voice with the least amount of effort,” she said. “The exercises are designed to get the whole system working as efficiently as it can.”

One of the most common goals for patients is to improve the environment of the larynx.

“We want the environment that your vocal folds live in to be as healthy and as free of irritants as possible,” she said. “If you are not drinking enough water and are drinking too much caffeine, that impacts the larynx environment. Of course, smoking affects that environment, so quitting smoking will also help. And if you have asthma and use an inhaler, that also can cause stress on the larynx. All these things can make your throat feel dry and irritated and lead to habitual throat clearing and other issues.”

Another factor that can cause problems is acid reflux.

“A large number of the population has acid reflux and are not symptomatic,” she said. “They do not show signs of heartburn or indigestion. When examining a patient, we can clearly see that something is irritating the tissue. And it is often times acid reflux causing the irritation.”

Krein added that treatment is available for acid reflux, and if left untreated, acid reflux can cause damage to the esophagus, resulting in inflamed tissue on the larynx.

Kari Krein points at an image of a larynx on the wall at her office at St. Cloud ENT. One of the important first steps in treating an irritated throat is to improve the environment around the larynx. This may include drinking more water, reducing the caffeine intake, or quitting smoking. Photo by Jim Palmer


Swallowing issues can also appear for a variety of reasons.

“It may be caused by weak muscles after a stroke or some other neurological diagnosis,” she said. “Once identified, we’d work with the patient on exercises to rehabilitate the swallowing function. If it is a progressive neurological diagnosis like ALS that isn’t going to recover or improve, then we focus on compensatory swallowing strategies to keep the patient safe and efficient with their oral intake. This may include positional strategies to use when swallowing. These strategies are designed to better protect the airway.”

If those treatments are not possible or not effective, then the patient might need something extra like a feeding tube, said Krein.

“Cancer patients are a big part of my patient cases,” she said. “For cancer patients, we focus on strengthening and compensatory strategies. We continue to check and recheck an advanced diet as they go through cancer treatment.”


“Normal voice and swallowing isn’t always the end goal,” said Krein. “Patients don’t always have that ability. But educating the patient and family on the mechanism of how it works—and why their voice or swallowing is functioning the way it is—really gives them a better understanding and acceptance of where they are at. Then we can progress from there and determine what kind of progress can be made.”

Sometimes that means completely fixing the problem, and sometimes that means improving the situation.

“The goal isn’t always getting back to normal,” she said, adding that education and understanding go a long way. “When I explain to someone why they have been having these issues for so long, they often have an ‘aha moment’ when they learn how things work and why this has been happening to them.”

When a patient shows great improvement or is able to get back to normal, it is a great feeling for both the patient and Krein.

“It is really rewarding,” she said. “The hardest part is that it doesn’t happen instantaneously. It takes some time, so you don’t get that instant gratification. But it is definitely rewarding when you can get someone recovered or when you are able to alter their behaviors so that they have their own voice back—or a significantly improved voice—so they feel more comfortable participating in their social life again.”

Krein encourages those who have been struggling with their voice or their ability to swallow to see an SLP or ENT provider.

To schedule an appointment with Kari Krein at St. Cloud ENT, call 320-252-0233. You can also visit their website at or like them on Facebook. St. Cloud ENT is located at 1528 Northway Drive in St. Cloud.

This is a paid business profile. If you would like to learn more about promoting your business in the Sr. Perspective with a business profile, call Jim at 320-334-3344.

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