DIsorders of Voice and Swallowing
 | |  | |  | |  | |  | |  |
Professional Voice surgery
Professional singers, actors, and other voice users who rely on their voices for their
livelihood require a higher level of care for their voice problems. When medical treatment
and voice therapy is not sufficient to solve the problem, surgery might be recommended.
These surgeries should only be performed by a laryngologist. Suspension
microlaryngoscopy with microflap technique is the gold standard treatment for a large
number of lesions of the voice box. Polyps, cysts, scar tissue, and sometimes nodules can
be removed under high power magnification. Specialized techniques of microflap
excision minimize surrounding damage to the vocal cords and allow for excellent healing
with return of the normal singing or speaking voice. There are minimal complications
and little discomfort from the surgery. Voice therapy with a specialized speech
pathologist with a classical singing background is essential both before and after surgery
for full recovery with an optimal performing voice.
Professional singers, actors, and other voice users who rely on their voices for their
livelihood require a higher level of care for their voice problems. When medical treatment
and voice therapy is not sufficient to solve the problem, surgery might be recommended.
These surgeries should only be performed by a laryngologist. Suspension
microlaryngoscopy with microflap technique is the gold standard treatment for a large
number of lesions of the voice box. Polyps, cysts, scar tissue, and sometimes nodules can
be removed under high power magnification. Specialized techniques of microflap
excision minimize surrounding damage to the vocal cords and allow for excellent healing
with return of the normal singing or speaking voice. There are minimal complications
and little discomfort from the surgery. Voice therapy with a specialized speech
pathologist with a classical singing background is essential both before and after surgery
for full recovery with an optimal performing voice.
Chronic Cough
Chronic cough can be debilitating, embarrassing, and uncomfortable. People often seek
multiple medical opinions from many different doctors. In the end, the cough continues.
Up to 40-50% of chronic cough (not asthma, sinusitis, or allergy) is due to
Laryngopharyngeal Reflux (LPR) disease or a Vagal Neuropathy. LPR is reflux into the
throat region with chronic cough, voice change, throat clearing, phlegm, lump in the
throat, and throat discomfort with problems swallowing. A Vagal Neuropathy is a cough
that is usually preceded by a tickle sensation, made worse by talking, eating, cold air,
laughing, and often occurs in spasms.
Vocal Fold Paralysis Surgery
People with a paralyzed vocal cord often have a breathy, weak voice; in addition, they
may aspirate - have food or liquid go into the lungs. An outdated way of thinking is to
wait for the nerve to heal. Why have severe hoarsness, shortness of breath, fatigue, and
trouble eating ? Vocal Fold medialization surgery can help to close the voice box,
provide a stronger, more natural voice, and help prevent aspiration. This can be
accomplished by an injection of material into the vocal folds to help push them together
(Injection Laryngoplasty). This injection is either performed in the office under topical
anesthesia, or in the operating room. Another procedure requires a small incision over
the Adam's apple and the placement of a small implant to push the paralyzed vocal fold
toward the midline (Medialization Thyroplasty). Both are short procedures, easily
tolerated, and with great results for improved voice and swallowing ability.
Dysphagia
Difficulty swallowing can occur from many different causes. At the Institute, we have a
full range of diagnostic tools to help identify the cause of the swallowing problem. We
perform office based transnasal esophagoscopy - an alternate way of examining the
esophagus in the office with topical anesthesia and no sedation (no risks of anesthesia, no
down time or missed work, minimal discomfort, and immediate results). In addition, pH
(acid) testing using the Restech system, FEESST (Flexible Endoscopic Evaluation of
Swallowing and Sensory Testing), MBS (Modified Barium Swallow) can all pinpoint the
cause. Our speech pathologists are experts in the treatment of many of these disorders.
They offer advanced therapeutic techniques, electrical stimulation of the swallowing
muscles, and guided swallowing exercises to help return a person's swallow to normal.
We have an abundance of experience with Head and Neck cancer patients who have
undergone surgery or chemoradiation and have subsequent swallowing problems or are
feeding tube dependent.
Chronic cough can be debilitating, embarrassing, and uncomfortable. People often seek
multiple medical opinions from many different doctors. In the end, the cough continues.
Up to 40-50% of chronic cough (not asthma, sinusitis, or allergy) is due to
Laryngopharyngeal Reflux (LPR) disease or a Vagal Neuropathy. LPR is reflux into the
throat region with chronic cough, voice change, throat clearing, phlegm, lump in the
throat, and throat discomfort with problems swallowing. A Vagal Neuropathy is a cough
that is usually preceded by a tickle sensation, made worse by talking, eating, cold air,
laughing, and often occurs in spasms.
Vocal Fold Paralysis Surgery
People with a paralyzed vocal cord often have a breathy, weak voice; in addition, they
may aspirate - have food or liquid go into the lungs. An outdated way of thinking is to
wait for the nerve to heal. Why have severe hoarsness, shortness of breath, fatigue, and
trouble eating ? Vocal Fold medialization surgery can help to close the voice box,
provide a stronger, more natural voice, and help prevent aspiration. This can be
accomplished by an injection of material into the vocal folds to help push them together
(Injection Laryngoplasty). This injection is either performed in the office under topical
anesthesia, or in the operating room. Another procedure requires a small incision over
the Adam's apple and the placement of a small implant to push the paralyzed vocal fold
toward the midline (Medialization Thyroplasty). Both are short procedures, easily
tolerated, and with great results for improved voice and swallowing ability.
Dysphagia
Difficulty swallowing can occur from many different causes. At the Institute, we have a
full range of diagnostic tools to help identify the cause of the swallowing problem. We
perform office based transnasal esophagoscopy - an alternate way of examining the
esophagus in the office with topical anesthesia and no sedation (no risks of anesthesia, no
down time or missed work, minimal discomfort, and immediate results). In addition, pH
(acid) testing using the Restech system, FEESST (Flexible Endoscopic Evaluation of
Swallowing and Sensory Testing), MBS (Modified Barium Swallow) can all pinpoint the
cause. Our speech pathologists are experts in the treatment of many of these disorders.
They offer advanced therapeutic techniques, electrical stimulation of the swallowing
muscles, and guided swallowing exercises to help return a person's swallow to normal.
We have an abundance of experience with Head and Neck cancer patients who have
undergone surgery or chemoradiation and have subsequent swallowing problems or are
feeding tube dependent.
KTP Laser Voice Surgery
The newest technique for curing diseases of the vocal folds and voice box includes the use
of a KTP laser. This technique is offered at the Institute for Voice and Swallowing
Disorders. This laser has an affinity for blood vessels allowing it to target abnormal
blood vessels and blood supply leading to lesions such as vocal fold polyps, papilloma,
dilated blood vessels, precancerous and cancerous conditions. This procedure is
primarily performed in the office under topical anesthesia with little or no recovery time.
Not only does this effectively remove the lesions, it does so with minimal or no
surrounding damage to the vocal folds and thus minimal or no scar formation. The
ultimate result is an improved voice and cure without the need for general anesthesia
The newest technique for curing diseases of the vocal folds and voice box includes the use
of a KTP laser. This technique is offered at the Institute for Voice and Swallowing
Disorders. This laser has an affinity for blood vessels allowing it to target abnormal
blood vessels and blood supply leading to lesions such as vocal fold polyps, papilloma,
dilated blood vessels, precancerous and cancerous conditions. This procedure is
primarily performed in the office under topical anesthesia with little or no recovery time.
Not only does this effectively remove the lesions, it does so with minimal or no
surrounding damage to the vocal folds and thus minimal or no scar formation. The
ultimate result is an improved voice and cure without the need for general anesthesia
| KTP Laser in Office Setting |
| KTP Laser in the OR |
Laryngopharyngeal Reflux Disease (LPR)
LPR. is not GERD. LPR is the reflux of stomach contents into the region of the
laryngopharynx. Although from the stomach, the symptoms, findings, and effects of LPR
are vastly different from GERD. Most people with LPR do not have GERD symptoms. GI
evaluation is often negative in patients with LPR. Unlike GERD, LPR is diagnosed
primarily based on symptoms, physical findings, and response to treatment. The most
commons symptoms are hoarseness, chronic cough, throat clearing, a lump in the throat
feeling, mucus, trouble swallowing, and sour taste, usually in combination. Physical
findings vary and are visualized endoscopically – either with a flexible laryngoscope or
video-stroboscopy (the gold-standard of laryngeal diagnosis). In addition, office-based
Trans-Nasal Esophagoscopy can help with diagnosis and with surveillance for esophageal
cancer and Barrett’s. Some studies have shown an association of esophageal
adenocarcinoma with LPR and a chronic cough or the other symptoms above may be the
only sign.
LPR. is not GERD. LPR is the reflux of stomach contents into the region of the
laryngopharynx. Although from the stomach, the symptoms, findings, and effects of LPR
are vastly different from GERD. Most people with LPR do not have GERD symptoms. GI
evaluation is often negative in patients with LPR. Unlike GERD, LPR is diagnosed
primarily based on symptoms, physical findings, and response to treatment. The most
commons symptoms are hoarseness, chronic cough, throat clearing, a lump in the throat
feeling, mucus, trouble swallowing, and sour taste, usually in combination. Physical
findings vary and are visualized endoscopically – either with a flexible laryngoscope or
video-stroboscopy (the gold-standard of laryngeal diagnosis). In addition, office-based
Trans-Nasal Esophagoscopy can help with diagnosis and with surveillance for esophageal
cancer and Barrett’s. Some studies have shown an association of esophageal
adenocarcinoma with LPR and a chronic cough or the other symptoms above may be the
only sign.