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 TNE – an alternate way of examining the esophagus in the office with topical anesthesia and no sedation (no risks of anesthesia, no downtime or missed work, minimal discomfort, and immediate results). In addition, pH (acid) testing using the Restech system, FEES (Flexible Endoscopic Evaluation of Swallowing), MBS (Modified Barium Swallow) can all pinpoint the cause. Medical and Surgical treatments exist for many swallowing problems. Many of these techniques have been introduced to this region by Dr. Zalvan. 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.
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 An outdated way of thinking is to wait for the nerve to heal.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 hoarseness, 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.
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 Neurogenic Cough Disorder. 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 Neurogenic Cough is a cough that is usually preceded by a tickle sensation, made worse by talking, eating, cold air, laughing, and often occurs in spasms. Dr. Zalvan is currently involved in numerous research projects exploring the cause and treatments of this cause of cough. He is the regional expert in sensory-related cough neuropathies and has spoken internationally on this sometimes difficult topic.
The newest technique for curing diseases of the vocal folds and voice box includes the use of a KTP laser. Dr. Zalvan, who lectures nationally and internationally on this topic offers this technique 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 resolution of 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
LPR – Laryngopharyngeal Reflux – is not GERD. LPR is the reflux of stomach contents into the region of the laryngopharynx. 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. Recent research demonstrates our DIET based approach works as
well, if not better than PPI (proton pump inhibitors like Prilosec). We are now working
with patients to STOP their many years of PPI use
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. Dr. Zalvan has extensive experience with our region’s singers: theater groups, conservatories, and chorus both on a local and national level. From amateurs to professionals, children and adults, proper diagnosis is key to an excellent outcome. 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 the majority of these benign 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.
Monsoon Jet Ventilation system – We are the only center in the region to use this technology. Jet ventilation allows for general anesthesia without the need for a breathing tube. A catheter, 1/10 in size is inserted under direct vision. This minimizes potential damage singers. There is less postoperative discomfort and better visualization during surgery.
SINGERS – TIPS to SING by before SURGERY: Make sure your surgeon is a LARYNGOLOGIST (either by fellowship training or senior with more than 75% of the practice devoted to the care of the professional voice). Ensure the anesthesiologist has extensive experience with singers, uses a small tube if one is used, has other options (LMA, jet, apneic), and understands the importance of the vocal folds and supporting structures. I HIGHLY recommend surgery with the use of the Monsoon Jet System.