Voice, Airway and Swallowing Disorders
Voice disorder symptoms can seem mild at first and often progress to more severe problems. Early diagnosis can ensure effective treatment, so if you experience any of the following problems, consult your otolaryngologist or contact us at Our Lady of the Lake Voice Center:
- Voice loss
- Vocal fatigue
- Constant clearing of throat
- Pitch problems
- Loss of vocal range
- Voice breaks
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- Atypical, unresponsive asthma
- Difficulty with tracheostomy
- Loud Breathing
- Persistent cough
- Shortness of breathing
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- Choking on food or liquids
- Food sticking
- Regurgitation of undigested food
- Sore throat or lump in the throat
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These problems are often signs of other medical complications, and we often consult with specialists in gastroenterology, internal medicine, neurology, pulmonology, and other disciplines, as well as singing teachers and voice coaches.
Treatment and Services:
Office laryngoscopy – After your team discusses what your symptoms are, they will need to examine your voice box, or larynx, in order to better counsel you. This is most traditionally done using a mirror which reflects light over your tongue and onto your voice box. However, in order to achieve a better level of detail, your team will often use state of the art endoscopes that are either passed through your nose or mouth to look around the tongue and down onto the voice box. This is done without sedation but rather with either local anesthesia (numbing spray) or without any anesthesia at all. The examination takes a couple of minutes and is generally very well tolerated.
Laryngoscopy with Stroboscopy
For patients with lesions of the vocal folds or voice disorders, it is often necessary to assess the vibration of the vocal folds. This is difficult because the vocal folds vibrate over 100 times per second and the human eye can only see 5 images in a second. For this reason, your team may use a technique called stroboscopy in which a microphone detects the pitch of your voice and uses it to calculate how fast your vocal folds are vibrating. This triggers a strobe light to pulse just off of the vocal fold vibratory frequency, creating a series of still shots of the vocal folds at various stages of the vibratory cycle.
Here at the OLOL Voice Center, we are currently researching the utility of a high-speed camera that allows the examination of the vocal folds in slowed real-time, but this is still experimental l only.
In-Office Bronchoscopy and Tracheoscopy – For patients with airway disorders requiring evaluation of the upper airway (trachea, bronchi), this procedure may be used. In this procedure, the nose is anesthetized as is the voice box. A long, slender endoscope is passed through the nose to look at the voice box. When the voice box is numb, the scope is passed into the upper airway for video evaluation. If necessary, interventions such as dilation or laser procedures may be performed at that time.
In-Office Vocal Fold Injection
Vocal fold injection is performed in order to give bulk to a paralyzed, weak, or bowed vocal fold. In this procedure, the patient’s nasal cavity is numbed using sprays. Local anesthetic is injected into the skin over the thyroid cartilage (Adam’s Apple). A scope is then placed through the patient’s nose in order to visualize the voice box. The Laryngologist will then pass a needle with the injectable through the voice box cartilage or around it into the vocal fold. This will be seen on the scope. Then, under visualization, the filler is injected into the vocal fold.
In-Office Laser Procedures
Some lesions of the vocal folds respond well to laser treatment alone. For these people, it is sometimes possible to treat them using a laser in the office without requiring a trip to the operating room. In these procedures, local anesthetic is used to numb the voice box and the nasal passage. A scope is then placed through the nose to visualize the voice box. A laser fiber is then passed through a channel within the scope. Then, using the scope for visualization, the Laryngologist can use the laser to ablate (destroy) a lesion, or, in some cases, to debulk it.
EMG-Guided Botulinum Injections
Botox, or botulinum, is a drug that blocks the connection between nerves and muscles. When injected into a muscle, it serves to weaken the contraction of the muscle. This can be useful in some voice conditions in which the muscles of the vocal folds spasm out of control, most notably spasmodic dysphonia.
This procedure is performed in the clinic. The skin over the patient’s neck is numbed using lidocaine. EMG pads are applied to the patient. An EMG-needle with the Botox in a syringe is then passed into the vocal folds through the skin of the neck. The EMG confirms placement of the needle and the Botox is injected.
Direct microlaryngoscopy is the mainstay of laryngeal surgery. This is performed in the operating room under general anesthesia. A tool called a laryngoscope is placed through the mouth and used to visualize the larynx. A microscope is then used to examine the vocal folds through the laryngoscope. In this setting, the Laryngologist has maximal stabilization and visualization in order to examine the vocal folds, resect lesions, or inject fillers as needed.
Trans-Nasal Esophagoscopy (TNE) – For patients with swallowing disorders requiring evaluation of the esophagus, TNE may be used. This procedure, performed in the office without sedation, uses a long, slender endoscope to evaluate the length of the esophagus into the stomach. The scope is passed through the nose after numbing medicine is applied to the nose. The exam takes a couple of minutes and is generally very well tolerated.
Trans-Oral Laser Microsurgery
Trans-oral laser microsurgery, or TLM, is a minimally invasive technique used to resect laryngeal cancers. This is performed in the operating room with the patient under general anesthesia. A tool called a laryngoscope is placed through the mouth and used to visualize the larynx. A microscope which has a special laser attachment is then used to examine the vocal folds through the laryngoscope. The Laryngologist will then use the laser and a set of specialized laryngeal instruments to resect the tumor from the voice box.
Endoscopic Zenker’s Diverticulotomy
For certain patients with Zenker’s Diverticulum, a minimally invasive procedure through the mouth can eliminate symptoms. This minimally invasive technique, also known as an Endoscopic Zenker’s Diverticulotomy, is performed in the operating room under general anesthesia. A special scope is placed through the mouth and used to visualize the diverticulum, the esophagus, and the wall diving the two. This wall is then divided using either a stapler or a laser. This prevents food from getting stuck in the pouch and alleviates symptoms of things getting stuck or regurgitated.
It is important to note that not all patients are candidates for this depending on the size of their pouch and their personal anatomy. While this procedure is relatively safe, it does have some risks including trauma to the teeth, mouth or tongue and, very rarely (<5%) perforation or leak in which contents from the esophagus leak out into the chest.
This is a procedure performed in the operating room with the patient under sedation but not general anesthesia. It can be performed for unilateral vocal fold paralysis or vocal fold atrophy. In this procedure, an incision is made in the skin of the neck and the thyroid cartilage (Adam’s apple) is exposed. The Laryngologist will then make a small hole in the cartilage and place an implant through the hole to push the vocal fold over.
This surgery is generally reserved for patients who have had paralysis for over one year, indicating that they will not have a spontaneous return of function or for patients who did not get sufficient improvement with injection.