Diagnostics and Treatments
Most voice, swallowing and cough problems are multifactorial. They are symptoms of underlying conditions. These conditions may include trauma, pathologies, misuse patterns, neurologic conditions, and/or emotional responses. Discovering these contributors and how they interact is the basis of our diagnostic approach. Imaging technologies such as endoscopy, stroboscopy, videofluoroscopy, and Flexible Endoscopic Evaluation of Swallow (FEES) allow us to visualize tissues and their movements. Laryngeal EMG helps us determine the innervations to various muscles used in voicing and swallowing, and various acoustic analyses quantify the characteristics of the voice and speech that are produced by those muscles and tissues. But nothing is more important than what you say about your difficulties with voice, speech, swallowing or coughing. The insights you give us and the detailed history of your problem usually provides crucial information that helps us work with you to create a treatment plan.
Treatments, like the various contributors, are multifactorial. We try to improve the tissues while also helping you to improve your use of those tissues. Treatments that improve tissues include surgery, medications, and learning how to take care of the tissues. Improving the use of your voice or swallowing involves therapy. Just like any other repair of damaged structures (knee, spine, etc), you would expect to receive therapy to help those repairs heal correctly, and to re-learn how to make the best use of them.
Surgical/physical techniques we utilize include:
- Direct Microlaryngoscopy: With various tools such as CO2 laser or microsurgery instruments the phonosurgeon is able to repair damaged tissues or remove pathologies with minimal effect on the structures necessary for voice or swallowing.
- Pulse Dye Laser: This focused wavelength of laser is used in-office to reduce the effects of varices (prominent blood vessels) and scar tissue in the larynx.
- Botox Injections: This again is an in office procedure that is used for spasmodic dysphonia, other dystonias and swallowing problems.
- Minimally Invasive Approaches: Advanced minimally invasive techniques are used to treat larynx neoplasms, pre-cancerous conditions and early cancer.
- Augmentation: Utilized to help correct gaps that can occur between the vocal cords as the result of vocal paralysis or loss of mas, this technique involves injecting material into one of the vocal cords to help it make contact with the other cord.
- Medialization: This technique is also used to move the vocal cords closer to each other and involves the placement of a silastic implant into the affected vocal cord.
- Voice therapy
- Laryngeal desensitization
- Respiratory re-training
- Swallow therapy
- Singing therapy
- Voice lessons
- Accent modification
Eugen Grabscheid MD Voice Center
Department of Otolaryngology –
Head & Neck Associates
5 East 98th Street
New York NY 10029