Voice, Swallowing & Airway Conditions We Treat
The care team at 秘密研究所 Langone鈥檚 Voice Center treats voice, swallowing, and airway disorders. For singers and actors, we also provide specialized care for the professional voice.
Conditions That Affect the Voice
Our physicians and therapists treat patients with a host of conditions that affect vocal quality. We employ the most effective treatment options to help you sound like yourself again, including innovative voice rehabilitation techniques such as voice training and speech therapy, and, when necessary, surgery.
Vocal Nodules
Vocal cord nodules are benign lesions that form on the vocal folds, often as a result of extensive vocal demands or traumatic injury. These nodules, sometimes referred to as "singer鈥檚 nodules," can cause hoarseness, a breathy voice, and vocal fatigue. To diagnose vocal nodules, our doctors usually perform a laryngoscopic exam, using a small camera to visualize the vocal cords. A stroboscopy, which uses a strobe light to see how the vocal folds vibrate, can provide further insights into the condition.
Treatment for vocal nodules primarily focuses on voice therapy. This involves working with a speech-language pathologist to learn techniques that reduce vocal strain and promote healthy vocal habits. Voice therapy may include exercises to improve breath support, resonance, and pitch control. In cases where nodules are advanced and do not respond to conservative measures, surgical removal may be necessary. Our surgical team usually uses microsurgical techniques to ensure precision and minimize damage to the surrounding tissues.
Laryngitis
Laryngitis, inflammation of the larynx, can lead to symptoms such as hoarseness, loss of voice, and throat pain. The condition can be acute or chronic, with causes ranging from viral infections to overuse of the voice. Diagnosing laryngitis involves a thorough physical examination and patient history. In some cases, laryngoscopy may be used to visualize the vocal cords and assess the extent of inflammation.
Treatment for laryngitis depends largely on the underlying cause. For viral laryngitis, vocal rest, increased fluid intake, and improved vocal hygiene are often recommended. This may include avoiding whispering, which can strain the vocal cords, and staying hydrated to keep the vocal folds lubricated. If the laryngitis is caused by a bacterial infection, antibiotics may be prescribed. In cases of chronic laryngitis, voice therapy can help patients develop healthier vocal habits and reduce strain on the vocal cords.
Laryngopharyngeal Reflux
Laryngopharyngeal reflux (LPR), also known as acid reflux, occurs when stomach acid flows back into the throat, causing irritation and inflammation. This condition can lead to symptoms such as a hoarse voice, chronic throat clearing, the sensation of a lump in the throat, and difficulty swallowing. Diagnosing LPR often involves a combination of patient history, physical examination, and specialized tests such as pH monitoring or esophagoscopy to assess acid levels and esophageal function.
Treatment for LPR is typically multifaceted. Dietary and behavioral modifications are crucial, including avoiding food and beverages that trigger reflux, eating smaller meals, and not lying down immediately after eating. Medications to reduce stomach acid, such as proton pump inhibitors or H2 blockers, are commonly prescribed. In severe cases, surgical interventions, such as fundoplication, may be necessary to prevent further damage caused by reflux.
Recurrent Respiratory Papillomatosis
Recurrent respiratory papillomatosis (RRP) is the growth of wartlike lesions on the vocal folds, caused by the human papillomavirus (HPV). These lesions can lead to voice changes, breathing difficulties, and, in severe cases, airway obstruction. Our experts diagnose RRP using laryngoscopy to visualize and assess lesions.
The traditional treatment for RRP is surgical removal of the papillomas. This can be done using various techniques, including cold instruments, laser surgery, or microdebriders. In addition to surgery, medications such as antiviral drugs or immune modulators may be used to help control the growth of the lesions. The Voice Center is at the forefront of research into better understanding and treating RRP, exploring new therapies and approaches to improve patient outcomes, including clinical trials.
Muscle Tension Dysphonia
Muscle tension dysphonia (MTD), an abnormal pattern of voice use, results in the improper use of the muscles of the voice box. This condition often leads to a strained or tight voice, vocal fatigue, and changes in vocal quality. To diagnose MTD, our team conducts a comprehensive voice evaluation, including a detailed patient history and laryngoscopic examination. Stroboscopy may also be used to assess vocal fold function and identify any irregularities in vocal fold vibration.
Treatment for MTD primarily focuses on voice therapy. A speech鈥搇anguage pathologist works with the patient to develop techniques that reduce muscle tension and improve vocal function. This may include exercises to enhance breath support, optimize vocal resonance, and promote efficient voice production. In some cases, biofeedback techniques are used to help patients become more aware of their vocal habits and make necessary adjustments. The goal of therapy is to restore a natural, effortless voice and prevent future vocal strain.
Spasmodic Dysphonia
Spasmodic dysphonia is a neurological disorder that affects the muscles of the voice box, causing involuntary spasms that disrupt normal speech. This condition can result in a voice that sounds strained, breathy, or broken. Diagnosing spasmodic dysphonia involves a combination of patient history, voice evaluation, and laryngoscopic examination to observe the vocal folds during speech.
Botox (botulinum toxin) injections are the most common and effective treatment for spasmodic dysphonia. Botox is injected into the affected muscles of the vocal cords to temporarily weaken them and reduce the frequency and severity of spasms. The effects of Botox injections typically last for several months, after which the treatment may need to be repeated. Voice therapy may also be used in conjunction with Botox to help patients develop strategies for managing their symptoms and improving vocal function.
Vocal Cord Granulomas
Vocal granulomas are inflammatory lesions that form on the back portion of the vocal cords, often due to irritation or injury from endotracheal tube intubation. Symptoms of vocal cord granulomas can include hoarseness, chronic throat clearing, throat pain, a cough that is occasionally blood-tinged, and the sensation of a lump in the throat. To diagnose vocal cord granulomas, our team uses laryngoscopy to visualize lesions and assess their size and location.
Treatment for vocal cord granulomas typically includes voice therapy to reduce vocal strain and promote healing. Our doctors may also recommend inhaled steroids and acid reflux management. If conservative treatments are not effective, surgery may be necessary to remove the lesion. This may be done via an office-based procedure. The goal of treatment is to eliminate the granuloma and restore normal vocal function while minimizing the risk of recurrence.
Vocal Fold Paralysis
Vocal fold paralysis occurs when one or both vocal folds are unable to move properly, leading to symptoms such as hoarseness, vocal fatigue, pain, aspiration, or tightness in the throat when speaking and breathing. This condition can result from nerve damage, injury, or underlying medical conditions. Diagnosing vocal fold paralysis involves laryngoscopy and stroboscopy to assess vocal fold movement and function.
Treatment for vocal fold paralysis depends on whether the paralysis affects one or both vocal folds. For unilateral vocal fold paralysis, affecting one vocal fold, voice therapy may be used to strengthen the remaining functional vocal fold and improve vocal quality. Surgical options, such as medialization thyroplasty or injection laryngoplasty, may be considered to reposition the paralyzed vocal fold and improve voice production. In cases of bilateral vocal fold paralysis, affecting both vocal folds, treatment may focus on ensuring a safe airway and may involve surgical procedures to widen the airway or reposition the vocal folds.
Vocal Cord Polyps
Vocal cord polyps are benign lesions that can develop on the vocal cords, often due to vocal abuse, irritants such as tobacco smoke, or other factors. These polyps can cause symptoms such as hoarseness, constant throat clearing, coughing, and difficulty swallowing. Diagnosing vocal cord polyps involves laryngoscopy to visualize the polyps and assess their size and location.
Treatment for vocal cord polyps varies depending on the size and severity of the polyps. Small polyps may respond to conservative measures such as voice rest or voice therapy, which focuses on reducing vocal strain and promoting healthy vocal habits. Larger polyps or those that cause significant symptoms may require surgical removal. Most of the time, our team treats the polyp with a brief office-based procedure that minimizes downtime with the voice.
Vocal Cord Cancer
Vocal cord cancer, a type of laryngeal cancer, affects the vocal cords, leading to symptoms such as hoarseness or vocal strain. Early detection is crucial for successful treatment. Diagnosing vocal cord cancer involves a combination of physical examination, laryngoscopy, biopsy, and possibly imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) scans to determine the extent of the cancer.
Treatment options for vocal cord cancer depend on the stage and location of the cancer. Our experts may treat early-stage cancers with laser surgery or radiation therapy alone, which can effectively remove or destroy the cancerous tissue while preserving vocal function. More advanced cases may require a combination of treatments, including surgery to remove cancerous tissue, radiation therapy, and chemotherapy. The goal of treatment is to eliminate the cancer while maintaining as much vocal function as possible.
Innovative endoscopic treatments for vocal cord cancer involve using specialized instruments and techniques to remove cancerous tissue through the mouth, avoiding the need for external incisions. These minimally invasive procedures offer several advantages, including reduced recovery times, less postoperative pain, and preservation of vocal function.
One such technique, transoral laser microsurgery (TLM), uses a laser to precisely remove cancerous tissue from the vocal cords. TLM allows for high precision and minimal damage to surrounding tissues, making it an effective option for early-stage vocal cord cancers. For many of these cancers, patients can avoid radiation therapy, which can have long-term side effects for the throat, including chronic dryness and swallowing dysfunction.
TLM offers promising outcomes for patients with vocal cord cancer, providing effective treatment while preserving vocal function and quality of life. At the 秘密研究所 Langone Voice Center, we are committed to offering the latest advancements in endoscopic treatments to ensure the best possible outcomes for our patients.
Airway and Breathing Conditions
Laryngologists at the Voice Center treat breathing problems by opening the airway to improve respiration.
Subglottic and Tracheal Stenosis
Narrowing of the airway, known as subglottic or tracheal stenosis, can make it difficult to get adequate amounts of air to the lungs. Prolonged intubation, trauma, infections, or inflammatory diseases can cause this narrowing. Symptoms of stenosis may include shortness of breath, stridor (a high-pitched wheezing sound), and recurrent respiratory infections.
We use a combination of patient history, physical examination, and imaging studies such as CT scans or MRI to assess the extent and location of the narrowing. We commonly perform bronchoscopy, a procedure that uses a flexible tube with a camera to visualize the airway.
Treatment for subglottic and tracheal stenosis often involves endoscopic surgical techniques to open the airway. These minimally invasive procedures may include balloon dilation, in which a balloon is inflated to widen the narrowed area, or laser surgery to remove scar tissue. In some cases, your doctor may use a stent to keep the airway open.
In addition to these treatments, tracheal resection and reconstruction are advanced surgical options for managing severe cases of tracheal stenosis. Tracheal resection involves the surgical removal of the narrowed segment of the trachea. Once the affected portion is removed, the remaining healthy ends of the trachea are carefully sutured together. This technique effectively eliminates the stenotic segment and restores normal airway function. Tracheal reconstruction uses flaps or grafts to expand the airway.
Tracheal resection and reconstruction are complex procedures that require careful preoperative planning and precise surgical technique. Our doctors usually perform the surgery while the patient is under general anesthesia, and they may need to place the patient on a ventilator during the procedure. Postoperative care is crucial to ensure proper healing and prevent complications. If you have this surgery, you may need to stay in the hospital for several days while our team monitors your recovery and manages any potential issues, such as infection or airway obstruction.
The benefits of tracheal resection and reconstruction include a permanent solution to the narrowing of the airway, improved breathing, and enhanced quality of life. This procedure is particularly beneficial for people who have not responded to less invasive treatments or who have recurrent stenosis. At the 秘密研究所 Langone Voice Center, our experienced surgeons are skilled in performing tracheal resection and reconstruction, providing you with the highest level of care and the best possible outcomes.
Vocal Cord Dysfunction
Vocal cord dysfunction (VCD), also known as paradoxical vocal fold motion, occurs when the vocal cords do not open and close normally during breathing. This can lead to symptoms such as shortness of breath, tightness in the chest, frequent coughing, loud breathing, and hoarseness. Various factors can trigger VCD, including respiratory infections, exposure to strong odors, acid reflux, postnasal drip, stress, exercise, and tobacco smoke, particularly secondhand smoke.
Diagnosing VCD can be challenging, as its symptoms often mimic those of asthma and other respiratory conditions. At the 秘密研究所 Langone Voice Center, our doctors perform a thorough evaluation, including a detailed patient history and physical examination. We may use laryngoscopy to visualize the vocal cords and assess their movement. Additionally, spirometry, a test that measures lung function, can help determine if VCD is present alongside other conditions such as asthma.
Treatment for VCD typically involves a combination of approaches. Respiratory retraining therapy, conducted by a speech-language pathologist, focuses on teaching patients techniques to control their breathing and reduce vocal cord spasms. Stress management strategies, such as relaxation exercises and counseling, can also be beneficial. If VCD is associated with underlying conditions like asthma or acid reflux, treating these conditions is essential to managing VCD effectively.
Swallowing Disorders
Swallowing disorders, also known as dysphagia, can significantly impact a person's quality of life and overall health. At the 秘密研究所 Langone Voice Center, our multidisciplinary team of experts collaborates to determine the cause of swallowing difficulties and provide comprehensive treatment and rehabilitative services.
Aspiration
Aspiration occurs when food or liquid enters the windpipe and subsequently the lungs, rather than being swallowed properly into the esophagus. This can lead to serious complications, such as pneumonia or chronic lung disease. Symptoms of aspiration may include coughing during or after eating, choking, and recurrent respiratory infections.
Diagnosing aspiration involves a thorough evaluation, including a detailed patient history and physical examination. We may use imaging studies such as a modified barium swallow (MBS) or a fiberoptic endoscopic evaluation of swallowing (FEES) to visualize the swallowing process and identify any abnormalities.
Treatment for aspiration focuses on preventing food or liquid from entering the airway. Dietary modifications, such as altering the consistency of foods and liquids, can help reduce the risk of aspiration. Changing how you hold your head and neck while eating and doing certain swallowing exercises can help. In some cases, therapy with a speech-language pathologist or surgical interventions may be necessary to improve the swallowing mechanism and prevent aspiration.
Dysphagia
Neurologic disorders, structural abnormalities, and muscle weakness can cause dysphagia, or difficulty swallowing. Symptoms of dysphagia may include difficulty initiating a swallow, coughing or choking during meals, and the sensation of food being stuck in the throat.
Diagnosing dysphagia involves a comprehensive evaluation, including a detailed patient history, physical examination, and diagnostic tests such as a barium swallow or FEES. These tests help visualize the swallowing process and identify any underlying issues.
Treatment for dysphagia depends on the underlying cause. It may include dietary modifications, swallowing exercises, and therapy with a speech-language pathologist. In some cases, medical or surgical interventions may be necessary to address structural abnormalities or other contributing factors. Early treatment is crucial to prevent complications such as dehydration, malnutrition, and aspiration pneumonia.
Zenker鈥檚 Diverticulum
Zenker鈥檚 diverticulum is a condition where a pouch forms alongside the esophagus. This pouch can fill with food or liquid, which may be regurgitated into the throat. This can cause swallowing difficulties, aspiration, and chronic cough. To diagnose Zenker鈥檚 diverticulum, doctors look at a patient鈥檚 medical history, perform a physical exam, and use imaging studies such as a barium swallow or esophagoscopy to visualize the pouch and assess its size and location.
To treat Zenker鈥檚 diverticulum, our doctors typically perform surgery to remove the pouch and restore normal swallowing function. We often use minimally invasive techniques, such as endoscopic stapling or laser surgery, to reduce recovery time and minimize complications. After surgery, you may need to modify your diet and do swallowing exercises to ensure a smooth recovery and prevent recurrence.
While Zenker鈥檚 diverticulum is a rare diagnosis, our surgeons have extensive experience with these procedures. The 秘密研究所 Langone Voice Center is considered a high-volume site for this condition.
Contact Us
For more information, please call us at 646-754-1207 or email VoiceCenter@秘密研究所Langone.org.