University Otolaryngology Associates Philadelphia ENT
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Speech & Swallowing

Most people take their voice for granted until they experience a voice or swallowing problem. A voice or swallowing disorder can greatly limit your ability to eat, drink or communicate and even a mild voice disorder can be a sign of a more serious health problem. At University Otolaryngology Associates we are here to help diagnose and treat your symptoms and causes for voice and swallowing disorders. If you have a concern as to whether or not this is the appropriate practice for your medical condition, please do not hesitate to call our office and ask to speak with one of our clinical staff members.

Speech and Swallowing Services:

Voice Disorders

Vocal problems occur with a change in the voice, often described as hoarseness. People with voice problems often complain about or notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. Other vocal problems may only be noticed with a change in singing ability that is most notable in the upper singing range. A more serious laryngeal problem is indicated by spitting up blood or when blood is present in the mucus.
Voice changes sometimes follow an upper respiratory infection and can last for as long as two weeks. The respiratory infection with associated coughing can cause swelling of the vocal folds, changing their vibration which results in an abnormal voice. Reduced voice use (voice rest) typically improves the voice after an upper respiratory infection, cold, or bronchitis. If voice does not return to its normal characteristics within two to four weeks, a medical evaluation by an ear, nose, and throat specialist is recommended. A throat examination after a change in the voice lasting longer than one month is especially important for smokers. (Note: A change in voice is one of the first and most important symptoms of throat cancer. Early detection significantly in-creases the effectiveness of treatment.)

Conditions which can cause changes in the voice:

Laryngitis: Laryngitis is an inflammation of the vocal folds resulting in a change in the vocal quality or an abnormal sensation in the throat while speaking or singing. Typically, laryngitis is viral in origin although other infectious agents can be the cause. The acute inflammation causes swelling of the vocal folds with slower vibrations, a deeper voice and a harsh, breathy vocal quality. A viral laryngitis will resolve within a few days to two weeks after onset. “Laryngitis lasting longer than two weeks should be evaluated by an Otolaryngologist Other causes of laryngitis can be treated effectively with medication or voice therapy These may include causes such as overuse disorders, candida infection (often associated with steroid inhalers) or acid reflux disease.

Vocal fold lesions: The vocal folds are tiny, delicate membranes within the voice box that vibrate during speech. Any abnormality of the membrane will change the vibration characteristics and alter the vocal quality. Any lesion of the vocal fold may result in a significant change in the voice. Lesions are often result of voice abuse either an acute issue (hemorrhage, granuloma) or from chronic voice use (nodule, cyst, polyp) A thorough Otolaryngologic evaluation is necessary, the vocal folds can be visualized and the appropriate diagnosis obtained leading to a specific treatment plan. Often, laryngeal videostoboscopy will be performed to have a better look at the vocal folds under a flashing light to obtain even more information about the vibration of the membranes. This is a simple office procedure performed after topical anesthesia of the throat with a small telescope that is inserted into the mouth. No sedation is usually required.

Vocal Fold Paralysis: Normal speech and swallowing requires normal movement of the arytenoid cartilages which move the vocal folds. The vocal folds will open during breathing and then come together during both speech and swallowing. This is accomplished by muscle activity of three paired intrinsic laryngeal muscles which are innervated by the recurrent laryngeal nerves. An injury to the nerve can result in paralysis of these muscles and the inability of move the vocal fold. This usually results in a weak, breathy voice, with vocal fatigue, shortness of breath and often swallowing issues. There are many causes for the nerve injury ranging from a completely benign, short duration viral inflammation to more significant causes such as a stroke, a traumatic injury, or at times an injury from a tumor that can be located anywhere along the course of the nerve which extends from the head to the chest. A thorough evaluation often including imaging studies of the head, neck and chest will determine the etiology for the paralysis. Treatment options include: observation, voice therapy or surgery to reposition the vocal fold. Often normal voice can be restored.

Throat Cancer- Throat cancers can occur in multiple different places of the throat ranging from the oral pharynx (tonsil) to the upper esophagus. Laryngeal cancers can develop within the voice box above, at or below the level of the vocal folds. Symptoms include: throat pain, cough, hoarseness, swallowing difficulty, a lump in the neck, shortness of breath or coughing up blood. Persistent symptoms, lasting more than two weeks should be evaluated. If identified early, laryngeal cancers can be effectively treated while preserving speech and swallowing function. Even more advanced tumors can be effectively cured through a combination of treatments including chemotherapy, radiation or surgery. The Physicians at University Otolaryngology have decades of experience and work closely with other regional and national oncologists to develop treatment plans that best serve our patients individual needs.

What can I do to prevent and treat mild hoarseness?

  • If you smoke, quit.
  • Avoid agents that dehydrate the body, such as alcohol and caffeine.
  • Avoid secondhand smoke.
  • Drink plenty of water.
  • Humidify your home.
  • Watch your diet–avoid spicy foods.
  • Try not to use your voice too long or too loudly.
  • Use a microphone if possible in situations where you need to project your voice.
  • Seek professional voice training.
  • Avoid speaking or singing when your voice is injured or hoarse.

Reflux Laryngitis or Laryngopharyngeal Reflux Disease (LPR)

Reflux laryngitis occurs when the voice box is exposed to gastric contents including gastric acid. This occurs in patients with acid reflux disease where the reflux reaches to the level of the larynx. Although many normal people will occasionally experience acid reflux with heartburn, any reflux that reaches the throat is considered abnormal. The lining of the voice box is extremely sensitive to the effects of acid exposure and becomes inflamed very quickly. It is estimated that the laryngeal lining is at least 100 times more sensitive to the effect of acid exposure than is the esophagus.

LPR can manifest in a wide variety of symptoms including:

  • Chronic cough (typically non-productive)
  • Globus (a sensation of a lump in the throat)
  • Mucus collection in the throat, especially if the mucus cannot be cleared
  • Hoarseness
  • Throat pain
  • Throat clearing
  • Difficulty swallowing

After taking a thorough history, our physicians may decide to use a pH probe to aide in the diagnosis of LPR. In the office, the restech probe is placed into the nose to record the PH in the throat for a 24 hour time period. The probe is not uncomfortable and does not interfere with swallowing and speaking, and patients continue with all normal activities while the probe is in place.

Swallowing Disorders

Swallowing disorders can have a variety of causes including infections, injury, reflux disease, growths or cysts, neck arthritis, muscular issues and neurologic causes such as multiple sclerosis, stroke, ALS, CRPS among many others. The appropriate diagnosis is critical to develop a treatment plan to return the patient to a normal diet without discomfort. We employ a large variety of diagnostic evaluation including videostroboscopy, transnasal esophagoscopy, fiberoptic, endoscopic evaluation of swallowing (FEES) and radiographic studies. The physicians at University Otolaryngology Associates work closely with speech and language pathologists, neurologists, radiologists and other providers to develop successful treatment approaches.

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