Diagnosing Voice Disorders
The diagnosis of voice disorders begins with the history and examination of the patient. The history is directed toward understanding:
- The potential cause of the disorder
- The overall health of the patient
- The patient’s past medical history
Treating Voice Disorders
Many voice disorders are the result of:
- Vocal behaviors, such as prolonged yelling
- Professional demands, such as public speaking, singing or teaching
- Normal aging
- Systemic disease
Voice therapy is directed toward maximizing the efficiency of vocalization through improving breath support, posture, articulation and reducing vocal demands. Vocal nodules and polyps represent two types of voice disorders that respond well to such treatments.
Surgery for Voice Disorders
Voice disorders that do not typically respond well to voice therapy include:
- Vocal fold paralysis
- Laryngeal benign and malignant neoplasm (tumors that are benign and non-spreading, or malignant and spreading)
- Laryngeal trauma
- Vocal fold cysts
- Vocal fold atrophy (loss of function of the small muscles inside the vocal cords so they do not vibrate against each other)
Diagnosing Swallowing Disorders
As with the evaluation of all health problems, a patient's history of illnesses and medical events can be a guide to find the cause of dysphagia. A previous stroke would suggest a neurogenic impairment, while regurgitation of undigested food is common in patients with a Zenker’s diverticulum (a hernia in the wall of the esophagus where it passes through the neck) arising at the upper esophagus.
In diagnosing a swallowing disorder, your doctor will perform a complete head and neck examination, in addition to:
- Observing the mobility and structure of the oral cavity
- Evaluating the appearance and the functioning of the pharynx and palate
- Using a flexible laryngoscope (a small fiberoptic telescope that may be passed through a nostril and in to the back of the throat to see the voice box and throat) passed through the nose in order to visualize the pharynx and larynx
In the acutely impaired patient, evaluation often begins with assessing the patient’s ability to swallow water. If the patient coughs or aspirates, further examination will be performed. Your physician may refer you to as speech-language pathologist for an instrumental swallowing examination such as a fiberoptic endoscopic examination of swallowing (FEES) or a videofluoroscopic swallow study (VFSS). FEES involves using a flexible fiberoptic scope passed through the nostril to view the act of swallowing in real time. A VFSS, also known as a modified barium swallow study, is performed in coordination with a radiologist. The patient is asked to drink and eat various textures of foods and liquids while a radiographic movie records the swallow.
Laryngoscopy permits visualization of the larynx using either flexible endoscopes passed through the nose or rigid endoscopes placed in the mouth above the larynx. Coupling a laryngoscope to a camera, or placing a video chip within the endoscope, permits the laryngeal image to be captured and video recorded.
Detailed analysis of the anatomy and movement of the vocal folds is provided by tracking the voice frequency and strobing light at this frequency through the endoscope. Laryngeal stroboscopy is best likened to the effect of flash strobes seen in light shows to provide the illusion that motion is slowed or frozen.
Treating Swallowing Disorders
Rehabilitation therapy requires the trust and understanding of the patient with the therapist. Goals are established with the patient and are based on the patient’s motivation and ability to participate while considering the nature and severity of the swallowing problem. The observations of the instrumental studies are used to determine maneuvers or strategies that promote successful swallowing. Therapy includes a variety of exercises that are designed to strengthen the tongue and throat muscles and to help protect the airway during swallowing.
Surgery for Swallowing Disorders
Surgical interventions are appropriate for strictures, diverticulum (outpouchings that food can get stuck in) of the digestive tract, removal of tumors and mechanical obstructions. Over the last decade, many of these operations have evolved from open procedures to less invasive transoral (performed through the mouth) operations using endoscopes or microscopes.