Voice and Throat Disorders

In This Section:

Airway Stenosis

Author: Ahmed M.S. Soliman, MD

Overview:
The term stenosis refers to the abnormal narrowing of a tube-shaped organ. In the human airway, the three main areas where this can occur are in the larynx (voice box), subglottis (just below the vocal folds), and trachea (windpipe). The main cause of laryngeal narrowing is having had a breathing tube in place. Other causes include certain autoimmune/rheumatological conditions (Wegener’s granulomatosis, Sarcoidosis Relapsing polychondritis, Amyloidosis), trauma to the neck or voice box, and surgery, or radiation to the larynx.

Symptoms:
Symptoms include noisy breathing, coughing, and shortness of breath. It is frequently misdiagnosed as asthma. The symptoms may become quite severe and life threatening.

What to Expect at Your Otolaryngologist Office Visit:
Evaluation will start with a complete examination of the head and neck. It will also include examination of the nose, voice box and the throat using a laryngoscope. Your doctor may order a chest X-ray, CT or other tests as appropriate. If you have had any of these already done, please bring them with you to the visit.

Treatment:
Treatment usually starts with evaluation of the larynx, subglottis, and trachea in the operating room. Endoscopic treatment with the laser and dilation is usually successful although sometimes, surgical reconstruction through the neck is necessary.

Chronic Cough

Author: Ahmed M.S. Soliman, MD

Overview:
A chronic cough is a cough that persists for eight or more weeks. Chronic cough can lead to exhaustion, rib fractures, vomiting, hoarseness and lightheadedness.

Symptoms:
Chronic cough is a symptom and not a diagnosis. It is typically the result of an underlying condition or health factor. The most common of these include tobacco use, certain blood pressure medications, asthma, chronic rhinosinusitis, and acid reflux. Other causes of chronic cough include respiratory infections, and chronic bronchitis.

What to Expect at Your Otolaryngologist Office Visit:
Evaluation will start with a complete examination of the head and neck. It will also include examination of the nose, voice box and the throat using a laryngoscope. You may be given some food to eat while the doctor examines your throat (called flexible evaluation of swallowing or FEES). Your doctor may order a chest X-ray, modified barium swallow, esophagram, sinus CT or other tests as appropriate. If you have had any of these already done, please bring them with you to the visit.

Treatment:
Treatment will depend upon what the underlying cause or causes. This may include dietary and behavioral modifications, antibiotics, antireflux medications, inhalers, etc.

Dysphagia (difficulty swallowing)

Authors: Nausheen Jamal, MD – Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine, Temple University

Overview:
Dysphagia refers to any difficulty swallowing that a person may have. This difficulty may occur in many different forms and will affect a person’s ability to eat or drink in the upper digestive tract – in other words, anywhere from the lips down to the stomach.

Causes of dysphagia vary as well. These include weakness of throat muscles, “pouches” within the throat or food pipe, narrowing of the throat or food pipe, muscle spasms, trouble with coordination within the throat or food pipe, or even issues with the teeth or dentures. Sometimes other medical conditions can lead to dysphagia. These include medications, prior stroke, any tumors, and prior surgeries.

Trouble with swallowing can cause drastic quality of life issues. In addition, it can lead to serious medical complications, such as pneumonia, malnutrition, and undesired weight loss.

Symptoms:

Coughing and choking during eating
Extra time needed to eat meals
Avoiding or having difficulty with certain food consistencies because of swallowing difficulty
Drooling
Difficulty chewing
Difficulty starting a swallow
Waking up at night choking or drooling
Food coming back up into the throat or nose during eating
Feeling food stick in the throat or chest
History of pneumonia
Weight loss and malnutrition

What to Expect at Your Otolaryngologist Office Visit:
A careful examination of your mouth and throat will provide your doctor with a lot of information. Your otolaryngologist may perform specialized tests, including a laryngoscopy (“scope” procedure through your nose and into your throat), a swallow evaluation, and possibly even a procedure to look in your food pipe.

It is possible that your otolaryngologist will order specialized testing, including x-ray swallow tests (such as a barium swallow or modified barium swallow). You may be given a referral to see a speech pathologist who is also trained in swallow disorders.

Treatment:
Because the causes of swallow disorders vary, so do the treatments.

Generally speaking, swallow disorders that are caused by issues of weakness or lack of muscle coordination are treated with swallow therapy, which is like physical therapy for the swallowing muscles of the throat. This therapy is performed by a speech pathologist.

Swallow disorders that are caused by areas of narrowing, “pouches,” certain types of muscle spasms, voice box movement disorders, or tumors are typically treated with surgery. Most of these surgeries are performed endoscopically, meaning that they are performed through the mouth without a need for incisions in the neck. Sometimes, however, a surgery that requires an incision in the neck is needed. Most surgeries require staying in the hospital for at least one night following the operation. A few minimally invasive surgeries may allow discharge on the same day as the operation. Your doctor will discuss if surgery is the right option for you, and what an operation might involve.

Spasmodic Dysphonia

Author: Ahmed M.S. Soliman, MD

Overview:
Spasmodic dysphonia (SD) is a rare neurologic disorder in which the larynx experiences involuntary spasms. There are three forms of the condition, adductor SD, Abductor SD, and Mixed SD, each with distinct vocal symptoms. It is estimated that roughly 50,000 people in North America have some form of SD. The condition usually sets in gradually during middle age, and is more likely to affect woman than men.

Symptoms:
Adductor SD, the most common form, causes the vocal folds to involuntarily close while speaking. The speech of someone with adductor SD sounds choppy, strained or strangled. Abductor SD is much less common and causes the vocal folds to involuntarily open with speaking that they do not vibrate properly. As a result, the voice may sound soft, weak or breathy. Mixed SD has features of both types and is rare.

What to Expect at Your Otolaryngologist Office Visit:
Evaluation will start with a complete examination of the head and neck. It will also include examination of the larynx or voice box using a laryngoscope. The examination is often videotaped and played back. Your doctor may order an MRI of your brain, and evaluation by Neurology and Speech Pathology.

Treatment:
Treatment usually involves weakening of the overactive muscle group with botulinum toxin. This treatment is usually done in the office and is highly successful. Voice therapy is often used as an adjunct to treatment. Rarely surgical procedures of the larynx are performed for this.

Zenker’s Diverticulum

Author: Ahmed M.S. Soliman, MD

Overview:
Zenker's diverticulum is a pouch that forms in the throat, where the esophagus meets the uppr part of the throat called the pharynx. The pouch forms by pushing through a weakened portion of the pharynx and balloons outward. The condition tends to occur in patients over 60 years but may occur in younger patients. It does not appear to be hereditary.

Symptoms:
The main symptom of Zenker's diverticulum is dysphagia, or difficulty swallowing. Undigested food or liquid can rise back into the throat and mouth even hours after swallowing. Other symptoms include choking, a buildup of mucous in the throat, bad breath, hoarseness, and recurrent pneumonias.

What to Expect at Your Otolaryngologist Office Visit:
Evaluation will start with a complete examination of the head and neck. It will also include examination of the voice box and the pharynx using a flexible laryngoscope. You may be given some food to eat while the doctor examines your throat (called flexible evaluation of swallowing or FEES). If you have had a swallowing test, please bring it with you. Otherwise, your doctor will likely order one.

Treatment:
In cases of mild dysphagia, Zenker's diverticulum can be treated with lifestyle changes. These include: Avoiding fatty, spicy and acidic foods, thoroughly chewing foods before swallowing, drinking lots of water after eating. If the dysphagia is severe, there are a variety of surgical options. The exact procedure our surgeons use will depends on the size and location of the diverticulum and include:

Cricopharyngeal myotomy: This procedure is ideal for removing small diverticula. It can be performed directly through the mouth with the laser or through a small incision in the neck.
Endoscopic diverticulotomy: This option involves dividing the wall between the esophagus and the diverticulum using the laser or a special staper/cut device. Once the wall is divided, food particles stuck inside the pouch are free to drain into the esophagus. The vast majority of Zenker’s diverticula are treated successfully in this minimally invasive manner.
Diverticulectomy and cricopharyngeal myotomy: This procedure is the complete removal of the pouch along with a cricopharyngeal myotomy and is used for a small percentage of patients where the sac is very large or cannot be accessed through the mouth. It is done through a small neck incision.