Thursday, January 22, 2015

Laryngeal Stroboscopy

Laryngeal stroboscopy is one of the most useful and state-of-the-art techniques currently available for the examination of the larynx.  At the Milton J. Dance, Jr. Head and Neck Center, the laryngeal stroboscopy examination is performed jointly by a physician and a speech pathologist.

Laryngeal stroboscopy examinationVIEW BROCHURE

Frequently Asked Questions about Laryngeal Stroboscopy

What happens during the evaluation?

Step 1:  You will first be asked to complete a questionnaire regarding the onset of your voice problem, your medical history and current medications, current voice demands, and any specific symptoms related to your voice problem.

Step 2:  A speech pathologist will guide you in performing simple vocal tasks using a microphone.  Computer analysis of your vocal quality will then be performed.

Step 3:  The physician may spray a topical anesthetic in your throat for your comfort during the procedure. (Note: Please inform the physician if you have had any reactions to anesthesia in the past.)

Step 4:  The physician will insert a small endoscope through your mouth towards the back of your tongue.  The endoscope provides a telescopic video recording of your larynx.  The speech pathologist will then ask you to perform various voice tasks in order to observe the movement of your vocal cords and the condition of your larynx.
Laryngeal stroboscopy examinationHow long will it take?

The entire evaluation may take approximately thirty minutes to one hour; however, the total time that the endoscope is in your mouth is only approximately two minutes.

When will I receive the results?

Immediately following the evaluation, the physician and speech pathologist will review your results and provide recommendations which may include one or all of the following:  referrals, medication, voice therapy, and/ or surgery.

How do I need to prepare?

There is no preparation required for the procedure.  You may eat and drink as you wish.  Please arrive 15 minutes prior to the appointment to complete the necessary paperwork.

For information or to schedule an appointment, please call (443) 849-2087.

Monday, January 12, 2015

Foamy Secretions

My brother has cancer of the esophagus - lost his voice and is now speaking again. He is still unable to swallow after radiation /chemo.  He keeps getting lots of foaming coming up even after trying to swallow one drop of water. Any suggestion to eliminate the foaming? Thanks

Barbara P. Messing, M.A., CCC-SLP, BCS-S replies...

Thank you for your online request. Certainly every situation is different and it is not possible for me to know what treatments were performed, but generally speaking - I would recommend that evaluation by a speech pathologist to determine why swallowing is not possible and that may indeed determine why foamy secretions are so persistent and copious.

Kind regards,

Barbara

Monday, January 5, 2015

Attorney Objects to Persistent Hoarseness

Richard Eventoff -- GBMC patient

For attorney Richard Eventoff, persistent vocal hoarseness presented a challenge in his everyday life. Treatment at the Johns Hopkins Voice Center located at GBMC changed his life. This is his story, in his own words.

Hospitals and doctors’ offices are all too familiar for me. I’ve had more than 15 surgeries during my life, from an appendectomy and tonsillectomy as a child to orthopedic surgeries on my knees and wrists as an adult. After a frightening open heart surgery in 2003, I hoped that my days of medical procedures would be behind me. Unfortunately, that was not the case.

In 2012, I started to develop a raspy voice that didn’t go away. It wasn’t a painful feeling; I was just always hoarse. The symptom continued for about a year and a half. Since I’m a lawyer who negotiates union contracts for a living, it’s important for me to be able to speak clearly and effectively. I finally went to see a doctor, looking for answers. The first doctor told me that I simply needed to rest my voice and the problem would resolve itself. So, for a while, I tried to do most of my work by email instead of speaking.

When the hoarseness didn’t go away, the doctor examined my throat more closely, diagnosed me with vocal cord disease and recommended surgical procedures to remove several lesions that had developed. But the symptoms persisted and the lesions kept coming back. My doctor sent me to see Lee Akst, MD, an otolaryngologist at the Johns Hopkins Voice Center located at GBMC, for more specialized treatment.

When I walked into the Voice Center, I was filled with uncertainty, wondering if I might have cancer or if I would need to have my vocal cords removed. When I met Dr. Akst, he had a calming effect on me. It was apparent that he had cared for patients like me before. He was very knowledgeable and took his time explaining everything to me.

Mr. Eventoff and Dr. Lee Akst, MD -- GBMC VoiceWith vocal cord disease, repeated surgeries can cause scarring in the throat, which affects the long-term quality of a person’s voice. I did not recover quickly from the first surgeries and had to whisper for weeks at a time afterward instead of speaking normally. I was concerned about what my voice might sound like in the future as a result of the procedures. Dr. Akst and the Voice Center team established a way to manage my vocal cord disease while keeping my voice quality intact using a technique called microlaryngoscopy. The treatment was much less invasive than what I had previously experienced. For example, when he looked at my throat, Dr. Akst used a device that went through my mouth instead of my nose. This method was easier and also put my anxiety to rest.

During my most recent appointment with Dr. Akst, he said my throat looks better than ever! I have never liked looking at the screen showing images of my vocal cords, but during this last appointment, Dr. Akst strongly encouraged me to look at the remarkable “before and after” photos. It was truly amazing to see the difference that I can already feel and hear. Today, everyday life is enjoyable. It’s much easier now to communicate with my clients! I’m married to a wonderful woman and a typical weekend finds us relaxing at the pool in our backyard with any of our nine grandchildren. In my free time, I help to rehabilitate birds of prey and tend to my freshwater stingray tank. There’s never a dull moment at our house! I’m so grateful to Dr. Akst and the Voice Center for allowing me to continue living the life I love.

An Inside Look at the Voice Center

Fender Voice & Music Studio—Voice therapy for performing artists is provided in the fully equipped music studio offering guitars, a digital baby grand piano, amplifiers, microphones and recording capabilities to meet the needs of performers.

Laryngeal Procedure Room—Laryngeal Stroboscopy, vocal fold augmentation/injections and vocal fold laser treatments are performed in the laryngeal procedure room. These procedures are performed for a variety of vocal fold impairments.

Stroboscopy Room—In the stroboscopy room, a physician or speech pathologist uses an endoscope, which provides telescopic video recordings of a patient’s larynx, to help diagnose underlying causes of a patient’s voice issues. During the procedure, the physician and the speech pathologist instruct the patient to perform various vocal tasks in order to observe vocal cord movement and to identify any vocal pathologies.

Body & Movement Room—The movement education studio is designed for body-centered therapy to enhance body awareness, release chronic muscular tensions and promote the physical freedom necessary for vocal flexibility

For additional information about the Johns Hopkins Voice Center located at GBMC, visit www.gbmc.org/voice or call 443-849-GBMC (4262).

Friday, December 12, 2014

Nodules / Polyps / Cysts


I have had 5 surgeries to remove remove polyps from my vocal cords and will have my 6th surgery on Dec 3rd. I have had 3 different doctors during the surgeries. My last surgery was done at UNC in Durham, NC, in June, 2014, and my upcoming surgery will be done at the the same hospital. The 5 previous biopsy have no signs of cancer. My question is should I continue having surgery to remove the polyps if they continue to return?

Melissa Kim, M.S., CCC-SLP writes... 
 
This is a question that would only be able to be answered by your surgeon; I would recommend that seek out a second opinion if you don't feel as though your physicians have thoroughly addressed your concerns.

Good luck to you!

Sunday, December 7, 2014

Son Loses Voice Often

My 11-year-old son loses his voice often. It started about 3 years ago. If he goes to camp, outdoor activities with groups of people, or anything that involves talking a lot or playing loud, he'll lose his voice. I took him to the doctor, who said probably nodules, and to try and keep him from talking when they get inflamed. My question is, if this continues, could this damage his voice for good? Are there any new signs I should watch for? I hate to see what it is going to sound like when he goes through the change.

Melissa Kim, M.S., CCC-SLP writes...

There are no "new" symptoms to look for... symptoms of nodules include hoarse, breathy vocal quality and a tendency to "lose" the voice with excessive use. I would suggest that you ask your physician for a referral to a speech pathologist. Voice therapy can often successfully resolve, or at least reduce, the nodules so that vocal quality and endurance improves.

Thank you for your question.

Friday, November 14, 2014

Hoarse Voice

For the last several years, I have experienced hoarseness in my voice, had the sensation of a lump in the throat (this symptom only after drinking MatTea vocal elixir for 7 days in a row), post-nasal drip, stuffy sinuses, chronic throat clearing, excessive throat mucous and a sore throat. I used to have a great singing voice (not professional, but I do talk for a living) but now I can barely make it through a song and I sound like an 80 year old smoker (and I am neither). I've been to ENT doctors and a speech therapist at Stanford, but nothing seems to help (and acid reflux medication seems to make it worse). I don't have nodules. Please help!

Melissa Kim, M.S., CCC-SLP writes...

There are any number of conditions that can contribute to the symptoms you describe, so to suggest a possible diagnosis would be conjecture. If you've seen general Ear, Nose, and Throat physicians for prior assessments, then I would suggest seeking out a laryngologist, an ENT who specializes in the treatment of voice disorders. Ask your physician for a referral or visit the American Academy of Otolaryngology at www.entnet.org to search by sub-specialty.

Good luck to you!