Voice and Dysphagia Centre

Other Information

WHEN TO SEEK HELP

VOICE

If you have;

• Sore throat or pain during or after voice use

• Hoarse, scratchy, rough voice

• Increased effort when producing voice

• Decreased loudness or pitch range

• Breathiness, weakness or vocal fatigue

• Shaky, strained voice or voice cutting off unexpectedly

DYSPHAGIA (swallowing problem)

• Pain while swallowing

• Inability to swallow

• A sensation of food getting stuck in thethroat

• Drooling

• Hoarseness

• Food coming back up (regurgitation)

• Frequent heartburn

• Food or stomach acid backing up into thethroat

• Weight loss

• Coughing blood

• Coughing or gagging when swallowing

What we treat 

STRUCTURAL PATHOLOGIES OF THE LARYNX

Malignant Lesions

1. Malignant Vocal Fold Lesions

2. Dysplasia/carcinoma in situ

3. Laryngeal Malignancy (Non-Vocal Fold Origin)

4. Oral cancers causing dysphagia

5. Skull base lesions causing dysphagia

Benign lesions

1. Vocal Fold Nodules

2. Vocal Fold Polyp(s)

3. Vocal Fold Cyst

4. Reinke’s Edema

5. Vocal Fold Scar

6. Vocal Fold Sulcus

7. Vocal Fold Granuloma

8. Contact Ulcer

9. Keratosis 

10.  Recurrent Respiratory Papillomatosis (RRP)

11. Globus pharyngeus

Vascular Abnormalities of the Vocal Fold

1. Vocal Fold Hemorrhage

2. Varix and Ectasia of the Vocal Fold(dilated blood vessels) 

Congenital and Maturational Changes 

1. Congenital Webs (Synechia)

2. Cri du Chat Syndrome

3. Down’s syndrome 

4. Puberphonia

5. Androphonia

6. Presbyphonia/Presbyphagia 

7. Choanal atresia 

8. Cleft lip/palate 

INFLAMMATORY CONDITIONS OF THE LARYNX

• Acute Epiglottitis
• Cricoarytenoid and Cricothyroid Arthritis
• Acute Laryngitis
• Laryngopharyngeal Reflux/GERD
• Chemical Sensitivity/Irritable Larynx Syndrome

TRAUMA OR INJURY OF THE LARYNX

1. Laryngeal Mucosa Trauma (Chemical and Thermal)

2. Intubation/Extubation Injuries of the Laryngeal Mucosa

3. Arytenoid Dislocation

SYSTEMIC CONDITIONS 

Endocrine

1. Hypo/Hyperthyroidism

2. Sexual Hormone Imbalances

3. Growth Hormone Abnormalities (Hyperpituitarism)

Immunologic

1. Allergic Diseases of the Upper Respiratory Tract

2. HIV and AIDS

3. Chronic Fatigue Syndrome

4. Sjogren’s Syndrome

NEUROLOGIC DISORDERS AFFECTING VOICE

Peripheral Nervous System Pathology

1. Superior &Recurrent Laryngeal Nerve Paralysis

2. Myasthenia Gravis

3. Peripheral Neuropathy 

Movement Disorders Affecting the Larynx

1. Spasmodic Dysphonia(Abductor&Adductor, Mixed)

2. Essential Tremor Affecting Voice

3. Meige’s Syndrome (Orofacial dystonia)

4. Tourette’s Syndrome

CENTRAL NERVOUS SYSTEM DISTURBANCE

1. Amyotrophic Lateral Sclerosis (ALS; Lou Gehrig’s Disease)

2. Wallenberg Syndrome (Lateral Medullary Syndrome/Infarct)

3. Parkinson Disease

4. Multiple Systems Atrophy (Shy-Drager Syndrome,Striatonigral Degeneration, Sporadic Olivoponto- cerebellar Atrophy)

5. Progressive Supranuclear Palsy (Includes Pseudobulbar Palsy and Steele-Richardson-Olszewski Syndrome)

6. Multiple Sclerosis

7. Cerebellar Disorders

8. Huntington’s Chorea

9. Myoclonus

10. CVA(stroke )

PSYCHIATRIC AND PSYCHOLOGICAL DISORDERS WHICH AFFECT VOICE AND SWALLOWING 

OTHER DISORDERS 

• Muscle Tension Dysphonia (Primary)
• Muscle Tension/Adaptive Dysphonia (Secondary)
• Ventricular Dysphonia
• Paradoxical Vocal Fold Movement Disorder (Vocal Cord Dysfunction)
• Laryngeal spasm /esophageal spasm 

Airway related disorders 

1. Airway masses, cysts, tumors and cancers

2. Laryngeal clefts

3. Laryngomalacia

4. Sleep apnea and airway obstruction related to craniofacial disorders, including micrognathia, Pierre Robin syndrome

5. Stridor or noisy breathing 

6. Subglottic hemangiomas 

7. Subglottic stenosis

8. Tracheal stenosis

9. Tracheomalacia and tracheobronchomalacia.

10. Vascular rings and complete tracheal rings

11. Tracheoespophageal fistula

Services offered 

• Rigid/Flexible laryngoscopy 
• Laryngeal videostroboscopy 
• Narrow Band Imaging (NBI)
• Laryngeal Electromyography
• Functional Endoscopic Evaluation of Swallowing (FEES)
• Flexible endoscope assisted biopsy of laryngeal lesion
• Botox injection for spasmodic dysphonia 
• Fat injection for vocal cord palsy
• Kashima cordectomy 
• Laser (Carbon dioxide) cordectomy for early vocal cord malignancy
• Conservative laryngeal surgeries (Partial laryngectomy, near total laryngectomy)
• Total laryngectomy with reconstruction and TEP valve insertion
• Airway reconstruction 
• Tracheal/ laryngeal stenosis surgeries
• Treatment for all kinds of dysphonia (voice disorders)
• Phonosurgery for all benign lesions of larynx
• Management of laryngopharyngeal reflux disease
• Treatment for granulomatous conditions of larynx
• Laryngeal Framework Surgery
• Tracheostomy- Management 
• Care for professional voice users
• Surgeries for reconstruction of food pipe damaged by conditions like corrosive poisoning. Eg: Colonic interposition, free jejunal flap reconstruction.
• Laryngeal suspension procedures for swallowing
• Cricopharyngeal myotomy

Voice and swallowing therapy

Speech-language pathologists (SLPs) specializing in voice therapy are involved in the diagnosis, assessment, planning, and treatment of individuals with voice disorders. SLPs are trained to evaluate voice use and vocal function to determine the cause of reported symptoms and to determine optimal treatment methods for improving voice production.

Voice therapy is a behavioral intervention technique that makes use of vocal hygiene, breathing exercises and exercises that facilitate better voicing.

Voice therapist  provides prevention information to individuals and groups known to be at risk for voice disorders, as well as to individuals working with those at risk, detail voice evaluation, including clinical and instrumental evaluation, identify normal and abnormal vocal function, describe perceptual qualities of voice, and assess vocal habits, make decisions about management of voice disorders to improve the quality of life, counsel patients and provide education aimed at preventing further complications from voice disorders.

Speech and swallowing pathologist is responsible for the diagnosis of swallowing problems and determining a course of treatment. Speech pathologists work as part of a multidisciplinary team to support people with dysphagia. The role of the speech pathologist is to evaluate swallowing dysfunction and difficulties using tools such as a bedside dysphagia evaluation, Modified Barium Swallow evaluation (MBS), or Fiberoptic Endoscopic Evaluation (FEES).

 Once an evaluation has been completed the role of the speech language Pathologist is to determine not only the safest diet for the patient in order to reduce their risk of aspiration also to provide support to ensure that mealtimes are safe and enjoyable for children and adults with dysphagia .SLP develops a mealtime          management plan for people with swallowing difficulties following the texture and consistency guidelines.