Download Treatment Options for Voice Conditions

Treatment Guide
Treatment Options
for Voice Conditions
Treatment Options for Voice Disorders
The Cleveland Clinic Voice Center is a center of excellence
within the Head & Neck Institute that is dedicated to the
treatment of voice disorders, particularly those of the professional voice user.
Through a team approach, Voice Center specialists tailor
voice disorder treatment plans to their patients’ needs. Ear,
nose and throat specialists, speech pathologists and voice
teachers provide primary services in conjunction with other
medical specialists. The Voice Center coordinates care of its
patients with Cleveland Clinic’s Center for Performance Medicine, Arts and Medicine Institute and Wellness Institute.
This guide provides an overview of the services and voice
disorder treatment options offered through the Voice Center.
Same-Day appointments are available.
Call 216.445.TALK or 800.223.2273, ext. 58255
Cleveland Clinic’s ear, nose and throat
program is top-ranked in Ohio and
among the top 10 in the nation.
HEAD & NECK INSTITUTE
CLEVELAND CLINIC | VOICE CONDITIONS | TREATMENT GUIDE
Types of
Voice Disorders
Cancer of the larynx – The inner walls of the larynx (voice box)
are lined with cells called squamous cells. Almost all laryngeal
cancers begin in these squamous cells. If not caught early, laryngeal cancer can spread (metastasize) to nearby lymph nodes
in the neck. If caught early, laryngeal cancer is very treatable.
Functional dysphonia is a condition in which the voice
becomes very hoarse in the absence of vocal fold or laryngeal
pathology (disease).
Hoarseness is a general term that describes abnormal voice
changes. When hoarse, the voice may sound breathy, raspy,
About Voice Disorders
Symptoms of a voice disorder can
include hoarseness, roughness of the
voice, discomfort when talking or singing,
and loss of singing control. The cause
of these symptoms cannot be determined
without the evaluation of a voice
disorder specialist.
strained or inconsistent, or there may be changes in volume,
clarity or pitch of the voice.
Laryngitis is an inflammation of the true vocal folds or larynx
in general (voice box) that causes hoarseness or the complete
loss of voice.
Laryngopharyngeal reflux disease is caused by the regurgitation of stomach acid up into the throat. This reflux can cause
inflammation and swelling in the throat or in the larynx (voice
box) and can cause hoarseness, a sense of a “lump” in the
throat (also known as globus sensation), a sense of mucous
sticking or a need to frequently clear the throat.
Laryngeal stenosis is a narrowing of the airway typically
caused by prior trauma to the vocal folds, joints that move the
vocal folds, or the airway immediately below the vocal folds.
Common causes of stenosis include trauma from intubation,
prolonged placement of an endotracheal tube, or the placement
of an endotracheal tube that is too large for the airway. Stenosis is also seen in patients with chronic autoimmune diseases
such as Wegener’s Granulomatosis and rheumatoid arthritis.
Muscle tension dysphonia is a condition in which there is an
imbalance of muscle tone in the muscles related to voice, causing hoarseness and vocal fatigue.
Same-Day appointments are available.
Call 216.445.TALK or 800.223.2273, ext. 58255
CLEVELAND CLINIC | VOICE CONDITIONS | TREATMENT GUIDE
HEAD & NECK INSTITUTE
papillomatosis can affect adults, children and infants.
This disease typically requires repeated procedures
to remove the papillomas. There is no cure for this
disease at this time.
Spasmodic dysphonia is a localized muscle disorder
of the larynx that causes the voice to have a spastic
strained or breathy quality.
Swallowing disorders – Dysphagia, or difficulty while
swallowing, can be caused by a number of possible
conditions including cancer, surgery or radiation
for cancer, laryngopharyngeal reflux, degenerative
neurologic conditions, strokes and esophageal motilPolypoid Corditis, also known as Reinke’s edema, is chronic
swelling of the vocal folds due to cigarette smoking. This typically causes hoarseness and will recur following surgery if the
patient continues to use tobacco.
Professional voice disorders – Many people who use their
voices for a living, including singers, teachers, coaches, clergy,
salespersons and other public speakers, may experience
temporary or more long-lasting problems with their voices.
These problems may be experienced as increased vocal fatigue,
decreased volume, decreased vocal clarity or discomfort after
ity problems. A multidisciplinary approach involving
speech pathologists, otolaryngologists (ear, nose and
throat doctors), gastrointestinal specialists, and neurologists is often required for appropriate diagnosis and
treatment.
Vocal fold dysfunction is a condition characterized
by episodes of shortness of breath, caused by inappropriate movement of the vocal folds, resulting in a
functional upper airway obstruction. Breathing and
laryngeal-control therapy are very effective treatments
speaking or performing. Persistence of such symptoms should
for this condition.
prompt a visit to a voice specialist.
Vocal fold lesions or masses are noncancerous
Recurrent respiratory papillomatosis is a disease in which
(benign), abnormal growths within or along the vocal
papillomas or wart-like lesions grow along the surfaces of the
larynx or vocal folds or, occasionally, along the respiratory
tract leading from the trachea into the lungs. The papillomas,
fold that impair normal vocal fold vibration and cause
hoarseness. These lesions include nodules, polyps or
cysts. They are treated by voice therapy, surgery, and
which are caused by the human papilloma virus, are typically a
sometimes both.
chronic problem characterized by irregular recurrence patterns.
Vocal fold paralysis is the immobility of one or both
This causes hoarseness, but can occasionally cause breathing
vocal folds, causing problems with either hoarseness
problems if the papillomas involve the lower airways. Laryngeal
or breathing. This requires a formal diagnostic work-up.
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CLEVELAND CLINIC | VOICE CONDITIONS | TREATMENT GUIDE
Short- and long-term voice rehabilitation typically involves
surgery, voice therapy or both.
Vocal fold scarring results from damage to or gradual loss of
the pliable layer of the vocal folds. This can occur as a result
of damage from repetitive trauma from poor vocal hygiene,
vocal abuse, intubation injury, congenital vocal fold lesions,
surgery or aging.
Surgical therapy includes procedures to remove benign, premalignant and malignant masses or lesions as well as temporary or more permanent procedures to rehabilitate vocal cord
paralysis.
•Vocal fold medialization procedures to rehabilitate unilateral
HEAD & NECK INSTITUTE
Care of the Professional
and Performing Voice
The Cleveland Clinic Voice Center, one of only a
handful of complete, dedicated voice treatment
centers in the country, specializes in helping voice
professionals perform better, prolong their careers
and preserve their voice health.
A laryngologist (a sub-specialized ear, nose and
throat doctor) and a speech-language pathologist
conduct evaluations to determine the cause of the
voice problem. The examination includes a formal
history and voice recording as well as a complete
head and neck examination and appropriate general
medical examinations, depending on the patient’s
vocal fold paralysis are typically done under local anesthesia
overall health history. A direct evaluation of the vo-
with light sedation.
cal folds usually is performed via videostroboscopy.
•Vocal fold injection and microsurgery of the vocal folds are
The voice team uses the information gathered to
performed through a specialized scope with microsurgical
diagnose the problem and to guide treatment. The
instruments.
patient’s voice teacher or personal doctor may be
Some surgical procedures will use laser technology. Some vo-
included in the treatment planning. There may be
cal fold surgeries will require a period of complete voice rest.
times in which the professional voice user needs
Surgery is typically outpatient or requires a brief stay in the hos-
to be evaluated at the theater or studio. The voice
pital. Postoperative discomfort is typically brief but patients may
team can give the performer images or videos of his
experience a sore throat, hoarseness, temporary numbness
or her vocal folds to be used to evaluate response to
of the tongue, or brief alteration in taste. Each surgical plan is
treatment and to have available should treatment be
individualized to the patient’s medical and vocal situation.
needed in other centers.
HEAD & NECK INSTITUTE
CLEVELAND CLINIC | VOICE CONDITIONS | TREATMENT GUIDE
Treatment Options
Most voice problems can be managed successfully without
surgery through behavioral change and medical care. If surgery
is necessary, specialized techniques that limit harm to laryngeal
tissues and strive to preserve the pliable, layered microstructure
of the vocal folds, are employed by our surgeons.
The Voice Center offers the following treatment options for various voice disorders:
Voice therapy - the use of vocal and physical exercises, along
with behavioral changes, to treat voice disorders and improve
vocal health.
Voice Center Services
Laryngeal manipulation - a technique for manually reposition-
Our full range of voice care services and state-
ing the larynx to reduce irregular muscle tenion and improve
of-the-art facilities help us to provide optimal
voice quality.
care for voices in need. We treat major prob-
Medical therapy may sometimes be used to treat laryngitis,
lems and minor disorders and offer personal
acid reflux or post-nasal drainage from allergies or infection that
consultations and comprehensive evaluations
causes laryngeal irritation.
to stop potential problems before they start.
Office-based procedures offer patients immediate benefits and
allow voice specialists to evaluate the effectiveness of the treat-
Voice Evaluation
ment as it is being done:
To evaluate voice issues, Voice Center spe-
•Botulinum toxin (BOTOX) injections are used for the tem-
cialists utilize state-of-the-art technology to
porary treatment of spasmodic dysphonia, typically improv-
assess laryngeal biomechanics and vocal fold
ing the quality of the voice for a period of time that ranges
oscillation. Cleveland Clinic Voice Center staff
between three and four months. The procedure is simple and
members perform physical exams and spe-
has had predictably good results, with most patients experi-
cialized tests on each patient to determine the
encing a return to normal or near normal voice.
nature and extent of their voice disorders.
These tests include voice recording and analysis, high-resolution video analysis via a flexible
or rigid endoscope, and videostroboscopy (a
procedure in which the oscillation and pliability of the vocal folds is evaluated). Formal
airway evaluation also can be performed. The
endoscopes visualize the vocal folds or airway
via the nose or mouth and are generally well
tolerated.
Same-Day appointments are available.
Call 216.445.TALK or 800.223.2273, ext. 58255
•Vocal fold injection for the short-term treatment of vocal fold
paralysis, paresis, or age-related vocal fold bowing.
•Laser surgery for the treatment of vocal fold lesions including
laryngeal papillomatosis, vascular lesions and laryngeal dysplasia. It is common for patients to initially undergo surgical
treatment in the operating room for these conditions and then
transition to office-based management.
CLEVELAND CLINIC | VOICE CONDITIONS | TREATMENT GUIDE
HEAD & NECK INSTITUTE
Services for Patients
Voice Center Specialists
Medical Concierge
Complimentary assistance for out-of-state patients and
families. 800.223.2273, ext. 55580, or email
[email protected]
Global Patient Services
Complimentary assistance for national and international
Tom Abelson, MD
Richard Freeman, MD, PhD
patients and families. 001.216.444.8184 or visit
clevelandclinic.org/gps
Remote Consults
Request a remote medical second opinion from Cleveland
Clinic. MyConsult is particularly valuable for patients who
wish to avoid the time and expense of travel. Visit
clevelandclinic.org/myconsult, email [email protected]
or call 800.223.2273, ext 43223.
Paul Bryson, MD
Douglas Hicks, PhD
MyChart®
Cleveland Clinic MyChart® is a secure, online personal
healthcare management tool that connects patients to their
medical record. Patients can register for MyChart through
their physician’s office or by going online to
clevelandclinic.org/mychart.
Michael S. Benninger, MD
Facebook.com/clevelandclinic
twitter.com/clevelandclinic
youtube.com/user/ClevelandClinic
Claudio Milstein, PhD
Explore our services, locations and more at
The Head & Neck Institute treats complex disorders of the ear, nose,
throat and mouth. It combines the expertise of otolaryngologists, oral
surgeons, dentists and voice specialists to provide compassionate care
for adult and pediatric patients and specialized care for the professional
voice. It collaborated in the world’s first successful larynx transplant and
the world’s first near-total face transplant, and it is one of the largest
programs of its kind. The Head & Neck Institute is one of 27 institutes
at Cleveland Clinic, a nonprofit academic medical center ranked among
the nation’s top hospitals (U.S. News & World Report), where more than
3,000 physicians and researchers in 120 specialties collaborate to give
every patient the best outcome and experience.
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