Laryngology

What is Laryngology?

Laryngology is the specialty dedicated to care for throat problems.  The larynx is also known as the voice box, and the larynx is the central organ for laryngologists.  The picture shown is a picture of the larynx from the front view.  The throat and larynx are amazing structures that allow patients to talk, sing, breathe, and swallow.  The vocal cords (or vocal folds) are small structures within the larynx that are essential for this normal functioning.  Unfortunately, some patients develop throat problems that lead them to seek care from a doctor or speech pathologist.  Symptoms that are commonly found in patients seeking such care include, voice changes (dysphonia), breathing problems or shortness of breath (dyspnea), swallowing problems (dysphagia), aspiration, sore throats, chronic cough, chronic throat clearing, and growths in the neck or throat.


When patients have these sorts of problems, they should have a full evaluation by a throat specialist.  Laryngologists are physicians who are uniquely trained and suited to evaluate and create a specifically tailored treatment plan for such patients, whether that be therapy, medicine, surgery, or a combination.  Speech pathologists are therapists who also specialize in throat disorders and work closely with laryngologists to help with the evaluation process and to provide the therapy needed for many patients.  

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Voice Problems (Dysphonia)

Professional Voice Care

 Professional voice users are individuals who use their voices for their livelihood, including performers, singers, lecturers, teachers, and others who rely on their voice.  Dr. Parker and his team have a particular interest in professional voice users, as they present a unique set of vocal problems that are optimally treated by voice specialty providers.  This includes services offered by few in the region, such as the most advanced evaluation techniques, voice therapy, office-based surgery, and state of the art procedures.  Rehabilitating these patients so that they can rely on and enjoy their voice again is our primary goal. 

Laryngeal Dysplasia and Cancer

Laryngeal dysplasia is a precancerous growth, while squamous cell carcinoma is the most common cancer of the larynx.  Voice changes are often the first sign, so patient with greater than 3-4 weeks of voice changes should be evaluated by a throat specialist.  Vocal cord dysplasia and cancer can be treated with surgery, radiation, or chemoradiation.  If caught early enough, these can be cured with very high success rates oncologically and vocally.  Dr. Parker specializes in photoangiolysis of these types of lesions, and is involved in research studying oncologic and voice outcomes.  

Vocal Cord Paralysis

When the nerves that supply the vocal cords are damaged, a vocal cord may become paralyzed, which can lead to a problem where the vocal cords cannot close effectively.  Patients may develop a hoarse voice, weak cough, and difficulty with swallowing.  Vocal cord paralysis can be treated with a quick, office-based procedure to re-position the vocal cord in a more favorable position.  Longer term options include a permanent re-positioning procedure or re-innervation procedure to achieve improvement in function.  Dr. Parker has been involved in research studying vocal outcomes from such surgeries.  

Benign Vocal Cord Growths

There can be large or very small growths on the vocal cords that can lead to significant voice changes for patients.  Nodules, polyps, cysts, polypoid corditis, papilloma, and other benign growths can lead to significant voice dysfunction because the alter the way the vocal cords need to vibrate.  Will nodules can resolve with therapy alone, many others require surgical excision.  

Laryngeal Papilloma

 Laryngeal papilloma or recurrent respiratory papillomatosis is a condition where benign growths can develop in the larynx (voice box) and other upper airway regions.  Papilloma on the vocal cords leads to significant hoarseness.  Papilloma can be treated by surgical removal and with medications to reduce regrowth.   Dr. Parker has been involved in research looking at some of these medications and how they affect recurrence rates.

Spasmodic Dysphonia and Vocal Tremor

Spasmodic dysphonia, vocal tremor, Parkinson's hypophonia, and other neurological problems can affect the voice box (larynx).  Spasmodic dysphonia is a problem of involuntary, irregular spasm of the vocal cords, while tremor is a rhythmic spams of the vocal cords.  They both can lead to significant voice changes.   Office-based botulinum toxin injections and therapy can significantly improve symptoms for patients.

Breathing Problems (Dyspnea)

Laryngeal Stenosis

Laryngeal stenosis occurs when the larynx (voice box, usually at the level or above the level of the vocal cords) develops scarring that limits its ability to open normally.  Because the larynx is part of the upper airway, this can lead to difficulty breathing.  There are a number of treatment options to open the larynx to improve breathing and to avoid or remove a tracheotomy tube.

Subglottic and/or Tracheal Stenosis

 Subglottic and/or tracheal stenosis refers to a narrowing below the level of the vocal cords that is usually from trauma or an inflammatory problem.  By narrowing the upper breathing passageway, patients develop difficulty breathing.  There are a number of treatment options to open these regions, including endoscopic and open surgical procedures.  

Vocal Cord Dysfunction

The vocal cords are the structures in the larynx (voice box) that open and close so that voice production, breathing, and swallowing can all be balanced.  Vocal cord dysfunction refers to vocal cords that do not open normally, which leads to trouble breathing, often in patients who need to breathe to play sports!  Typically, this can be completely treated with therapy.

Vocal Cord Paralysis

 The vocal cords are the structures in the larynx (voice box) that open and close so that voice production, breathing, and swallowing can all be balanced.  When both vocal cords are paralyzed, they often lie in a position that makes it difficult to breath (voice can be normal!).  There are a number of surgical options to help these patients.

Recurrent Respiratory Papilloma

Laryngeal papilloma or recurrent respiratory papillomatosis is a condition where benign growths can develop in the larynx (voice box) and other upper airway regions.  In adults, but especially in children, these can grow large enough to make it difficult to breathe.  Papilloma can be treated by surgical removal and with medications to reduce regrowth.

Obstructing Growths in the Throat and Neck

There are a number of benign (non-cancerous) and malignant (cancerous) growths that can limit breathing.  Whether blocking the airway from within or pushing from the outside, anyone with upper airway breathing trouble need to be evaluated and treated right away.

Swallowing Problems (Dysphagia)

Zenker's Diverticulum

During swallowing, pressure is generated in the throat to move food and liquid to the stomach.  Sometimes, this pressure can push through an area of weakness and turn into a small out-pouching (a diverticulum).  A Zenker's diverticulum is a type of out-pouching that is associated with difficulty swallowing solid food, getting food caught, and sometimes coughing up food after a meal.  Fortunately, a Zenker's can typically be treated with a minimally invasive procedure that resolves the symptoms.  Dr. Parker was part of a research project evaluating various endoscopic techniques.  

Cricopharyngeal Dysfunction

At the top of the swallowing tube (esophagus) is a ring of muscle called the cricopharyngeus muscle.  This muscle acts like a belt to keep food, liquid, etc from coming up from the stomach, but also must relax and open during swallowing so that food can go down to the stomach.  When the cricopharyngeus muscle is "over-active" or "tight" patients have trouble getting food, particularly more solid food, into the esophagus.  Food gets "caught".  This problem can be treated with dilation, use of botulinum toxin, and/or surgical procedures to release the muscle. 

Esophageal Stricture

Esophageal stricture is a problem that occurs when there is a narrowing of the swallowing tube (esophagus).  Due to this narrowing, patients describe difficulty getting solids foods, sometimes even liquids, from the upper throat down to the stomach.  This type of swallowing problem can be quite significant for patients and even cause a health risk if food or liquid goes into the lungs.  Esophageal stricture can be treated with a minor outpatient procedure to stretch the area, open up the narrow area, and allow food and liquid to go down more smoothly.

Reflux

Reflux refers to material coming up from the stomach and into the swallowing tube (esophagus) and upper throat (pharynx and larynx).  Acid reflux refers to acidic material, while non-acidic reflux refers to enzymes and other materials.  In either scenario, patients can feel heartburn, indigestion, voice changes (hoareness, dysphonia), chronic cough, feeling lump in the throat, and/or throat clearing.  Reflux can also lead to other problems, such as nose and sinus disorders or pre-cancerous changes to the esophagus.  Reflux can be managed with diet, medications, or surgical procedures to improve symptoms and to reduce risk of other issues that can arise.

Growths Affecting Swallowing

There are a number of benign (non-cancerous) and malignant (cancerous) growths that can arise in the neck or throat.  These can cause a variety of changes in swallowing based on location, size, and invasiveness.  Some growths affect the structures in the throat, while others can cause damage to important nerves.  If patients notice progressive trouble with swallowing solids and/or liquids, then a full evaluation should be performed to identify the problem and to create a treatment strategy.  If the problem is due to a growth in the neck or throat, then a tailored treatment plan can be created to not only improve swallowing, but also to treat the growth underlying the problem. 

Age-Related Swallowing Changes

Changes to swallowing occur as individuals age.  There are a number of subtle and not so subtle effects that arise in the throat that can lead to difficulty getting solid and/or liquid foods from the upper throat (pharynx and esopahgus) to the stomach.  If patients are having progressive trouble swallowing, including having trouble getting food or pills down, coughing or choking with meals, or having to change diet significantly, then a full evaluation is important to identify the problem and create treatment options.  These often include swallowing therapy, medication, and/or interventional options.