Perspectives on Voice and Voice Disorders

Coordinator's Corner

Sandage, M. — 2009-03-04

Dollars $$ Sense

Nikjeh, D. A. — 2009-03-04

The Evolution of Diagnosing Benign Vocal Fold Lesions: From Vague to Specific

Gartner-Schmidt, J. L., Rosen, C. A. — 2009-03-04

The evaluation and treatment process for dysphonia due to benign vocal fold lesions (BVFL) can often be a complex and confusing process for clinicians as well as patients. There is no one perfect method, and there are many different approaches to this problem. It is our goal to share our multidisciplinary team evaluation process, decision-making approach, and treatment for patients with these types of voice fold lesions. Our goal is to highlight the teamwork and cross disciplinary cooperation that optimizes patient evaluation and care.

A Synopsis of the Management of Vocal Fold Scar

Hapner, E. R., Klein, A. — 2009-03-04

Vocal fold scarring remains one of the greatest therapeutic challenges in laryngology and voice therapy. The loss of superior lamina propria results in a change in the pliability of the vocal folds with changes in glottal configuration, glottal closure, and reduced to absent mucosal wave motion. This results in dysphonia of varying severities including breathiness, roughness, loss of pitch range, and flexibility. The aim of this article is to present a brief review of vocal fold architecture and a discussion of the etiologies of vocal fold scarring. Methods to evaluate vocal fold scarring are presented with examples of findings in laryngoscopic, acoustic, aerodynamic, and perceptual assessments. Medical, surgical, and behavioral treatment for vocal folds scaring including sample therapy tasks are included.

Management of Adult Vocal Fold Nerve Injury

Woo, P., Carroll, L. M. — 2009-03-04

Diagnosis and management of nerve impairment in adults can be difficult due to the myriad of other diagnoses that must be considered. Accurate diagnosis of severity of a nerve impairment and determination of prognostic indicators for return of adequate function are paramount to best management. The strongest prognostic test of nerve function is electromyography. Team management by an otolaryngologist and speech-language pathologist of vocal fold paralysis needs to be sensitive to the patient's needs, both short-term and long-term. This article summarizes the current diagnostic tests and options. Case studies are included to guide the reader through team management and surgical options.

Hands-Free Cough and Speech in Long-Term Tube-Free Tracheostomy

Milstein, C., Akst, L. M., Eliachar, I. — 2009-03-04

A surgical technique developed by Dr. Isaac Eliachar in the Section of Laryngotracheal Reconstruction, Cleveland Clinic Department of Otolaryngology, dramatically improves quality of life in patients who require a long-term tracheostoma. This procedure, called "long-term tube-free tracheostomy" (LTTFT), creates a self-sustaining tracheostoma that requires no tracheotomy tubes to maintain patency. The advantages of a tube-free procedure are numerous, and the improvements in quality of life of patients who have successfully undergone this operation are readily noticeable. These benefits include (a) removal of tracheal appliances, such as tracheal tubes, valves, vents, and stents; (b) prevention of tissue damage associated with appliances and a decrease in tissue irritation and formation of granulation tissue; (c) better secretion management, elimination of frequent clogging of tracheal appliances, and need for suction; (d) prevention of aspiration; (e) retention or re-establishment of the functions of sniffing and smelling; and (f) performance of hands-free cough and speech production due to the self-constricting capabilities of the stoma. The purpose of this article is to present the concept of LTTFT as an alternative to standard tracheotomy in select patients. The difference between LTTFT as an alternative to tracheotomy and the impact these differences have upon medical decision-making will be emphasized.