New Center for
Voice Offers Treatment Options
November / December 2002
From common hoarseness to rare disorders, otorhinolaryngologists
at the recently established Penn
Center for Voice at Pennsylvania
Hospital diagnose and treat a wide variety of voice disorders.
Persistent Hoarseness or Throat Pain
"If a patient has persistent hoarseness, throat pain or discomfort
they should be seen by an otorhinolaryngologist. In most
cases
it will not be a serious condition but the symptoms should
not be ignored," says Joel
H. Blumin, MD, director of the Penn Center for Voice. "At
times we find laryngeal cancer in patients who smoke or
scarring of the vocal cords, but many patients with hoarseness
may simply have reflux which is easy to treat with medication."
Otorhinolaryngologists
at the Penn Center for Voice also treat cancers when voice
preservation is a high priority.
An uncommon
disorder that presents with hoarseness and difficulty breathing
is laryngeal papilloma or warts of the vocal cord. Although
this disorder usually affects children, it can develop in
adults. The standard treatment involves laser surgery to
remove
the warts, but recently specialists have been using a potent
antiviral medication, cidofovir, that is injected into the
affected area.
Patients undergoing this new regime may be
able to avoid frequent trips to the operating room. Although
most often people think of singers or TV/radio personalities,
professional vocalists also include those who rely on their
voices to interact and perform their jobs, such as teachers,
clergy and sales professionals. Vocal cord nodules or polyps,
bleeding into a vocal cord, and reflux are familiar problems
of the professional vocalist whose symptom is often hoarseness. "In
addition to treating the clinical condition, the Penn Center
for Voice also provides ongoing therapy and advice
on how to better use and preserve the voice," says Dr. Blumin.
Spasmodic Dysphonia
Spasmodic Dysphonia is an uncommon neurologic disorder that
affects between 35,000 and 50,000 Americans. It causes contraction
of the muscles that control the vocal cords and leaves patients
with a hoarse-sounding, non-fluent voice. Although usually
treated with botox injections, some patients find that botox
does not work well for them and they seek alternative treatment,
such as surgery. In more than 90 percent of patients, surgery
leaves them speaking normally without the spasms.
"Spasmodic
dysphonia is an extremely socially debilitating condition.
Those affected cannot speak, don't interact with others
and
often spend their time sitting at home. After surgery they
can speak normally and regain their lives," explains Dr.
Blumin, who is one of the few surgeons in the country who
have been
trained to surgically correct this disorder. The operation
entails cutting the nerves within the voice box that lead
to the spasming muscles. Utilizing a microscope for the delicate
suturing, new unaffected nerves are connected to the cut
nerve
ends to provide improved control.
Unfortunately, it is not
unusual for patients to remain undiagnosed for more than
a
year. They are often told it is a psychological disorder
with no treatment. Dr. Blumin and fellow otorhinolaryngologists
and voice disorder specialists Joseph
P. Atkins, Jr., MD, executive director of the Penn
Center for Voice and James
P. Kearney, MD, are skilled at recognizing unusual
voice disorders.
Parkinson's Hypophonia
Parkinson's Hypophonia, a weakness of the vocal cords, is
present in 70 to 90 percent of patients with Parkinson's Disease
(PD). A simple treatment involves injecting a material into
the patient's vocal cords to temporarily strengthen them.
The injection can be repeated every few months. "Despite the
fact that most patients with PD cite their weak voice as very
bothersome, most cases go untreated," says Dr. Blumin, who
works closely with the Parkinson's Disease and Movement Center
at Pennsylvania Hospital.
Scarring of the Airway
When patients have narrowing or scarring of the airway due
to an injury, the traditional treatment method involves
inserting
a permanent tracheotomy. Instead, otorhinolaryngologists
at the Penn Center for Voice open the scar and reline it
with
new tissue (from the mouth or the skin) that prevents the
scar from reforming. Dr. Blumin recalls one patient who
had
a tracheotomy placed when he was in his teens due to a bizarre
accident. Twenty years later Dr. Blumin performed corrective
surgery and the patient now speaks normally with no tracheotomy.
Transgender Voice
Transgender voice is also corrected at the Penn Center for
Voice through a fairly simple surgical procedure. Working
through a small incision in the neck, surgeons open the
voice
box and readjust the cartilages to alter the voice. This
procedure is also performed on patients undergoing a sex
change operation.
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