Voice and Swallowing (Throat Problems)
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Boston Medical Center's Voice and Swallowing department houses a team of experts, including voice therapists, laryngologists, and speech-language pathologists and offers a wide array of diagnostic and treatment options for people with vocal or swallowing disorders.
"Dr. Grillone is one of the kindest most competent physicians I've ever seen. Highly professional and thoughtful in addition to solving a problem I've had for a while."
~ John A.
Voice problems such as the voice being tired or strained after prolonged usage can affect both professional and personal life. Voice problems often originate in the lungs, throat, larynx, and mouth and can be caused by a variety of conditions, including acute laryngitis; acid reflux; or polyps, cysts, or nodules on the vocal folds. Thankfully, the vast majority of voice problems are caused by non-life-threatening disorders and are easily treatable.
To schedule a consult with one of BMC’s voice and swallowing experts, call us at 617.638.8124.
Voice and Swallowing (Throat Problems)
Moakley Building 617.638.8124
Conditions We Treat
Acid reflux happens when the muscle at the bottom of the esophagus (tube that carries food to the stomach from the mouth), called the esophageal sphincter (LES), does not close properly and stomach acid leaks back into the esophagus. This can cause a burning sensation in the chest area. Acid reflux is caused by a number of things, including certain foods like citrus foods and onions, alcohol, and conditions like pregnancy and being overweight.
Esophageal cancer occurs the esophagus, which is the tube that connects the throat to the stomach. This type of cancer is more common in men than women and is not very common in the United States.
Vocal cord lesions (physicians call them vocal fold lesions) are a group of noncancerous (benign), abnormal growths within or along the covering of the vocal cord. Vocal cord lesions are one of the most common causes of voice problems and are generally seen in three forms; nodules, polyps, and cysts.
Paradoxical vocal fold movement (PVFM), happens when the vocal folds close instead of open. For example, when taking a deep breath, the vocal folds should open to let air through to the lungs. With PVFM, the vocal folds will close, making it hard to breathe. Often misdiagnosed as asthma, PVFM most often causes wheezing, stridor, and breathing problems.
Sulcus vocalis, like vocal fold scarring, is an indentation or retracted area on the vocal fold (cord) from scarring. It's sometimes called a hole in the vocal cord. The vocal cords are the structure that open for breathing, close for swallowing, and vibrate as air passes through to produce sound. With sulcus vocalis, an alteration in the vibration of the cord happens, causing abnormal vocal sounds including hoarseness. It can also cause vocal weakness and fatigue.
The glands are found in and around your mouth and throat. The major salivary glands are called the parotid, submandibular, and sublingual glands. They all secrete saliva into the mouth, the parotid through tubes that drain saliva, called salivary ducts, near the upper teeth, submandibular under the tongue, and the sublingual through many ducts in the floor of the mouth.
Spasmodic dysphonia is a rare, chronic neurological disorder that causes spasms in the vocal chords, interrupting the ability to create sound. Symptoms may start slowly, with the voice sounding tight with breaks when speaking. Symptoms develop over time until speech is difficult to understand. The cause of the spasms is generally thought to be an abnormality in the central nervous system.
Vocal cord paralysis happens when the nerve impulses to the vocal box (larynx) are interrupted, causing paralysis. Because the vocal cord muscles not only help produce sound but help to keep saliva, food and fluid from entering the windpipe (trachea), vocal cord paralysis requires medical help. The condition can be caused by number of things including nerve damage during surgery, from cancer, or a viral infection.
Laryngeal cancer is a type of throat cancer that develops in the voice box (larynx), which contains the vocal cords that vibrate to make sound when air is directed at them. Using tobacco products and drinking alcohol can raise the risk of laryngeal cancer.
Zenker's diverticulum (ZD) is a condition characterized by a pouch that develops in the upper esophagus in the neck.
Treatments & Services
Botulinum toxin, or botox, injections may ease symptoms in some patients with motility disorders.
This is a medical treatment that uses focused light. Surgeons can focus on a small area and damage less of the surrounding tissue. Patients who have laser therapy may experience less pain, swelling, and scarring than with traditional surgery.
Cidofovir is an injectable antiviral medication used to treat laryngeal papilloma.
Other Voice and Swallowing (Throat Problems) Treatments
A number of other therapies are available for voice and swallowing problems.
Diagnostics and Tests
The Center offers diagnostic options for papillomas and early stage larynx cancer, and for swallowing and voice problems due to Parkinson's disease, stroke and other neurological disorders.
This state-of-the-art voice center provides the full scope of diagnostic testing including:
- Acoustic Analysis
- A variety of in-office laryngeal procedures
Video laryngoscopy is a form of indirect laryngoscopy in which the clinician does not directly view the larynx. Instead, visualization of the larynx is performed with a fiberoptic or digital laryngoscope inserted through the nose or mouth.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
FEES is a procedure that allows physicians to assess areas surrounding the voice box and opening of the esophagus, through the use of a small flexible telescope.
Transnasal Esophagoscopy (TNE)
TNE uses a camera that is passed through the nose as a way to examine the esophagus in patients at risk for esophageal cancer and other disorders. TNE doesn’t require sedation, unlike other techniques widely used to look into the esophagus.
This test evaluates your swallowing. Pharyngeal and upper sphincter manometry can detect the sphincter’s (muscle that maintains constriction of a natural body passage) failure to relax and assess the coordination between the contraction of the pharynx and the relaxation of the upper esophageal sphincter.
A barium swallow (also called a contrast esophagram), is a series of x-rays of your esophagus. For the test, you will drink a barium-containing liquid, which coats the inside of the esophagus and makes its shape and contours appear on x-rays.
An esophagram, or contrast esophagram (also called a barium swallow), is a series of x-rays of your esophagus. For an esophagram, you will be asked to drink a barium sulfate liquid while x-rays are taken of the swallowing process.
Modified Barium Swallow Study (MBS)
This test is used to view your swallowing function. You will be asked to swallow a variety of barium-coated substances, such as liquid, applesauce, and a cracker.
Pharyngeal pH Reflux Testing
Pharyngeal pH monitoring is a test used to evaluate for effects from gastroesophageal reflux disease that could be affecting the throat and result in swallowing, breathing, or voicing problems.
Performers generally look upon vocal problems with dread. There are few things worse than having to walk in front of an audience with the fear that your voice may not function properly. A routine examination by a voice care team can often make the difference between a successful performance and a canceled one.
Benign and Malignant Tumors of the Head and Neck, Robotic Surgery and Minimally Invasive Surgery for Head and Neck Tumors, Laryngeal, Voice and Swallowing Disorders, Surgical Treatment of Sleep Apnea, Diseases of the Trachea and Esophagus, Zenker's Diverticulum
Professor of Otolaryngology, Head & Neck Surgery, Boston University School of Medicine
Hoarseness, Parathyroid, Thyroid and Voice Problems, Zenker's Diverticulum
Hoarseness and voice disorders, Professional voice, Dysplasia and vocal cord cancer, Office-based laser laryngeal surgery, Airway and swallowing disorders, Diseases of the trachea and esophagus, Zenker's Diverticulum
Speech Language Pathologists
Dysphagia (swallowing problems), Dysphonia (voice problems), Cognitive Deficits and Aphasia (language problems), Reflux-related disorders
Dysphonia (voice disorders), professional voice, globus syndrome, muscle tension dysphagia
Professional voice, dysfunctional breathing, muscle tension dysphonia, irritable larynx and chronic cough
Dysphagia, dysphonia, and neurogenic disorders of language and cognition
Swallowing assessment, FEES, MBS, dysphagia therapy, aphasia, cognitive-communication deficits
Dysphagia (swallowing problems), Dysphonia (voice problems), Reflux-related disorders, Alaryngeal Rehabilitation included Tracheoesophageal (TEP) Voice Restoration/Management
Feeding Difficulty, Selective Eating, Pediatric Dysphagia
Dysphagia (swallowing problems), Alaryngeal rehabilitation including tracheoesophageal (TEP) voice restoration/management, Evaluation and treatment of swallowing problems after head and neck cancer
Kim Boscodoss, MS, CCC-SLP
Michelle Ganann, CCC-SLP
Anna Lifvergren, CCC-SLP
Juliet Ochura, MS, CCC-SLP, CLC
Jennifer Perez, MS, CCC-SLP, CLC
Krystal Radnor CCC-SLP-CFY Clinical Fellow
Keri Miloro, CCC-SLP
Casey Scott, MS, CCC-SLP-CFY Clinical Fellow
Samantha Ashinoff, MS, CCC-SLP
Vocal Cord Dysfunction Study - Looking for Participants
Do you experience any of the following?
- Shortness of breath due to exercise or stress
- Paradoxical vocal fold motion (PVFM)
- Vocal cord dysfunction (VCD)
If so, and you're over 12 years old, you are a good candidate for our breathing retraining study. BMC and the University of Haifa are conducting a joint study on a breathing retraining program for paradoxical vocal fold motion - PVFM (also known as vocal cord dysfunction: VCD).
PVFM can look a lot like an asthma attack, including shortness of breath or difficulty breathing. However, PVFM will not respond to asthma medication. Also, unlike asthma, a person will have more difficulty inhaling than exhaling. This is a common disorder among athletes; physical exertion can be a trigger.
Contact Information for the study
Hadas Golan, MS/CCC-SLP
Email: [email protected]
Location: 830 Harrison Avenue, Suite 1425
The STEPP LAB for Sensorimotor Rehabilitation Engineering is affiliated with the Department of Otolaryngology – Head and Neck Surgery through principal investigator, Dr. Cara Stepp. They are a multidisciplinary group of researchers with the shared goal of improving the assessment and treatment of sensorimotor disorders of voice and speech, applying techniques from electrical engineering, computer science, rehabilitation engineering, neuroscience, laryngology, speech science, and communication disorders. Ongoing studies in the lab are in collaboration with clinician-investigators with primary appointments in the Department of Otolaryngology – Head and Neck Surgery.