Services

Voice

Dr. Feinberg will examine your vocal cords using state-of-the-art imaging, providing a high resolution recording of the vocal folds vibrating. This provides a slow motion, magnified image, which Dr. Feinberg will review with you to identify your vocal problem.

• Flexible distal chip laryngoscopy: A thin flexible laryngoscope which is passed through your nose and into your throat, capturing a high resolution image of your larynx.
• Rigid transoral laryngoscopy: A rigid laryngoscope is placed in your mouth, capturing a high resolution, magnified image of your larynx.
• Laryngeal stroboscopy: A flashing light will illuminate the larynx, providing a slow-motion view of the vocal fold vibration. Stroboscopy is combined with either the flexible distal chip laryngoscope or the rigid transoral laryngoscope.
• Voice evaluation: A recording will be made of your voice, and a computer analysis will be performed to quantitate the characteristics of your voice disorder.
• Laryngeal electromyography (EMG): Performed in conjunction with a neurologist, the electrical activity of the muscles in your larynx will be measured.

Swallowing

For patients with swallowing issues, Hoag’s Voice and Swallowing Center offers transnasal esophagoscopy,which does not require sedation – a significant convenience over the conventional procedure. We also offer swallowing evaluations with sensory testing, an important diagnostic study for patients suffering from difficulty swallowing and aspiration.

• Barium swallow: The patient swallows barium and an x-ray is taken of the neck, mouth and chest. Abnormalities of the digestive tract and swallowing mechanism are identified.
• Esophageal manometry: A thin catheter is placed into the esophagus to measure the pressure at specific locations throughout the esophagus as the patient swallows.
• Flexible endoscopic evaluation of swallowing (FEES): A flexible laryngoscope is passed through the nose and into the throat.
• Flexible endoscopic evaluation of swallowing with sensory testing (FEESST): Similar to FEES, but in addition delivers pulses of air to your hypopharynx (lower throat) in order to measure your airway protective capacity.
• pH Testing: Measures the acidity in your esophagus and pharynx and helps to diagnose reflux of stomach acid into the esophagus and lower pharynx.
• Transnasal esophagoscopy: A thin flexible endoscope is inserted through your nose, and passes into the esophagus and stomach, imaging the lining of your digestive tract but requiring no sedation. Biopsies may be taken as needed. Transnasal esophagoscopy, which does not require sedation – a significant convenience over the conventional procedure.
• Modified barium swallow (MBS): The patient is given varying consistencies of solids and liquids mixed with barium, and an x-ray is taken of the mouth, neck, and chest. The swallowing mechanism is evaluated.

Speech Pathology

Treatment for many of voice and swallowing issues requires voice and/or swallowing therapy; therefore, we work closely with Hoag speech pathologists, who provide specialized rehabilitation services—a critical component of the program.

Office Procedures and Treatments

• Botox injection: An injection of Botox into the laryngeal muscles is performed using electromyographic (EMG) guidance. This is a common procedure for patients with spasmodic dysphonia, laryngeal granuloma, and on occasion, muscle tension dysphonia.
• Cidofovir Injection: For some patients with recurrent laryngeal papillomatosis, Cidofovir, an anti-viral medication, is injected directly into the larynx. This procedure is performed without sedation, and is often combined with office-based laser surgery.
• Injection laryngoplasty: The vocal folds are augmented with a variety of materials in order to provide bulk to a paralyzed, scarred, or atrophic vocal cord. The injection is performed without sedation by placing a needle through the mouth.
• Office-based biopsy: For abnormalities in the pharynx, larynx, and esophagus, we can often avoid general anesthesia and perform a biopsy using a small forceps passed through the flexible laryngoscope.
• Office-based laser surgery: Without sedation, we use a pulsed KTP laser to treat laryngeal papillomatosis and precancerous conditions of the vocal cords in the office. A small fiber is placed through a flexible laryngoscope, targeting the blood vessels within the lesion. We are the only center in the region offering this cutting-edge modality.
• Voice therapy: Our team includes expert speech pathologists who will teach you techniques to improve your voice and swallowing function. Many disorders require a combination of voice therapy and surgery in order to achieve the best outcome.

Surgical Procedures

• Arytenoid repositioning: For some patients with paralysis of the vocal fold, medialization alone does not restore normal laryngeal closure. In some cases, we perform adduction arytenopexy, a procedure that restores the arytenoid to its normal position.
• Cricopharyngeal myotomy: For patients with ineffective relaxation of the upper esophageal sphincter, we perform endoscopic laser division of the cricopharyngeus muscle.
• Medialization laryngoplasty: For the paralyzed vocal fold or for vocal folds that are atrophic, we insert Gore-Tex through the laryngeal cartilage to medialize the vocal fold.
• Surgery for laryngeal cancer: We offer a variety of options to patients depending on their extent of disease. These include minimally invasive endoscopic laser surgery, open partial laryngectomy, and when all other options are exhausted total laryngectomy. In addition we offer a variety of techniques for laryngeal reconstruction following cancer surgery.
• Surgery for airway stenosis: We offer a variety of treatments for airway stenosis involving the larynx, subglottis, and trachea.
• Suspension microlaryngoscopy: Using minimally invasive techniques we treat conditions of the vocal folds while protecting and preserving the normal vocal fold structure and function.