Office-Based Laryngology Procedures
All of these procedures are performed with topical (spray) and occasionally local anesthesia. Sedation medicine is rarely required. The visit takes 30 minutes in total, but the procedure itself is usually much shorter than that.
Patients can return to work after the procedure and eat or drink one hour after the procedure. Blood thinners (e.g. Aspirin, Plavix, Coumadin) might need to be discontinued before some procedures. One to two weeks after some procedures, voice therapy is recommended.
Many of these procedures used to be performed only in the operating room and required general anesthesia. However, general anesthesia carries a higher risk of complications and requires more recovery time than office-based procedures. Patients who undergo office-based procedures can drive themselves home and rapidly return to work. Complications such as bleeding are very rare.
New and exciting lasers are available for use in the office. The lasers are able to access the larynx (voice box) by being passed through a flexible camera (endoscope) that goes through a nasal passage. These lasers function well because they treat diseased tissue and limit damage to the natural tissues. This feature means that disease can be treated and voice function is protected.
The lasers are used for treatment of:
- Leukoplakia: These are white patches on the vocal cords producing hoarseness. These patches usually are not cancerous but usually are pre-cancerous (on the way to becoming cancer). These lesions often are found in people with tobacco and/or alcohol exposure and can be found even if those exposures stopped many years ago. Periodic treatments usually are required to reduce the leukoplakia; these treatments are designed to prevent progression to cancer and to improve voice.
- Papilloma: These are benign growths on the larynx (voice box), usually on the vocal cords, that reduce the size of the air passage and impair voice quality. This disease can occur in children and adults. Papilloma almost will certainly return, so many treatments could be required over time to control disease.
- Reinke’s Edema: This condition results in abnormally large vocal cords and a low pitched and rough voice, and usually is found in adult female smokers. Stopping smoking is ideal but even that will not allow the vocal cords to return to normal and treatment is required for voice improvement. In rare occasions, the vocal cords become so large that they cause restriction of the airway.
- Small Polyps, Ectasias and Varices: These are abnormally large and/or prominent blood vessels on the surface of the vocal cords, which often are seen in people with heavy voice use – singing or speaking. The blood vessel changes can increase in size, making hoarseness worse, or can rupture, causing bleeding within the vocal cord.
Vocal Fold Injections
This procedure is designed to deliver a temporary filler material into one or both vocal folds to move them closer together. When the vocal folds are closer together, better voice, swallowing and an effective cough can be generated.
This procedure usually is performed effectively through the mouth using special instruments. It also can be done with a small needle through the neck, or through the nose using a flexible camera (endoscope). Immediate return to work is possible and eating and drinking can resume one hour after the procedure.
Vocal fold injections sometimes are used for treatment of:
- Vocal Cord Paralysis: When the nerves or muscles controlling the movement of the vocal cord back and forth are injured and the vocal cord no longer moves, it is considered vocal cord paralysis. Patients will experience a weak, breathy voice that requires effort to produce. They also could experience coughing and choking when eating and drinking as well as a weak cough. In severe cases, patients might have pneumonias from aspirating food or liquids and could lose weight.
- Vocal Cord Paresis: This condition is a less severe case of vocal cord paralysis (see above) in which some motion of the affected vocal cord is preserved. Symptoms are similar to vocal cord paralysis, but usually less severe.
- Vocal Cord Scar: When the normally soft and elastic surface of the vocal cord is replaced by firm scar, people experience a breathy, effortful and soft voice quality. This condition is very difficult to cure, but some treatments - including vocal cord injection - offer relief.
- Aging Vocal Cords: As we age, our vocal cords become smaller and therefore don’t meet easily when we try to use our voice. Speaking becomes effortful and patients experience a soft voice easily drowned out by surrounding noise. Injections move the vocal cords closer together for easier voice production. Voice therapy also is helpful in conjunction with vocal cord injections or other more permanent surgical options.
- Transnasal Esophagoscopy (TNE): This procedure is performed through the nose using a flexible camera (endoscope) and is designed to examine the esophagus and stomach. It generally is performed in patients with heartburn, chronic cough, globus pharyngeus (lump in the throat sensation) and swallowing problems.
- Transnasal Tracheoscopy (TNT): This procedure is performed through the nose using a flexible endoscope (camera) and is designed to examine the larynx (voice box) and trachea (wind pipe). It generally is performed in patients with suspected narrowing of the airway.