Local Multidisciplinary Approach to Voice and Swallowing Problems

By Robert Strominger, MD

 

For the past several years, Cayuga ENT and Head-Neck Surgeons and Cayuga Medical Center have collaborated with the Sir Alexander Ewing-Ithaca College Speech and Hearing Clinic to offer important services to area residents with voice, speech, and swallowing disorders. We have modeled this program after a similar clinic at the University of Pittsburgh, which is recognized as a national leader in this field of medicine.

 

Once a week, graduate students in speech and language pathology at Ithaca College participate in the evaluation and treatment planning of patients referred from voice teachers, ear, nose and throat specialists, speech-language pathologists, and area doctors. Consultative team members include Mary Pitti, adjunct clinical instructor in speech-language pathology and audiology at the Ewing Clinic, Phyllis Mazurski, MS, CCC-SLP, a certified speech-language pathologist on staff at Cayuga Medical Center, and myself.

 

Our multidisciplinary approach incorporates leading-edge diagnostic technology, treatment, and therapy with graduate-level clinical training. The patients we see benefit from in-depth consultations with specialists in otolaryngology and speech and language pathology at the same time future speech and language pathologists are enriching their education. Ensuing treatment and therapy is provided by board-certified physician specialists and speech-language pathologists.

 

Evaluating vocal cord function

 

A technology called videostroboscopy visualizes the vibratory behavior of the vocal cords in action and we use this to diagnose many types of voice disorders. The most common voice problems we see come from overuse of the vocal cords and the development of vocal cord nodules, which are equivalent to calluses on the vocal cords. Speech therapy is typically the first approach to treatment and works well for most people. For patients who do not respond to speech therapy, phonosurgery may be required; it is performed locally at both Cayuga Medical Center and Surgicare.

 

In the realm of voice disorders, we also commonly evaluate and treat the following conditions: vocal cord polyps (from acute trauma to the vocal cords, such as bleeding from severe coughing or prolonged smoking); vocal cord paralysis; neurological voice disorders (such as with Parkinson’s disease); paradoxical vocal-fold motion (which interferes with breathing); and presby larynges (aging of the vocal cords).

 

Evaluating swallowing functions

 

People who have suffered a stroke, who have undergone treatment for head-neck cancer, or who have neurological disease (such as Parkinson’s) often develop difficulties swallowing. To analyze these problems, we perform functional endoscopic evaluation of swallowing (FEES). FEES is performed on inpatients and outpatients at Cayuga Medical Center. Using a fiberoptic nasolaryngoscope, we can observe a patient swallowing foods of different consistencies to diagnose the problem.

 

Having reached a diagnosis, we work with the patient to develop adaptive swallowing maneuvers to see what works best for that individual. These patients then go on for swallowing therapy with a certified speech-language pathologist. Aspiration pneumonia is the leading cause of death for those who survive the initial stroke and we feel strongly that having this service available locally is imperative for our community.

 

Meeting multiple goals

 

Our clinical teaching collaboration meets a number of goals. Patients benefit from a multilevel consultation that results in the kind of topnotch swallowing and voice evaluations not typically found outside of a major university setting. Local specialists benefit from teaching graduate students affiliated with a highly regarded speech and language pathology program. The students gain clinical experience and patient contact. And lastly, Cayuga Medical Center physicians and speech-language pathologists are partnering with Ithaca College, to the benefit of everyone involved.

 

Dr. Strominger is board certified in otolaryngology and is a member of the medical staff at Cayuga Medical Center. He completed a fellowship in otolaryngology and voice and speech disorders at the NIH National Institute of Deafness and Other Communication Disorders, following his surgical training at Washington University Medical School in St. Louis. Dr. Strominger is in practice with Cayuga Ear, Nose, Throat and Head-Neck Surgeons and can be reached there at (607) 266-0772.