Treatments Offered at the Voice Center

At NYU Langone’s Voice Center, our team specializes in the treatment of conditions that affect the voice, swallowing, and breathing. We highly encourage all patients to contact us as soon as you notice any symptoms of voice or swallowing problems, as issues confronted early result in more effective and less invasive treatment. 

Voice Center Director Dr. Milan R. Amin

For more information about treatments offered at the Voice Center, please call 646-754-8642 or email voicecenter@med.nyu.edu.

Testing and Diagnosis

At the Voice Center, we provide you with an individualized treatment plan based on the results of our advance diagnostic testing for voice problems.

Voice Analysis and Vocal Fold Evaluation 

A voice evaluation involves a series of tests performed by ear, nose, and throat specialists to analyze your voice and help determine what is wrong. Typically, the voice evaluation involves a voice recording, which is then run through a series of computer programs that analyze the data. 

We also perform computerized voice analysis to assess hoarseness, which is often a difficult complaint to evaluate because it can be very subtle. The term hoarseness is also very general and not specific to any one cause. The use of a computer to analyze different speech patterns has been helpful in distinguishing different disorders.

At the Voice Center, patients typically undergo other testing in addition to computerized voice analysis to allow for a highly accurate diagnosis, which is necessary for proper treatment. 

Stroboscopy

Stroboscopy is a tool that allows the examiner to gather information on the vibratory nature of the vocal folds. The technique uses a strobe light that is linked to the frequency of the patient's voice. When a person utters a tone, the light strobes at a frequency that is identical or close to the frequency of the person’s voice. 

The recording device produces a set of images that mimic the true cyclical vibration of the vocal cords. By using the information from the stroboscopy exam, an expert can gather information to diagnose and evaluate conditions such cancer, the presence of scar tissue or stiffness in a vocal cord, and the relative tone of the vocal cords.

Voice Treatments

We can treat you for a range of conditions that affect vocal quality, as well as help preserve vocal quality while you undergo treatments for conditions such as cancer. Here is an overview of the voice and swallowing treatments we provide.

Loss of Voice Treatment

We need to determine the underlying cause of your loss of voice before treatment can begin. Please do not wait for complete voice loss to seek help from our specialists, especially for the care of a professional voice, including singers, performers, actors, and teachers. 

The time from onset of voice loss can mean the difference between simple treatments, such as rest, fluids, and voice therapy, and possible surgery.

Vocal Cord Dysfunction Treatment

When your vocal cords do not open and close normally when you breathe, called vocal cord dysfunction (VCD), treatment is best coordinated by an entire team of voice specialists, consisting of ear, nose, and throat physicians, speech therapists, and professional voice experts.

The purpose of this comprehensive approach is to uncover the underlying causes of VCD and help patients gain better control over their vocal cords to avoid severe attacks that make it difficult to breathe.

The treatment for VCD may include speech therapy; managing your stress using biofeedback techniques, relaxation, and psychotherapy; and treatment of underlying asthma, acid reflux, or postnasal drip.

Vocal Cord Cancer Treatment

Since the advent of the CO2 surgical laser, surgery for vocal cord cancer treatment has expanded. Some surgeons prefer using the laser for primary excision of early forms of this cancer. 

The advantages are the ability to surgically explore the lesion to reveal the true extent of disease; the ability to remove the cancer at one time during outpatient surgery, instead of prescribing six weeks of standard radiation therapy; having a specimen to analyze to ensure that the entire tumor was removed; and the surgery has fewer side effects than radiation therapy. 

We can perform radiation therapy when it is indicated. 

Vocal Nodules Treatment

Depending on the underlying cause, treatment for vocal nodules and polyps may include specific medications, speech therapy, or surgery to remove the nodule or polyp from the vocal cord. Medical treatment involves therapy for acid reflux disease, allergies, or thyroid problems. Speech therapy can help reduce nodules.

Behavioral intervention includes improved vocal hygiene, which may involve smoking cessation and improved hydration in addition to innovative techniques to reduce vocal fold trauma. Treatment or surgical removal of vocal nodules has the best outcome when they are small. 

Please contact us when you begin to show symptoms so that we are able to diagnose the problem as early as possible.

Muscle Tension Dysphonia Treatment

The most common muscle tension dysphonia treatment programs involve voice rehabilitation, voice therapy, stress management, medical or surgical treatments when necessary, and Botox®. Muscle tension dysphonia treatments should only be done after a thorough evaluation by an ear, nose, and throat physician. 

We strongly advise professionals who depend on their voice to schedule an appointment at our clinic as soon as symptoms appear. The sooner we're able to treat you for the underlying cause of your voice problems, the better the outcome.

Recurrent Respiratory Papillomatosis Treatment

Treatment for recurrent respiratory papillomatosis involves removing the lesions to relieve airway obstruction and improve voice quality. 

The primary treatment involves procedures using laser, microdebridement, or surgery. Potassium titanyl phosphate, also known as KTP, is a highly effective treatment for papillomas, especially on or around vocal folds. The laser has several advantages, including safety and not being out of work for too long, and there is no need for general anesthesia. 

Vocal Fold Paralysis Treatment 

Before vocal cord paralysis treatment begins, it is important to recognize partial or bilateral voice paralysis, diagnose underlying cause, and—most importantly—administer emergency care for difficulty breathing and loss of voice.

Vocal fold paralysis may be caused by surgeries on the thyroid, other head and neck procedures, and throat cancer. Vocal cord paralysis treatment differs depending on whether the paralysis is on one side of the vocal folds, called unilateral, or both sides, called bilateral. 

For unilateral vocal cord paralysis treatment, our doctors and surgeons perform various techniques to bring the paralyzed vocal cord to the center of the larynx and bring the normal vocal cord toward the relocated paralyzed cord. The sooner the paralysis of vocal cords is detected, the better the chance that the paralyzed vocal cord can be relocated using a very reliable injection.

Treatment of vocal cord paralysis on both sides is called bilateral vocal fold paralysis treatment. The most important part of this treatment is correcting difficulty breathing. Our objectives are to separate the paralyzed vocal cords to open up the airway and improve breathing, while preserving as much of the vocal capabilities as possible.

In most circumstances, this procedure may require a tracheostomy, which is the surgical creation of a temporary hole in the neck so that a person can breathe. Only trained ear, nose, and throat surgeons may determine if a tracheostomy is required. 

Sometimes, our doctors see patients after emergency situations when tracheostomies have already been created, so it's important to recognize the early signs of vocal cord paralysis, especially loss of voice, and contact us as soon as possible.

Laryngitis Treatment 

Laryngitis treatment is aimed at returning your professional voice to its best as soon as possible. Treatment of laryngitis is based upon an accurate diagnosis of the underlying causes, which we determine by using both laryngoscopy and stroboscopy. 

Managing laryngitis typically includes acute treatment of the damage to the vocal folds, treatment for infections, voice therapy, and voice rest.

For chronic laryngitis, we work with multiple voice specialists on your treatment plan, which may require medication, voice therapy, and surgery depending on the time from onset of the underlying conditions.

Spasmodic Dysphonia Treatment

Spasmodic dysphonia treatment may involve injecting medications such as Botox® into specific muscles to block the contractions that cause the symptoms of spasmodic dystonia. 

Treatments for Swallowing Disorders

Treatments for swallowing disorders may include dietary restrictions, behavioral interventions, prescription medications, and surgery. For many people, invasive options can be avoided if the disease and underlying conditions are caught early enough. 

The team at the Voice Center may use one of several methods to examine and evaluate your swallowing problem, including: 

  • barium swallow, during which an X-ray is taken of the mouth, neck, and chest as a person swallows barium, to demonstrate abnormalities in the swallowing mechanism or digestive tract
  • esophageal manometry, which is the placement of a thin catheter into the esophagus to measure movement as a person swallows
  • flexible endoscopic evaluation of swallowing, which uses a flexible fiberoptic endoscope in the throat in order to visualize the actual swallow in progress
  • pH testing, which is designed to evaluate patients with gastroesophageal reflux disease and laryngopharyngeal reflux disease by monitoring acid exposure within the esophagus and voice box
  • transnasal esophagoscopy, which is the insertion of an ultra-thin endoscope through the nose to the stomach
  • videofluoroscopic swallow study, during which an X-ray is taken of the mouth, neck, and chest as the patient swallows barium of varying consistencies to assesses the ability to swallow

Surgical Options

After all noninvasive options have been exhausted, or when surgical intervention has been proven to be most effective, Dr. Milan Amin and his team of expert ear, nose, and throat surgeons perform the most advanced surgeries for vocal and throat disorders.

Choice of surgical options depends how soon our doctors diagnose the underlying condition of your voice problem. These methods include: 

  • injection augmentation, which is the injection of a substance into one or both of the vocal cords to bring them closer together, closing the “gap” and resulting in a stronger voice
  • laryngeal reinnervation, which creates a new, functioning nerve supply to the paralyzed vocal cord
  • laryngectomy, which is surgical removal of the voice box, usually as treatment for cancer of the larynx
  • laryngoplasty, which are a set of procedures designed to alter the voice box to change or improve the voice
  • microlaryngoscopy, which is a surgical technique using specialized microinstruments and a surgical microscope that enables highly magnified views of the vocal cords and surrounding regions
  • in-office biopsy of throat lesions
  • tracheostomy, which is the insertion of a tube into the trachea, or windpipe, through the neck to enable easier breathing
  • pulsed dye laser, a proven technology that has recently been applied to the voice box

For more information about these treatment options, please call 646-754-8642 or email voicecenter@med.nyu.edu.