Overview

The Institute for Voice and Swallowing Disorders was founded on the premise that combining talented, experienced diagnosticians with state-of-the-art technology would result in the kind of individualized treatment plans that would make a critical difference in people’s lives.

The clinical activities of the Center are multidisciplinary, involving laryngology, speech pathology, and vocal pedagogy. We work closely with gastroenterologists, neurologists, oncologists and nutritionists because of our belief that symptoms of one complaint may indicate the presence of other conditions that need attention.

Our patients span the age range from pediatric to the elderly. The professional voice users include not only singers but also all those who rely on their voices for their professional work (i.e. teachers, clergy, actors). Both children and adults can complain of gagging and choking, chronic cough, chronic hoarseness or feeling a lump in the throat, all of which may indicate the presence of a swallowing problem. Specific treatments are available for those with spasmodic dysphonia or swallowing disorders associated with radiation and chemotherapy for head and neck cancer.

Medical Director, Craig H. Zalvan, MD, is a Board Certified Laryngologist. Dr. Zalvan was awarded a Medical Degree from Albert Einstein College of Medicine. He completed an Otolaryngology (ear, nose & throat) residency at Manhattan Eye & Ear Hospital and Columbia-Presbyterian Hospitals which included training at Memorial Sloan-Kettering Cancer Center and New York Hospital. His specialty fellowship in laryngology focused primarily on voice and swallowing disorders at St. Luke’s Roosevelt Hospital in Manhattan.

The Institute for Voice & Swallowing Disorders

777 North Broadway, Suite 303
Sleepy Hollow, NY 10591

The voice

The distinctive sound of one’s voice is the result of the balancing of four systems.

  1. A source of power that generates adequate air pressure, from the lungs, the diaphragm and the abominable muscles;
  2. A source of vibration from the vocal folds which are housed in the voice box or larynx;
  3. A source of resonance which includes the throat, mouth, sinuses and nose;
  4. A source of articulation, including the tongue, palate and lips.

When the systems are out of balance because of tension, growth, inflammation or weakness, voice problems can develop.

Hoarseness is one of the most common complaints. It is often associated with a cold, sore throat or vocal overuse and disappears on its own. Persistent hoarseness requires medical evaluation.

Vocal misuse and abuse may develop without any awareness on the part of the speaker. The voice is hoarse and tires easily. Vocal fatigue sets in toward the end of the day. Total loss of voice may occur at times. There can be tightness in the throat or poor breath support after excessive talking or use of loud voice. Children are often “voice abusers” during summer camp.

Disorders of the voice

Muscle Tension Dysphonia (MTD)
Muscle tension is the overuse of neck and throat muscles when speaking or singing, Tension is often the result of trying to compensate for irritation, weakness, swelling or a growth that is causing the imbalance.

Vocal Masses
Although vocal fold nodules (or singer’s nodes) are frequently diagnosed, nodules are far less common than other benign vocal growths which include cysts and polyps. Symptoms include hoarseness, breathiness, loss of singing range and voice breaks.

Vocal Fold Paralysis
Failure of one vocal fold to move during speaking may be due to a stroke, trauma to a nerve during surgery or a result of a viral disease. The primary vocal problem is breathiness.

Spasmodic Dysphonia
Also described as “stuttering of the larynx,” the voice sounds strained and strangled., rapidly starting and stopping. The voice sounds choppy. Hoarse and tight. Thought to be a movement disorder, or dystonia, it is treated with Botox injections and voice therapy.

Vocal Incompetence
Vocal fold incompetence, or bowing, is a condition when the vocal folds do not completely come together during speaking. The condition can be due to poor muscle strength or loss of tone, often associated with aging or neurological conditions such as Parkinson’s disease. Breathiness, hoarseness and fatigue are the primary complaints.

Paradoxical Vocal Fold Movement (PVFM) or Vocal Cord Dysfunction (VCD)
This abnormal vocal fold movement often occurs during physical exercise, resulting in shortness of breath, tightening of the muscles in the throat and wheezing. It is often misdiagnosed as an asthmatic attack.

Laryngopharyngeal Reflux (LPR)
Caused by the regurgitation of stomach contents up through the esophagus into the throat, stomach acid coats and damages the tissues of the throat. People often complain of voice changes, throat clearing, mucus in the throat, trouble swallowing, a globus or lump in the throat, burning in the throat or chronic sore throats. Most of the people do not have heartburn or indigestion, typical of GERD (Gastroesophageal Reflux Disease). Patients with LPR are often unaware of their condition.\

Chronic Cough
Although chronic cough has been associated with asthma, sinusitis or allergy, it is often related to LPR or a vagal neuropathy. LPR is reflux that irritates the back of the throat. A vagal neuropathy can cause a cough that is usually preceded by a tickle sensation, made worse by talking, eating, cold air or laughing and often occurs in spasms. Depending on the cause, the symptoms can be treated by different medications.

Laryngeal Cancer
Hoarseness is the primary sign and symptom. There may be pain when swallowing or tenderness in the neck. Early diagnosis often results in an excellent prognosis.

Symptoms

Symptoms depend on the nature and severity of the condition. They can include:

  • Hoarseness
  • Breathiness
  • Vocal fatigue
  • Pitch breaks
  • Strain
  • Neck pain
  • Vocal tremor

Test your voice

Take a test and assess your voice. A score of 15 or more may indicate the presence of a voice problem requiring medical evaluation by a laryngologist.

Voice Handicap Index (VHI-10), Henry Ford Hospital

Circle the response that indicates how frequently you have these experiences:

0=never, 1=almost never, 2=sometimes, 3=almost always, 4=always

  • My voice makes it difficult for people to hear me.
    0    1    2    3    4
  • People have difficulty understanding me in a noisy room.
    0    1    2    3    4
  • My voice difficulties restrict my personal and social life.
    0    1    2    3    4
  • I feel left out of conversations because of my voice.
    0    1    2    3    4
  • My voice problem causes me to lose income.
    0    1    2    3    4
  • I feel as though I have to strain to produce voice.
    0    1    2    3    4
  • The clarity of my voice is unpredictable.
    0    1    2    3    4
  • My voice problem upsets me.
    0    1    2    3    4
  • My voice makes me feel handicapped.
    0    1    2    3    4
  • People ask “What’s wrong with your voice?”
    0    1    2    3    4

Assessment by the voice team

The medical diagnostic examination is conducted by a Laryngologist. The flexible fiberoptic laryngoscope is used to visualize the anatomy and physiology of your throat and vocal folds. Videostroboscopy permits a detailed, slow-motion view of the vibration of your vocal folds which can identify abnormalities that cannot be observed by any other technique. Laryngeal electromyography assesses nerve function that controls the movements of the vocal folds.

A voice evaluation is conducted by a speech-language pathologist who has specialized in disorders of the voice. After a thorough history of voice use and abuse, lifestyle, medications, medical history, eating and drinking habits and singing history, an acoustic voice analysis will provide objective information regarding pitch, loudness and vocal quality. Breath support, rate of speaking and vocal resonance also impact vocal functioning. Singing technique and style are evaluated for both professional and non-professional singers.

Voice therapy

Three of our speech-language pathologists are specially trained as voice therapists. This training permits them to focus solely on disorders of the voice. They have learned the newest and most effective techniques for voice rehabilitation. Additionally, each voice therapist is a trained singer which allows for assessment and treatment of both the speaking voice and the singing voice. Voice therapy programs are individualized to the specific needs of each patient. Breath control, abdominal support and projection are needed by singers as well as other professional voice users such as actors, teachers, attorneys, politicians, preachers and public speakers.

Therapy for voice disorders is typically prescribed as the initial treatment modality for many voice disorders. Although the number of sessions varies, it is often completed in 6-8 weeks. Vocal function is then reassessed and additional medical management may be considered.

Respiratory Retraining is a specialized remedial program for patients with Vocal Cord Dysfunction (VCD) or Paradoxical Vocal Fold Movement (PVFM) or chronic cough. Breathing exercises reduce excessive laryngeal tension and abnormal vocal fold movement prior to voicing and relax upper chest muscles.

Lee Silverman Voice Treatment (LSVT) was designed to remediate vocal function in Parkinson’s patients. The program centers on one therapeutic target: increased vocal loudness. Attention to loudness seems to energize the speech system and has positive effects on rate of speaking, precision of articulation and overall speech intelligibility.

Medical and surgical interventions

Suspension Microlaryngology is the gold standard for resecting polyps, cysts, scar tissue and nodules under high power magnification. Specialized techniques of microflap excision minimize surrounding damage to the vocal folds and allow for excellent healing with return of the normal singing or speaking voice. There are minimal complicat5ions and little discomfort from the surgery. Voice rest is typically required for one week after surgery. Voice therapy with a voice specialist with a classical singing background is essential for full recovery with an optimal performing voice.

KTP Laser Vocal Fold Surgery is the most recent tool for treatment of diseases of the vocal folds and larynx. This laser has an affinity for blood vessels, allowing it to target abnormal blood vessels and blood supply leading to lesions such as vocal fold polyps, papillomas, dilated blood vessels, precancerous and cancerous conditions. KTP laser surgery is primarily performed in the office under topical anesthesia with little or no recovery time. Not only does the laser remove the lesions, it does so with minimal or no damage to the vocal folds, avoiding scar formation. The result is an improved voice without the need for general anesthesia.

Tracheal/Airway Surgery is performed when a stenosis or narrowing of the trachea or windpipe occurs, leading to chronic shortness of breath, difficulty breathing and noisy breathing. Dilation procedures can be done in the office or operating room, using a new balloon technique and/or a laser to widen the airway.

Injection Laryngoplasty is an office procedure to rehabilitate paralyzed vocal folds. Material is injected that assists in pushing the vocal folds together, improving both the speaking voice and airway protection during swallowing.

Laryngeal Botox Injections eliminate the muscle spasms that present normal voice for patients with spasmodic dysphonia.

pH Probe is used to evaluate reflux symptoms during a 24-hour period. The probe can sense when there is acid in the throat. The results will indicate whether medication, diet modification and/or lifestyle changes can help in relieving the symptoms of LPR.

Video

Contact

The Institute for Voice & Swallowing Disorders
777 North Broadway
Suite 303
Sleepy Hollow, NY 10591
(914) 366-3636

Doctors & Staff

Specialty: Otolaryngology

Board certified: Otolaryngology, Laryngologist specializing in voice and swallowing disorders

Additional languages: Spanish

Primary Practice
Phelps Institute for Voice & Swallowing Disorders
777 North Broadway, Suite 301
Sleepy Hollow, NY 10591
(914) 366-3636

Office 2
1055 Saw Mill River Road
Suite 101
Ardsley, NY 10502
(914) 693-7636