Several new technologies, some invented and pioneered by the Voice & Swallowing Directors, are routinely utilized at the Voice and Swallowing Center in order to comprehensively assess the precise nature of the patient's voice and swallowing difficulties.
EndoSheath
Technology
As much as technologically possible, we use single-use disposable
endosheaths during the endoscopic procedures that are performed at the
Voice & Swallowing Center.
The endosheaths are specially designed sheaths that cover the insertion tubes of the flexible endoscopes. The advantages of endosheaths is that they prevent cross contamination, and that it frees up medical personnel to devote more time to direct patient care.
To view a picture of EndoSheath Technology, please click here.
To visit the website of Vision Sciences, the manufacturers of EndoSheath Technology, please click here.
FEESST
Flexible Endoscopic Evaluation of Swallowing with Sensory Testing
FEESST, pioneered by the Voice and Swallowing Center’s Jonathan Aviv MD, is the state of the art non-radioactive alternative to modified barium swallow studies. This exam will allow for direct assessment of the motor and sensory aspects of the swallow in order to precisely guide the dietary and beghavioral management of patients with swallowing problems to decrease the probability of aspiration pneumonia.
Velopharyngeal closure, anatomy of the base of the tongue and hypopharynx, abduction of the vocal folds, pharyngeal musculature and the aptient's ability to handle his/her own secretions are assessed.
FEESST also allows evaluation of extra-esophageal manifestations of gastro-esophageal reflux including asthma, hoarseness, laryngitis, globus and aspiration.
FEESST is a two part test. The first part of the test assesses sensation in the larynx in order to illicit an airway protective reflex. The second part of the test involves giving food to the patient (with green food coloring mixed in) and watching/ tracking where the food travels in the throat region.
Benefits of FEESST- Immediate results including dietary recommendations
- Outpatient, in-office, procedure
- Non-radioactive alternative to modified barium swallow studies
- Cost effective
- Portable capabilities
For more information about FEESST click here.
Pulse Dye Laser
The Pulse Dye Laser (PDL) was developed over 20 years ago, initially
to treat dermatological conditions such as port wine stains on the face,
head and neck, warts and, recently, fine facial wrinkles located about
the eyes and mouth.
The PDL has also been used to successfully treat papillomas of the larynx, as well as to treat dysplasia of the vocal cords. The PDL has shown to be far less tissue destructive than the more commonly used CO2 laser. In fact, given what we now know about the PDL, the CO2 laser is actually far more dangerous to the tissues (causes more scarring and irreversible tissue injury) than the PDL. The significant advantage of the PDL, and that which separates it from all other destructive lasers such as CO2 and argon is that it selectively ablates the microvasculature of the lesion in question, thereby sparing the surrounding normal tissue.
The PDL penetrates epithelium without damaging it, and is selectively absorbed by the underlying microvasculature. The PDL used in the Voice & Swallowing Center, is used as part of the treatment administered for patients with laryngeal papillomas.
Transnasal Flexible Laryngoscopy (TFL) Biopsy
Transnasal Flexible Laryngoscopy (TFL), is a way of examining the
larynx and throat with a thin, flexible endoscope that is passed via the
nose which permits a magnified view of the laryngeal structures and
functions.
We are now able to take a biopsy of the vocal fold without needing to bring the patient to the operating room and without using general anesthesia.
This is how the procedure is performed:
A special sheath with a channel is placed over a flexible endoscope.
Next, a drop of liquid anesthetic is applied to the area we want to
biopsy while the patient is WIDE awake sitting up in the examination
chair without any general anesthesia.
The advantages for the Patient are:
1. The patient doesn't need to go to the operating room
2. The patient doesn't need to have general anesthesia
3. The patient avoids the risks inherent with general anesthesia
4. The patient can go back to work the same day
The advantages to the Physician are increased efficiency:
1. The physician stays in the office (no need to travel to a hospital)
2. There is no operating room turn around time
In certain cases, a patient with a large tumor in the throat might need a tracheotomy if taken to the operating room. However, in this office setting as described above, the patient is spared a tracheotomy minimizing all discomfort and danger associated with the procedure.
TransNasal Esophagoscopy (TNE)
TransNasal Esophagoscopy (TNE) is a way to examine the esophagus in an
office-based, unsedated manner by passing an ultrathin scope through the
nose.
The benefits of TransNasal Esophagoscopy are that you get immediate
results, it is less costly, and you can return to work the same day
after the examination since no intreaveneous sedatives are used.
The traditional ways of examining the esophagus fall into 2
categories, rigid esophagoscopy in the operating room performed under
General Anesthesia, or flexible esophagoscopy in the endoscopy suite
performed under intravenous, or conscious sedation.
With both of those techniques the esophagoscope is placed via the mouth into the esophagus. In both cases the anesthesia required to perform the procedure generally requires that the patient lose a day from work. With the transnasal technique only topical anesthesia is required so that patient may return to work shortly after the procedure is completed.
To view a video of TransNasal Esophagoscopy, please click here.
Dr. Aviv has co-authored a book on TNE entitled The Atlas of
TransNasal Esophagoscopy.
To find out more information, please click here.
Chronic cough is one of the most common reasons for seeking treatment from an ear, nose and throat physician. Millions of dollars are spent on tests and medications, both prescription and over the counter drugs, to try and stop coughing. A chronic cough is one that lasts two months or more and that is resistant to traditional treatments. Patients come into the office with complaints of continuous coughing, visits to many physicians, trials with many types of medications and often no change in the symptoms. There are many causes for chronic cough. A thorough diagnostic evaluation may uncover reasons for the cough and a method for treating it.
The diagnostic visit includes a thorough ear, nose and throat examination. Visualization of the vocal folds often reveals information leading to treatment. A vast majority of people cough because they are experiencing laryngeal reflux and a condition called paradoxical vocal fold motion disease. Laryngeal reflux is usually accompanied by hoarseness, daytime cough, a sensation of fullness in the throat and some difficulty swallowing. Paradoxical vocal fold motion is a movement disorder of the larynx in which the vocal folds partially close while breathing instead of remaining open. This condition can lead to air hunger, shortness of breath or choking.
The Voice & Swallowing Center has extensive experience with the diagnosis and treatment of chronic cough. Dr. Murry has published reports of patients recovering from chronic cough that has lasted for many years. Dr Aviv is experienced in the medical treatment of chronic cough. The treatment usually involves a combination of medication and behavioral management. The medical regimen is tailored to the patient's specific problems. The behavioral management consists of a series of exercises called Respiratory Retraining. These exercises, which may take place over a period of 4 to 9 weeks, focus on reducing the irregular breathing pattern associated with cough. Most patients achieve success. Relief from chronic cough provides a significant improvement in a person's quality of life and allows them to go about their daily routine with improved breathing, voice quality and without the strain of coughing throughout the day.
Video Stroboscopy
Video Stroboscopy is a specialized diagnostic procedure in which a
stroboscopic light is used in conjunction with a laryngoscope to
electronically slow down the motion of the vocal folds in order to
identify subtle changes in vibratory patterns that are diagnostically
significant. Video Stroboscopy is used to differentiate vocal fold
nodules from vocal fold polyps and cysts. With the use of a camera and
video recording system, the examination can be viewed many times by the
examiners and patient.
To view a video of Video Stroboscopy, please click here.
Optical Transesophageal
Echocardiography
Traditional Transesophageal Echocardiography (TE) is a very commonly used method of examining the heart and heart function with ultrasound. The test is performed by a cardiologist who passes a TE probe via the patients mouth, and the patient swallows the probe into their esophagus.
Since the esophagus lies right next to the heart, the images obtained from TE are superior to the images obtained with Echocardiography where the ultrasound probe is simply placed on the skin of the chest of a patient. The shortcoming of traditional TE is that the TE probe is passed through the mouth by feel, that is, without any optical guidance. The larynx, or voice box, sits between the mouth and the esophagus, so when a probe is blindly passed in this area of the body, the vocal cords can be inadvertently traumatized.
We are currently working on the development of an Optical TE probe which will allow direct visualization of the structures in the throat as the TE probe is placed into the esophagus.
Please note: An abstract was recently published in the Journal of the American College of Cardiology (JACC) regarding our initial findings.
The study involved 60 consecutive patients who were undergoing a regularly scheduled Transesophageal Echocardiography (TE) procedure.
The patients were randomized to one of two groups:
Group 1. The physician performing the procedure carried out the procedure in the traditional (blind) manner. That is, the TE probe was placed in the patients mouth along the throat, and then directed into the esophagus (the structure that connects the throat to the stomach) by feel.
Group 2. The physician performing the procedure carried out the procedure while looking at a monitor that showed real-time images of where the transesophageal echocardiography probe was traveling in the patients throat before it was directed under direct visualization into the esophagus.
The results of the study were that patients who had the TE probe passed under optical visualization had a statistically significant less chance of trauma to the throat structures than patients who had the traditional (non-optically guided) method of TE-probe placement.
We are continuing the study since the initial 60 patients, and have
over 160 patients now enrolled.
