Laryngology and Voice : Laryngology Treatments

Laryngology Treatments


Voice therapy is a common means of treatment for individuals with hoarseness that may be related to improper vocal usage, over-use, and/or misuse of the vocal system. Voice therapy is typically curative in about 80% of cases of vocal fold nodules. And, therapy is critical in the remainder of cases to help prevent recurrence due to improper vocal usage.
Voice therapy is similar to physical therapy in that techniques are utilized to retrain muscle groups to produce the voice with less effort, strain, and in better alignment. Therapy frequently includes exercises that must be practiced to create a new automatic pattern of speaking. In some cases, voice therapy may be considered compensatory and not designed to cure a problem with the vocal folds but to prevent worsening and promote the best possible voice attainable considering the underlying condition of the vocal folds. This can happen in individuals that have undergone surgeries resulting in scarring that limits full vocal fold vibration or after radiation therapy for small vocal fold cancers.
There are usually 3 components to voice therapy: Education: The patient with a voice disorder will be explained the nature of their problem and how the way in which they use their voice contributes to it. This usually involves viewing and reviewing videostroboscopic images of their vocal folds in slow motion to better be able to see the impact of lesions or movement problems on natural vocal fold vibration. Vocal Hygiene: Patients typically learn specific ways in which they can best take care of their voice. This may include anti-reflux recommendations where reflux is felt to be contributing to their problem. Hydration is critical and patients are counseling to increase water intake and reduce substances like caffeine that increase dehydration. Patients also learn about other vocal behaviors that may adversely affect their voice like throat clearing, abnormally loud speaking, etc. Directed Vocal exercises: This aspect of therapy deals with individualized exercise programs developed for each patient to specifically address their needs. Programs are continually monitored during sessions and modified as needed.


The Botox Clinic within the Department of Otolaryngology at the University of Miami Miller School of Medicine is the oldest in the state of Florida and one of the busiest programs in the country. Botulinum toxin (Botox®) is a neurotoxin that has been used since the early 1980s for medicinal purposes. Small, controlled dosages of Botox are safely used to control muscle spasms in a variety of muscles throughout the human body.
Additionally, the Botox Clinic is also actively involved in the treatment of individuals with difficulty swallowing or dysphagia due to a specific type of muscle spasm affecting the upper sphincter that controls food entry into the esophagus. This treatment is usually coordinated with other specialized studies to delineate the nature of the spasm and potential benefits of treatment with botox.


Our team in the Department of Otolaryngology has been treating patients with vocal fold paralysis for the past decade with an in-office procedure that takes less than 15 minutes. Under local anesthetic, an inert filler material is injected through a fine needle to bulk up and push over the paralyzed vocal fold. This allows the mobile vocal fold to meet the paralyzed one more easily and with much less effort when speaking. Patient tolerance is good with only mild discomfort. Results are usually instantaneous and, depending on which material is injected, last anywhere from 2-3 months to 1 year. Over time, the material is generally reabsorbed, but many patients can experience longer lasting improvement.
Vocal surgery – OR procedures