Voice and Swallow


The Voice Center of Ear, Nose, & Throat Associates is dedicated to providing comprehensive evaluation and treatment of voice and swallowing disorders.


The larynx ("voice box") is approximately at the mid point of your neck. It includes the vocal folds and the cartilage that protects them in your neck.

The vocal fold is made up of muscle, on top of which is a flexible layer or covering called mucosa. When you breathe in or out over the vocal folds, they vibrate up to 800 times per second. Those vibrations produce the sound, or voice, that your mouth then forms into speech.

Swallowing Disorders


Dysphagia is a swallowing disorder caused by the difficulty moving food from the mouth, to the esophagus (food tube), to the stomach.

Signs and symptoms

  • inability to control food/saliva in the mouth
  • coughing during or after meals
  • recurring pneumonia
  • unexplained weight loss
  • “gurgly” voice quality after mealtime

Possible causes

Possible causes of dysphagia may include neurologic disturbances (stroke, paralysis), cancer of the mouth or throat, or age-related changes.


Dysphagia can be assessed through a simple office examination called F.E.E.S. (Flexible Endoscopic Evaluation of Swallowing). In this exam, the speech pathologist or physician will insert a small flexible scope into your nose in order to look at your throat while you swallow. To do this, you will be asked to eat and drink everyday foods. This procedure allows your swallow to be videotaped and helps determine the best treatment.


If recommended, therapy for dysphagia will be provided by the Speech Pathologist. This may include swallowing precautions, techniques, and / or modification of diet.

Breathing Disorders

Paradoxical Vocal Fold Dysfunction (PVFD)

PVFD is a breathing disorder that often imitates asthma-like symptoms. During inhalation, the vocal folds inappropriately narrow, causing constriction of the airway. This closing causes mild to severe respiratory distress. Such “attacks” can last anywhere from seconds to minutes to an entire day. PVFD is often misdiagnosed and treated as asthma due to similarities in presentation.

Symptoms and Causes

  • Shortness of breath
  • Tightness in throat
  • Coughing
  • Difficulty "getting air in"
  • Fullness in throat
  • Wheezing on inhalation


  • Exercise/physical Activity
  • Stressful situations
  • Upper respiratory infections
  • Emotional upset
  • Postnasal drip
  • Odors, fumes, smoke



PVFD can be assessed through a simple office procedure called videoendoscopy. This allows the speech pathologist or physician to view the vocal folds during breathing and voice production. This procedure will be video recorded in order to review.


Common treatments for PVFD:

  • Breathing exercises with speech pathologist
  • Relaxation techniques
  • Counseling
  • Medications to treat associated problems
Voice Disorders

Voice disorders are caused by a variety of conditions. Abuse or misuse of the voice with yelling, singing, or speaking is common. Changes in the vocal folds due to smoking, aging, or growths are possible. Medical conditions such as chronic acid reflux or thyroid disorders need to be considered. Lack of movement and poor or improper function of the vocal folds are other causes.

Signs and Symptoms of Voice Disorders:

  • Hoarseness
  • Vocal fatigue
  • Weak or breathy voice
  • Loss of singing range
  • Loss of voice
  • Pitch breaks, or abnormally high or low voice
  • Strained voice
  • Tremor
  • Pain while speaking/singing


After meeting with your physician, you may be scheduled to see a speech pathologist for videostroboscopy. This simple office procedure shows the vocal folds vibrating in slow motion in order to see details of possible growths, vocal cord motion, and function. A scope attached to a camera will be used to see the vocal folds, either through your nose or mouth. This is usually a quick and well-tolerated procedure. Anesthetic spray may be used to make it more comfortable. The strobe exam is recorded on videotape for later review with your physician followed by an explanation of the findings and discussion of options for treatment and rehabilitation.

Voice Therapy

If voice therapy is recommended, you will be scheduled to see a Speech Pathologist. Your exam findings and voice use patterns will be further evaluated in order to provide an appropriate course of treatment. For the professional/singing voice, the expertise of the voice instructor is used to establish proper use and techniques.

Spasmodic Dysphonia

Spasmodic dysphonia is a neurological voice disorder characterized by frequent “breaks” or “shut-offs” while speaking. Speech may be effortful, strained, or unpredictable. At this time, it is unknown what causes this disorder. Although not a cure, Botox has proved to be effective in treating the vocal symptoms.

Botulinum Toxin (Botox)

Botox injections are performed by a physician as an office procedure. Botox temporarily stops the vocal folds from spasming, which can relieve symptoms for up to several months. If you would like more information about the use of Botox for spasmodic dysphonia, please contact us.

Speech Pathologist

The Voice Care Center currently has two speech pathologists who are qualified and experienced in evaluating and treating patients with voice or swallowing disorders.

After the initial exam, your physician may refer you to the speech pathologist for further evaluation and treatment. Together, they will collaborate to determine the best course of treatment.

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