Just Say the Word: Columbia University Medical Center Makes it Easier To Swallow and To Speak

Unique Voice and Swallowing Center Offers Innovative Help for Problems of the Throat

Apr 15, 2003

New York, NY

Although we do it over 2,000 times every day, for some people the simple, unconscious act of swallowing is so difficult as to be almost impossible. And for others, deterioration in voice quality can hinder livelihood or quality of life. Help is now available through the Voice and Swallowing Center at Columbia University Medical Center at NewYork-Presbyterian Hospital, which is dedicated to the evaluation and treatment of voice and swallowing problems, and is the sole center of its kind in New York City.

Consisting of a team of nationally recognized specialists, state-of-the-art diagnostic technology, emergency care, and patient education, the Center offers comprehensive and complete care of the voice and swallowing systems. Because of the expertise of our staff, we're able to diagnose and successfully manage a wide variety of voice and swallowing problems, says Jonathan Aviv, M.D, the medical director of the Center and professor of otolaryngology at Columbia University College of Physicians & Surgeons.

People tend not to think about swallowing or even how they sound, but when something goes wrong, it becomes noticeable and often very uncomfortable. And it can lead to bigger problems, he adds.

The larynx, or voice box, is the primary organ responsible for voice production and for normal swallowing, explains Thomas Murry, Ph.D., the Center's clinical director and professor of clinical speech-pathology in otolaryngology at Columbia University College of Physicians & Surgeons. Although it's a small organ, there are a number of things that can 'go wrong' with it, causing problems for the elderly as well as the young, for people who use their voice professionally, like singers and actors, and for the rest of us, who rarely give a thought to either our voice or swallowing, he adds.

Dysphagia, or difficulty in swallowing, can result from many conditions. Neurological disorders such as stroke, Parkinson's disease, cerebral palsy, multiple sclerosis, and amyotrophic lateral sclerosis (ALS, commonly referred to a Lou Gehrig's disease) can cause dysphagia of varying degrees because of the effects these conditions have on the nerves and muscles involved in swallowing. Tumors, ill-fitting dentures, poor dental condition, head or neck surgery, medications, and even the common cold also can make it difficult to swallow properly. One of the most common causes of dysphagia is gastroesophageal reflux disease (GERD), which occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort, which then results in impaired swallowing.

Dysphagia often results in an inadequate intake of nutrition, which can lead to significant health problems such as weight loss and dehydration. Untreated, it can also lead to aspiration, whereby food goes down the wrong pipe. Instead of food or liquids traveling past the pharynx and through the esophagus into the stomach, they instead are routed down the trachea and often into the lungs. This can cause chronic coughing, airway obstruction, and choking. More serious is if food or liquid actually enters the lungs, the result can be aspiration pneumonia. This is an extremely significant problem. About one-third of individuals who have had a stroke subsequently develop dysphagia, and, unfortunately, many of them develop aspiration pneumonia. Aspiration pneumonia linked to swallowing problems causes about 40,000 deaths in the U.S. each year. In light of the rapidly growing elderly population, attention to swallowing problems is becoming increasingly important, emphasizes Dr. Aviv.

Treatment for dysphagia depends on its causes. Patients are evaluated through history and testing, which can include transnasal endoscopy, barium swallow x-ray or videofluoroscopy, or FEESST (flexible endoscopic evaluation of swallowing with sensory testing). FEESST was developed by Dr. Aviv and is a nonradioactive alternative to barium swallow x-rays. The test permits direct assessment of the motor and sensory aspect of the patient's ability to swallow. It also allows for evaluation of manifestations of GERD.

One of the main benefits of FEESST is that it can be done in the office, rather than in a special radiology suite in the hospital, says Dr. Aviv. And it provides us with practical recommendations for dietary and behavioral management for patients who can still take food by mouth as well as for those who are on tube feedings. It also is of tremendous help in identifying specific rehabilitative swallowing therapies for each patient. Therapies can include modifications of head or neck posture, food placement within the mouth, medications, changes in food consistency, swallowing exercises, or surgery.

While usually not life-threatening, voice problems can have a severe impact on those who base their livelihood on how they sound. Especially when they find themselves 'without a voice' when they need it most. But voice problems can have a detrimental effect on those who don't rely on the quality of their voice to earn a living. Pain, discomfort, hoarseness can make social interaction difficult for many people, with the result that they almost stop talking or avoid social situations or career opportunities where speaking is mandatory, notes Dr. Murry. Voice problems can be the result of a variety of conditions. These include vocal polyps, cysts, nodules, paralysis, and misuse of the voice. It should be remembered that prolonged hoarseness without any signs of flu or cold should alert someone to the possibility of a more serious disease, such as throat cancer.

Patients are evaluated by a thorough history and a variety of tests. These can include acoustic analysis, vocal performance evaluation, aerodynamic evaluation, video strobolaryngoscopy, and a voice handicap survey. Treatment consists of behavioral voice therapy, medications, phonosurgery, botulinum (Botox™) injections, laryngeal reconstruction or framework surgery, or postcancer voice rehabilitation.

Too many people have been told that there isn't any help for them or that their problem isn't that significant and they try to make adjustments. But that's not the case. Swallowing and voice problems are often serious, or if untreated, can lead to bigger problems. There is help for them, for their swallowing problems, for their voice problems. Just say the word. We're here to help, concludes Dr. Aviv.