AIRWAY & BREATHING  |  Conditions We Treat

Subglottic stenosis is when the upper section of your trachea (windpipe) is narrower than usual so that there’s a whistling noise when you breathe, or you feel short of breath. 

Who does it affect?
Anyone can have subglottic stenosis. Your newborn baby may be born with an unusually narrow airway (congenital subglottic stenosis). Several things can cause subglottic stenosis in adults, but it can happen for no known reason (idiopathic subglottic stenosis). It is a rare condition affecting 1 in every 400,000 people.

How is it treated?
Without treatment, severe subglottic stenosis can become life-threatening.  But treatment to widen the narrow area in your windpipe can effectively treat the condition.

Chronic cough is a cough that lasts for 8 weeks or longer. This cough is often dry and unproductive and can occur in episodes throughout the day. It has often not responded to typical medical treatments.

What is the effect?
Chronic cough often occurs because the throat has become hypersensitive to certain triggers. Common triggers include odors, eating and drinking, temperature change, air quality change, and robust voice use like laughing, talking on the phone and singing.

How is it treated?
Cough treatment at the Ark-La-Tex Center for Voice, Airway and Swallowing often includes a combination of improvement in laryngeal hygiene and medical management of contributing factors. We also offer behavioral cough suppression therapy, a treatment offered by upper airway-specialized speech-language pathologists that trains you to suppress the cough and eventually results in a reduction in or elimination of the urge to cough.  This therapy can be complete in  person in the office or via telehealth.

For those patients with complex chronic cough you may be referred to our multidisciplinary cough clinic. During this monthly clinic patients are evaluated by a team including a Laryngologist, Allergist and Speech Language Pathologist.

Literally laryngomalacia means “soft larynx”. It is caused by floppiness of the tissue above the vocal cords. When a person breathes in, these tissues fall in toward the airway and cause the airway to be partly blocked. The blockage at the area of the voice box creates noisy breathing. Most commonly this impacts infants but very occasionally can impact an adult.

Who does it affect?
Laryngomalacia is the most common cause of noisy breathing in infants. More than half of infants have noisy breathing during the first week of life. Most other babies have it within 2 to 4 weeks of birth. It is rare, but laryngomalacia can happen in older children or adults, usually those with other medical problems.

Bilateral vocal fold paralysis is a disorder characterized by complete immobility of both vocal folds, often occurring as a result of surgical injury or malignancy. This condition leads to voicing, swallowing, and/or breathing difficulty. If the vocal folds are paralyzed in an open position, voicing can be negatively affected. Swallowing may also be difficult if the vocal folds cannot close to protect the airway, leading to risk for aspiration pneumonia.

What is the effect?
Patients with bilateral vocal fold paralysis often develop significant difficulty breathing as the vocal folds can no longer open appropriately when breathing in or out. Depending on the position of the paralyzed vocal folds, surgery may be required to either bypass the larynx (voice box) or widen the narrowed portion of the vocal folds in order for the patient to breathe safely. Contraindications for these different procedures depend on each individual’s medical history and should be thoroughly discussed with the surgeon.

How is it treated?
Pre-procedure Considerations: As there are multiple surgical options available to treat airway compromise due to bilateral vocal fold paralysis, it is important that the patient have a thorough discussion with the surgeon regarding the side effects and reversibility of each procedure. Each procedure carries different risks of affecting the patient’s voice quality, breathing, and swallowing function.

Possible procedures include:

• Tracheostomy - A surgical opening into the trachea below the level of the vocal folds to bypass the narrowed portion of the airway
• Transverse cordotomy – Removal of the posterior portion of the vocal fold to improve the airway
• Arytenoidectomy - Removal of the arytenoid cartilage(s) to improve the airway

A tracheotomy is an operation during which a small opening is made through the skin of your neck into your windpipe or trachea.  After the skin has healed open, the opening is called a stoma or a tracheostomy.  A tracheostomy tube is kept in the stoma to keep the hole open.  Sometimes you may hear people refer to the tracheostomy as the “trach”. 

There are many reasons a tracheostomy may be needed.  These reasons include:

• Severe lung disease or muscle weakness or other conditions making breathing difficult, requiring the use of a breathing machine.
• The trachea or larynx may be too small or obstructed and air is not able to go in or out of the lungs.  The tracheostomy is used to bypass the larynx and allow air to enter the trachea or keep the airway open.
• Mucous can build up in the lungs and block airflow if it is not coughed out.  When there is too much mucous, a tracheostomy allows mucus to be suctioned out to improve breathing.
• A tracheostomy may be needed for a short time or a longer time. 

Here at the Ark-LA-Tex Center for Airway, Voice and Swallowing we can help you care for your tracheostomy.  We can assist with the ordering of supplies. We are able to offer guidance regarding speaking with a tracheostomy tube and using a speaking valve. In addition, we can help you determine when removal of the tracheostomy tube may be appropriate.

Also called throat cancer: A disease that starts in the larynx, the part of the throat that contains the vocal cords

What are the symptoms?
Laryngeal cancer symptoms can be similar to those of other conditions. They may include:

• Coughing up blood or bloody sputum
• Ear pain
• Hoarseness
• Lump in the neck or throat
• Sore throat or cough that does not go away
• Trouble or pain when swallowing

What is the cause?
Certain factors can increase your risk of developing larynx cancer. Having one or more risk factors does not mean you will develop cancer, and some people with no risk factors develop the disease. Laryngeal cancer more often affects males, older adults, and African Americans.

Your risk for laryngeal cancer also increases with:

• Heavy alcohol use
• Human papillomavirus (HPV) infection
• Poor nutrition
• Tobacco use
• Weakened immune system

How is it diagnosed?
Diagnosis involves several steps which may include:

• Laryngoscopy
• Biopsy
• Computerized tomography scan (CT scan)

How is it treated?
Treatment of laryngeal cancer can involve a combination of surgery, chemotherapy and radiation depending on the extent of the disease.

Voice and swallow rehabilitation after total laryngectomy (removal of the voice box).

• After total laryngectomy there are many methods of rehabilitating the voice. The two most common methods are the use of the electrolarynx and the use of a speech prosthesis (TEP). We take a multidisciplinary approach to TEP or speech prosthesis management. Our laryngologist and Speech Language pathologists work closely to plan for placement of the TEP and assist with changes and education regarding use.
• After total laryngectomy patients may have some difficulty swallowing. We work together to help the patient return to a normal diet. This may include esophageal dilation or swallow therapy following cancer treatment.

What is paradoxical vocal fold motion?  Also known as vocal cord dysfunction, paradoxical vocal fold motion is a condition in which the vocal cords spontaneously close, cutting off the air supply.  It can often present like asthma, and some individuals may experience symptoms of both conditions simultaneously.

What are the symptoms?
Symptoms of PVFM include:  Shortness of breath, chronic cough or throat clearing, wheezing or stridor (noisy breathing), upper chest or throat tightness, intermittent hoarseness. Individuals may experience symptoms of PVFM during exercise and while laughing or crying.  Environmental factors such as cigarette smoke, cold air, strong aromas, and upper respiratory infections can trigger PVFM. Health conditions such as heartburn, reflux, and post-nasal drip can also irritate the vocal folds and contribute to PVFM.

How is it treated?
Treatment options for PVFM may include:

• Reflux medications or dietary changes to reduce reflux
• Use of nasal sprays or nasal washes for post-nasal drip
• Speech therapy to learn breathing techniques to relax the vocal folds.
• Anxiety treatment