TREATMENTS & SERVICES

These types of examination use fiberoptic (small cameras on cables) instruments to assist the examiner in looking at the larynx. The instruments possess a small camera in which the examiner can see the larynx. Usually, the picture seen with the instrument is fed via a camera lense into a digital recorder. This allows us to document your condition and also lets us keep a record for comparison with earlier, and later, exams.

In an examination with a flexible scope, you are given a spray to clear out your nose and to make it a little numb (anesthetize). The flexible fiberoptic scope is then sent through the nose and down the back of the throat into the pharynx. From this position, an image of the larynx and vocal folds (including their movement and position during breathing and speech) can be obtained and recorded.

An examination using a rigid scope involves placement of the tip of the instrument at the back of the tongue to provide a view of the throat. A prism at the tip of the scope allows the provider to see down into the larynx. This type of exam provides clear and highly magnified images of the vocal folds

The doctor may perform a test called a stroboscopy, which is a medical examination of the vocal folds and their motion. It is a simple test, performed in the doctor’s office to examine both the anatomy and function of the vocal folds.

During speech, the vocal folds vibrate far too quickly (over 100 times per second) to be examined with the naked eye. In order to overcome this, a strobe light is used to illuminate the vocal folds in slow-motion. A strobe emits bright pulses of light at evenly spaced intervals. If the frequency of those pulses is the same as the vibration frequency of the vocal folds, then the folds will appear "frozen" in time. If, however, the frequency of the strobe is slightly less than that of the vocal folds, the folds will appear to move in slow-motion.

This type of exam is important because it allows the vocal folds to be examined while you talk. Many problems with the larynx involve changes of this structure which in turn cause a change in the vibration of the vocal folds. During examination with a regular light source, these changes might go unnoticed. Stroboscopic examination allows the provider to see if any irregularities are present.

Here is what happens:

• The doctor sprays a numbing medication into the patient’s nose and throat.
• The patient leans forward and holds their tongue with gauze.
• The doctor inserts an endoscope (a narrow tube) into the mouth. The endoscope is equipped with a camera and a flashing (strobing) light that helps the practitioner see the vibration of the vocal cords in slow motion.
• The patient follows prompts to make certain vocal sounds so the doctor can see how the vocal cords function.

As in Flexible Endoscopy, above, a FEES study uses a flexible scope to evaluate swallowing function. The nose is first decongested and anaesthetized (numbed) and then the scope is gently inserted through the nose in order to look at the structures of the larynx and pharynx. With the scope in place, the patient is then asked to do a variety of speech tasks which allow for the identification of any abnormalities in structure or function. After this, the patient receives something to swallow. In individuals who have a long history of aspiration and swallowing difficulties, this step to swallow may occur without food or liquid. In individuals who are currently eating and drinking, a variety of regular food and liquids are given to observe how the patient swallows. The examiner will assist if and when problems happen.

During the examination, the patient and any family/caregivers in the room are able to see the examination in real-time on a monitor. This allows the examiner to teach students or residents, and to educate the patient, about the nature of the problem, evaluation of various swallowing strategies, and methods to teach swallowing maneuvers and exercises. This examination and the techniques then can form the basis of swallowing treatment.

Trans-nasal esophagoscopy (TNE) is a test that helps your doctor diagnose and treat problems of your esophagus and stomach. When you swallow, food and liquid go down a tube called the esophagus to reach your stomach. Transnasal esophagoscopy is an in-office test that your doctor can perform to diagnose a problem with your esophagus or stomach. It involves a doctor inserting a narrow tube into your nose. You swallow the tube, and a light and a tiny camera on the end help your doctor see the esophagus and stomach.

Transnasal esophagoscopy is simple and does not hurt. The doctor applies numbing medication to your nose and throat, and most people tolerate it easily.

Your doctor might recommend transnasal esophagoscopy if you are experiencing symptoms that suggest a problem with your esophagus or stomach. These symptoms include:

• Difficulty swallowing, or the sensation of food getting stuck (dysphagia)
• A foreign body sensation or feeling a “lump” in the throat (globus sensation)
• Heartburn or regurgitation
• Hoarse voice
• Chronic throat clearing, throat irritation, chronic cough, excess throat mucus and other, similar symptoms

If you have symptoms such as chronic cough or swallowing difficulties, there are several tools that can help identify the problem. Your doctor will discuss options with you and recommend tests based on your individual needs.

In some situations when a doctor wants to look at the patient’s esophagus or stomach, transnasal esophagoscopy can be an alternative to an esophagogastroduodenoscopy (also known as EGD, or upper endoscopy), a more involved procedure that can take longer than transnasal esophagoscopy and require sedating medication.

Transnasal esophagoscopy can help your doctor find a problem in your esophagus or be part of a treatment. Your doctor can collect a sample of tissue (biopsy) from your larynx (voice box), esophagus or stomach to examine under a microscope. The procedure can be used to gently widen a tightened area in the esophagus by inflating a balloon attached to the tube, take a sample of a suspicious looking area, or to inject medication into parts of the esophagus.

TNE helps your doctor get a look at your esophagus passageway and your stomach opening to see what might be causing your symptoms.

What happens during a TNE?

• After you sign a release giving your doctor permission to perform transnasal esophagoscopy, he or she will spray the inside of your nose and throat with numbing medicine.
• The doctor will guide the end of the narrow tube into your nose and down your throat.
• The tiny camera on the tube will provide your doctor with a view of the esophagus as the tube moves downward. The doctor will look for conditions that would cause your symptoms.
• If the doctor is using transnasal esophagoscopy as part of a treatment to address a condition, there might be other steps, such as collecting specimen of tissue or expanding a tight area of the esophagus so you can swallow more easily.
• Afterward, the doctor will remove the tube and you can resume your activities. You can eat or drink as soon as the numbing medication wears off.
• Your doctor will discuss the findings with you and recommend a treatment plan based on your diagnosis.

Are there side effects or risks involved?
The doctor inflates air into your esophagus during transnasal esophagoscopy, so you might have some temporary burping afterward. Your nose or throat might be temporarily irritated from the tube.

Flexible bronchoscopy is a procedure to examine the breathing airways. This test lets your healthcare provider see the inside of the airways and take tissue or mucus samples.

The bronchoscope is a thin tube-shaped instrument. It's inserted through the nose or mouth, down the trachea, through the bronchi into the lungs, and into the smaller branches of the airway, the bronchioles. A camera at the end of the tube takes images which are then transmitted to a video screen.

A bronchoscopy allows your physician to evaluate the condition of your airway and lungs. Awake bronchoscopy can be performed in the office to provide dynamic upper airway evaluation.

Fluoroscopy is a technique, similar in principle to an ordinary X-ray. It is used to check and test how a patient is swallowing, if a swallowing problem is suspected. However, in contrast to the single picture of a simple x-ray, videofluoroscopy provides a continuous video image. This study is done with a radiologist and speech pathologist.

In this exam, the patient swallows barium (a special mixture of chemicals) of different thickness. While the patient swallows, the examiner is able to see how the barium moves through the mouth and into the pharynx and esophagus.

HRM is sometimes performed concurrently with an MBSS if there is concern for weakness in your throat or esophagus during swallow, or if there is a constriction of your upper esophageal sphincter (UES) which is the doorway to your esophagus from your throat.

A small pressure catheter is passed through the nasal passageway then swallowed to monitor for muscular activity during the swallow. You will be given several consistencies made up of barium, a naturally occurring mineral which shows up on X-ray and allows the speech-language pathologist to analyze your swallow function.

Most assessments are between 4 and 7 minutes in length.

A CT scan of the neck is much like an X-Ray. It can be used to evaluate the vocal cords, larynx and trachea. It can be used to help diagnose laryngeal injuries, airway stenosis and vocal cord paralysis.

Pulmonary function tests measure the lungs’ capacity to hold air, to move air in and out, and to absorb oxygen. Pulmonary function tests are better at detecting the general type and severity of lung disorder than at defining the specific cause of problems; however, these tests can be used to diagnose some specific disorders, such as asthma and chronic obstructive pulmonary disease (COPD).

Airflow measurements are made with a spirometer, which consists of a mouthpiece and tubing connected to a recording device. The person’s lips should be held tightly around the mouthpiece, and nose clips should be worn to ensure that all the air inhaled or exhaled goes through the mouth. A person inhales deeply, then exhales forcefully as quickly as possible through the tubing while measurements are taken. The volume of air inhaled and exhaled and the length of time each breath takes are recorded and analyzed. This measurement is repeated several times to be sure the results are consistent.

Often, the tests are repeated after a person takes a medication that opens the airways of the lungs (bronchodilator).