Your First Visit
When you visit the UPMC Voice Center, a team of voice care experts will be available to you. The team works together to evaluate and treat you at the best possible level of care.
Your Medical History
During your first office visit, you will be asked to complete a medical history and background questionnaire, reflux symptom index, and the voice handicap index questionnaire. You will be asked about your general health, medical background, and family history so your doctor will be able to gain insight into any associated or familial problems that might be related to the current condition. You also may be asked to describe your problem, when it began, the symptoms, and how it is affecting you.
In addition, your otolaryngologist may ask about your voice use, vocal training, or associated swallowing or breathing difficulties. You will be asked to provide a list of medications that you take, including prescription, over-the-counter, and alternative medications.
The Voice Examination
During the voice examination, the doctor and a speech-language pathologist will start by carefully listening to your voice and may ask you to repeat some specially worded phrases. This allows the doctor to identify the vocal problem further.
The speech-language pathologist also will perform a voice evaluation. This involves sophisticated recordings made of your voice that allow for computer-assisted analysis and quantitative measurement. Acoustic and airflow measurements can be helpful by providing another measurement of the perceived voice problems. In addition, the speech-language pathologist may ask you to do some voice exercises to see if they can help your voice problem.
The Physical Examination
The doctor will examine your head and neck-including your ears, nose, sinuses, mouth, throat, and larynx (voice box). Your doctor will use one of several methods to view your larynx. He will also examine the major nerves that control your hearing, vision, eye and facial movements, and speech and swallowing (called cranial nerves II through XII).
Your doctor will check your neck, salivary glands, and thyroid by pressing in specific places on your neck to feel for enlarged lymph nodes or masses. This manipulation may also reveal pain or tension in the associated muscles of your larynx. The inside of the mouth, tongue, teeth, and throat will be examined as well.
If there is concern that your voice problem has a neurologic cause, a laryngeal electromyogram (EMG) might be performed, although this exam usually requires an additional visit. This procedure assesses the nerve signals to the muscles of the larynx and is similar to an electrocardiogram (EKG). In this case, the electrical signal from the brain and nerves to the vocal cords is measured by a special recording needle placed in one of the muscles of the larynx. There is minimal pain associated with these measurements, but there may be an uncomfortable sensation of pressure.
The Results of Your Visit
You will receive a detailed explanation of the findings of the examination, treatment options, and a specific treatment plan. Depending on the treatment plan, you may be:
- Prescribed medicine or scheduled for further evaluation or therapy
- Scheduled for x-rays or a repeat laryngeal examination while swallowing if you have an associated swallowing problem
- Scheduled for CT scans to provide your doctor with further diagnostic information
- Referred to a singing voice specialist for further evaluation
Your doctor also will take the time to completely answer any questions you may have.
Methods of Viewing the Larynx
Learn more about the anatomy of the larynx
The flexible nasopharyngoscope provides more dynamic information of the larynx and pharynx. It also is helpful in examining for the presence of sinonasal disease. The nose may be sprayed with an anesthetic and decongestant spray. These sprays usually taste bad and will temporarily numb the nose and throat. The spaghetti-like scope is then passed through the nose and into the back of the throat in order to see the larynx and airway.
For a more detailed examination of the vocal folds, your doctor may want to perform a laryngoscopy, using a flexible or rigid laryngoscope. The laryngoscope is a thin instrument that is connected to a camera. The laryngoscope is threaded through the nose or mouth and dropped down the back of the throat. Using the laryngoscope, your doctor can obtain close-up images of your voice box and vocal folds.
Because your vocal cords vibrate too fast to be seen by the naked eye, a type of slow motion video that uses a strobe light is used to slow down the vibration of the vocal cords for evaluation. Laryngoscopy helps identify problems of a general nature, but videostroboscopy provides a more detailed view and can reveal problems with the vocal cords such as lesions or vibratory irregularities. It also provides photo documentation of the larynx for later review and comparison. The images can be made via a rigid or a flexible exam.