Treatments for the full spectrum of laryngeal conditions are now being offered by Alissa Collins, MD, and Seth Cohen, MD, MPH, otolaryngologists-head and neck surgeons and voice care specialists in the Duke Voice Care Center. The team is treating the full spectrum of laryngeal conditions—from laryngitis and voice strain to vocal cord paralysis, vocal tremors, polyps, laryngeal papillomas, and tracheotomies. They also help patients with voice problems related to acid reflux, allergies, chronic cough, and swallowing disorders.

“A substantial portion of the patient population being treated for laryngeal conditions may have lung cancer or other comorbidities that make surgery in the OR more involved or more risky than usual,” says Cohen. “We’re pleased to offer this new approach to providing care for chronic, debilitating conditions in a better fashion with less morbidity.”

Common treatments that Cohen and Collins perform in the airway clinic include:

• Injections for vocal cord paralysis. Patients with paralyzed vocal cords are often treated with injections either through the mouth or the neck. “We’re finding that if we treat this condition as early as possible after diagnosis patients are getting long-term benefits from it,” says Cohen.
• Laser procedures for lesions. Laser procedures are used to treat a host of lesions that historically have required general anesthesia in the OR.  Conditions such as recurrent laryngeal papillomatosis and vascular polyps are treated in the clinic now, allowing patients to get back to their lives faster.
• Steroid injections for subglottic stenosis. A large study of treatments for idiopathic subglottic stenosis is underway at Duke. One of the techniques showing early promise is serial steroid injections into the stenosis, similar to procedures for a keloid or hypertrophic scar. “People with idiopathic subglottic stenosis often spend years going to gastrointestinal and pulmonology providers searching for a solution, and many are being taken to the operating room for surgery every six months. But we can do injections in the clinic and keep them out of the operating room,” says Collins.
• Tracheostomy removal. “Some patients are given a tracheostomy and told there’s nothing more that can be done,” says Collins, “but that is life-altering for people. So, if we can say there’s something else we can do to get the trach out, even though it may affect a patient’s voice a little, a lot of people are willing to take that chance.”

One of Cohen’s patients recently benefitted from injection laryngoplasty performed in the clinic after steroids, antibiotics, and a proton pump inhibitor (PPI) failed to treat his debilitating vocal cord paralysis. “Unfortunately, patients experiencing larynx symptoms may suffer unnecessarily because of misdiagnosis before they consult a specialist,” says Cohen. This patient’s voice returned to normal within a few days of the procedure and he’s had no further problems.

Looking at the future of voice disorder treatments, Cohen says Duke is involved in computational fluid dynamics modeling studies to examine how inhaled steroids might help concentrate anti-inflammatory medications in the area of stenosis. Other areas of research will involve the overuse of PPIs and how it contributes to adverse events such as pneumonia.

“Problems with the larynx affect our voices, our enjoyment of meals, and our ability to exercise and even to breathe, so it’s very rewarding to help patients with these conditions,” says Collins.