DIsorders of Voice and Swallowing
Professional Voice surgery
Professional singers, actors, and other voice users who rely on their voices for their
livelihood require a higher level of care for their voice problems.  Dr. Zalvan has
extensive experience with our region's singers: theater groups, conservatories, and chorus
both on a local and national level. From amateurs to professional, children and adults,
proper diagnosis is key to an excellent outcome. When medical treatment and voice
therapy is not sufficient to solve the problem, surgery might be recommended.  These
surgeries should only be performed by a
laryngologist.  Suspension microlaryngoscopy
with microflap technique is the gold standard treatment for the majority of these benign
lesions of the voice box.  
Polyps, cysts, scar tissue, and sometimes nodules can be removed
under high power magnification.  Specialized techniques of
microflap excision minimize
surrounding damage to the vocal cords and allow for excellent healing with return of the
normal singing or speaking voice.  There are minimal complications and little discomfort
from the surgery.  Voice therapy with a specialized speech pathologist with a classical
singing background is essential both before and after surgery for full recovery with an
optimal performing voice.
Chronic Cough

Chronic cough can be debilitating, embarrassing, and uncomfortable.  People often seek
multiple medical opinions from many different doctors.  In the end, the cough continues.  
Up to
40-50% of chronic cough (not asthma, sinusitis, or allergy) is due to
Laryngopharyngeal Reflux (LPR) disease or a Neurogenic Cough Disorder.  LPR is
reflux into the throat region with chronic cough, voice change, throat clearing, phlegm,
lump in the throat, and throat discomfort with problems swallowing.  A Neurogenic Cough
is a cough that is usually preceded by a tickle sensation, made worse by talking, eating,
cold air, laughing, and often occurs in spasms. Dr. Zalvan is currently involved in
numerous research projects exploring the cause and treatments of this cause of cough.  He
is the regional expert in sensory related cough neuropathies and has spoken
internationally on this topic.

Vocal Fold Paralysis Surgery

People with a paralyzed vocal cord often have a breathy, weak voice; in addition, they
may aspirate - have food or liquid go into the lungs.  An outdated way of thinking is to
wait for the nerve to heal.  Why have severe hoarsness, shortness of breath, fatigue, and
trouble eating ?  
Vocal Fold medialization surgery can help to close the voice box,
provide a stronger, more natural voice, and help prevent aspiration.  This can be
accomplished by an injection of material into the vocal folds to help push them together
(
Injection Laryngoplasty).  This injection is either performed in the office under topical
anesthesia, or in the operating room.  Another procedure requires a small incision over
the Adam's apple and the placement of a small implant to push the paralyzed vocal fold
toward the midline (
Medialization Thyroplasty).  Both are short procedures, easily
tolerated, and with great results for improved voice and swallowing ability.

Dysphagia - Swallowing Disorders

Difficulty swallowing can occur from many different causes.  At the Institute, we have a
full range of diagnostic tools to help identify the cause of the swallowing problem.  We
perform office based
transnasal esophagoscopy TNE - an alternate way of examining the
esophagus in the office with topical anesthesia and no sedation (no risks of anesthesia, no
down time or missed work, minimal discomfort, and immediate results).  In addition,
pH
(acid)
testing using the Restech system, FEES (Flexible Endoscopic Evaluation of
Swallowing),
MBS (Modified Barium Swallow) can all pinpoint the cause.  Medical and
Surgical treatments exist for many swallowing problems. Many of these techniques have
been introduced to this region by Dr. Zalvan. Our speech pathologists are experts in the
treatment of many of these disorders.  They offer advanced therapeutic techniques,
electrical stimulation of the swallowing muscles, and guided swallowing exercises to help
return a person's swallow to normal.  We have an abundance of experience with
Head and
Neck cancer
patients who have undergone surgery or chemoradiation and have
subsequent swallowing problems or are feeding tube dependent.
KTP Laser Voice Surgery

The newest technique for curing diseases of the vocal folds and voice box includes the use
of a
KTP laser. Dr. Zalvan, who lectures nationally and internationally on this topic offers
this technique at the Institute for Voice and Swallowing Disorders.  This laser has an
affinity for blood vessels allowing it to target abnormal blood vessels and blood supply
leading to resolution of lesions such as
vocal fold polyps, papilloma, dilated blood vessels,
precancerous and cancerous conditions
.  This procedure is primarily performed in the
office under topical anesthesia with little or no recovery time.  Not only does this
effectively remove the lesions, it does so with minimal or no surrounding damage to the
vocal folds and thus minimal or no scar formation.  The ultimate result is an improved
voice and cure without the need for general anesthesia
KTP Laser in Office Setting
KTP Laser in the OR
Laryngopharyngeal Reflux Disease (LPR)

LPR. is not GERD.  LPR is the reflux of stomach contents into the region of the
laryngopharynx.  Although from the stomach, the symptoms, findings, and effects of LPR
are vastly different from GERD.  Most people with LPR do not have GERD symptoms.  GI
evaluation is often negative in patients with LPR. Unlike GERD, LPR is diagnosed
primarily based on symptoms, physical findings, and response to treatment.  The most
commons symptoms are
hoarseness, chronic cough, throat clearing, a lump in the throat
feeling, mucus, trouble swallowing, and sour taste
, usually in combination.  Physical
findings vary and are visualized endoscopically – either with a flexible laryngoscope or
video-stroboscopy (the gold-standard of laryngeal diagnosis). In addition, office-based
Trans-Nasal Esophagoscopy can help with diagnosis and with surveillance for esophageal
cancer and Barrett’s.  Some studies have shown an association of esophageal
adenocarcinoma with LPR and a chronic cough or the other symptoms above may be the
only sign.
Recent research demonstrates our DIET based approach works as well, if not
better than PPI
(proton pump inhibitors like Prilosec). We are now working with patients
to STOP their many years of PPI use.
Zalvan C, Reilly E. Symptomatic vallecular cysts:
diagnosis and management with the KTP laser
Eur Arch Otorhinolaryngol
DOI 10.1007/s00405-016-4026-1. April 2016
Monsoon Jet Ventilation system - We are the only center in the region
to use this technology. Jet ventilation allows for general anesthesia
without the need for a breathing tube. This minimizes potential damage

singers. There is less postoperative discomfort and better visualization
during surgery.