Evaluation and Treatment of Breathing Problems
1. Evaluation of Chronic Cough
Lakeshore Professional Voice Center specializes in the management of refractory cough. Evaluation by Dr. Rubin is initially performed. He may recommend testing, a trial of medications, and/or voice therapy with respiratory retraining. A combined team approach with the voice pathologist is often required.
Voice therapy with respiratory retraining includes cough suppression techniques, exercises to control breathing patterns, vocal hygiene recommendations, and management of cough and its triggers.
2. Evaluation of Paradoxical Vocal Fold Motion (Vocal Fold Dysfunction)
Previously called “Vocal Cord Dysfunction (VCD),” Paradoxical vocal fold motion (PVFM) is a disorder of the larynx (voice box). The vocal folds need to open when the air comes into the lungs and stay open when the air comes out. When an episode occurs, the vocal folds behave “paradoxically” and they close to some degree when they should be open. PVFM can present as a chronic cough as well as breathing difficulties. A team approach is taken to evaluate and treat PVFM. Some medications might be appropriate as sometimes neuralgia and/or acid reflux might contribute to the disorder. Voice therapy with respiratory retraining is often the best treatment. Biofeedback techniques are taught to break episodes of PVFM. Patients are taught to identify and avoid triggers, as well as vocal exercises to control vocal fold movement and breathing patterns.
3. Evaluation of Airway Stenosis
Some breathing problems occur due to narrowing of the airway from scarring (often from previous prolonged intubations), bilateral vocal fold paralysis, and some medical conditions. Dr. Rubin evaluates these problems in the office.
Endoscopic Surgery for Bilateral Vocal Fold Paralysis and Laryngeal Stenosis
Although the larynx or “voice box” is best known for producing voice, its most important function is providing a passageway for air to get into the lungs when one breathes. At times, this passageway can be compromised due to a number of reasons, such as: having a breathing tube in place for a long time, having surgery in the neck that results in both vocal folds being paralyzed, and certain autoimmune disorders. Many times these issues may be managed endoscopically (through the mouth) using a combination of lasers and balloon dilators. Often a tracheostomy tube can be avoided. Other times, patients may already have received a tracheostomy tube, and the goal of surgery will be to open the airway enough to be able to remove it. Unfortunately, in some cases, opening the airway may compromise some of the other functions of the larynx, such as voice production and protecting the airway during swallowing. A full discussion of these risks is necessary before any operative intervention. In some more complex cases, open surgery (with an incision through the neck) is required.