Conditions and Surgeries
The inability to burp (Retrograde Cricopharyngeal Dysfunction, R-CPD) is a dysfunction of the upper esophageal sphincter. The patient has often had the condition for an extended period of time, sometimes even since childhood.
The underlying cause of the inability to burp remains unclear.
The inability to burp is typically accompanied with a feeling of pressure behind the sternum, gurgling sounds in the throat and flatulence. Consuming many types of food, especially carbonated drinks, causes discomfort.
Treatment of the inability to burp:
The inability to burp can be treated with a Botox injection.
The injection typically uses 100 units of botulinum toxin type A. The procedure is performed under general anaesthesia. After the procedure, the patient is discharged on the same day.
An oesophagoscopy or other examinations may be performed in connection with or prior to the procedure.
Results of the treatment:
The objective is to restore the ability to burp normally and achieve the disappearance or substantial alleviation of symptoms.
A large proportion of patients experience permanent results after the procedure, with less than 10% of patients needing another injection.
An Adam’s apple reduction (tracheal shave) is usually performed on transwomen with conspicuously prominent thyroid cartilage. The procedure is carried out as day surgery and the wound heals in about a week. The wound will leave a small scar that will fade over time and at best disappear entirely.
Your voice may become hoarse due to laryngitis, stressed vocal folds or external irritants. In practice, hoarseness is due to imperfect closure of the opening between the vocal folds as a result of inflammation of the vocal folds, a scar, tumor or other unevenness. Hoarseness may also be caused by vocal fold paralysis, but this is a far rarer condition. The tolerance of the vocal folds differs from individual to individual. Excessive strain can ruin even the best-trained voice.
The assessment of your voice problem at the Voice Clinic includes a 45-minute consultation during which the problem is evaluated and the vocal folds are examined using a flexible endoscope. If necessary, additional studies at the voice laboratory and assessment by a speech therapist can be arranged.
A hoarse voice is a typical symptom of vocal fold lesion. Prolonged hoarseness may be a cause for concern, even though the changes are usually benign in nature.
Surgical removal of vocal fold lesions and taking of biopsies (samples) are usually performed under general anesthesia using microlaryngoscopy (observation with a microscope), enabling laser surgery. If necessary, biopsies can also be taken under local anesthesia.
After the surgical procedure and taking of biopsies, the patient can go home the same day. A pathological examination of the nature of the lesion will be completed in about a week.
A particular disorder of the vocal fold muscles is called laryngeal dystonia, also known as spasmodic dysphonia (SD). Depending on whether the disorder affects the muscles that open or close the vocal folds, the symptoms can manifest, for example, as tightness of a person’s voice, or as breaks or weakness occurring in the voice.
The problem can be a mentally and socially awkward problem, and can limit the person from practicing a profession where speaking is essential.
In patients with diagnosed adductor spasmodic dysphonia, myoneurectomy can be a decisive surgery.
What is myoneurectomy?
Myoneurectomy is a surgery to remove a specific vocal fold muscle called a thyroarytenoid muscle and its nerve branches.
This method aims to restore the natural function of the vocal folds, improve voice quality, and reduce other disturbing symptoms. The effect of the surgery is similar to the alternative treatment with botulinum toxin injections, but the effect of myoneurectomy is usually permanent.
How is myoneurectomy performed?
During myoneurectomy, an experienced surgeon carefully identifies and resects the active muscles while maintaining the surrounding healthy tissue. This accuracy helps to minimize potential adverse effects and ensures optimal treatment outcome for the patient.
Patient-driven care
The voice clinic’s commitment to patient-driven care is central to every procedure. Before recommending myoneurectomy, our multidisciplinary team will conduct a thorough assessment to determine the most appropriate treatment for the patient. We stress the significance of open communication, ensuring that the patient is well informed and supported throughout the process.
Recovery and rehabilitation after myoneurectomy
After myoneurectomy, approximately 60% of patients have been found to have permanent relief following the initial surgery. The rest of the patients may experience symptoms of spasmodic dysphonia after approximately 6 months when the removed branch of nerves re-grows. The surgery can be repeated twice after the initial surgery to remove the grown nerve branch. If the spasmodic dysphonia returns, and the patient no longer wishes or is not eligible for another surgery, they can be treated with botulinum toxin injections. At this point, lower than normal doses of botulinum toxin are often sufficiently effective and their effect will last longer.
The voice is an important means of communication and a major part of human personality. As people age, muscle fibers undergo natural shrinkage (atrophic dysphonia), which in some people can also affect the vocal folds. This in turn can worsen the quality of the speaking voice. The vocal fold changes typical of ageing can sometimes even be seen in those aged thirty, even if their other muscles are in perfect shape.
A voice lift refers to procedures that make the voice sound stronger and more sonorous. The most common voice lift procedure is temporary vocal fold augmentation by injecting filler. The procedure can be carried out under both local anesthesia and general anesthesia. The patient’s voice will usually be tight for a few days after vocal fold augmentation. The improvements become apparent after this recovery period. The effects of a voice lift on the voice are always individual. The procedure is effective for a year on average, but in some cases the effect lasts only for a few months. At best, the voice quality can be better for up to two years. Vocal fold augmentation is generally performed with a temporary, absorbable filler.
The pitch-raising procedure – the feminization of the voice – is called glottoplasty.
There is a substantial difference in the pitches of the voices of men and women. Women who find their own speaking voice too low for comfort and transwomen (male-to-female transsexuals) may want to raise the pitch of their voice.
Various pitch-raising procedures are available. Some are performed under local anesthesia, and some under general anesthesia. The choice of procedure depends on whether the patient wishes to raise the pitch of their voice slightly (a woman who wishes to get rid of a low bass voice) or to achieve a substantial change in pitch (e.g. when a male larynx is adjusted – “tuned,” in a way – to produce a female voice).
The effect of vocal fold paralysis on the voice depends on the position in which the vocal fold has been paralyzed and to what extent it has reduced vocal fold stiffness and muscle mass.
What are treatment methods of vocal fold paralysis?
There are several treatment methods. The choice of method depends on the patient’s voice needs. Some cases of vocal fold paralysis get better over time, but it is just about impossible to predict how well and quickly paralysis will improve.
Paralysis on one side is treated with vocal fold augmentation or by correcting its position. Some of these procedures can be performed under local anesthesia, while others are done under general anesthesia. The experts at the Voice Clinic have long experience of using fascia as vocal fold filler. This is the only permanent filler sourced from your own body. When treating recent paralysis, temporary vocal fold augmentation can be performed to improve the voice. The filler will dissolve from the vocal fold if the paralysis improves on its own.
Voice deepening surgery permanently lowers the pitch of the voice. Because voice plays an important role in personal identity and social perception, some individuals feel their natural speaking voice is too high for their gender identity or expectations.
Who may benefit from voice deepening?
Voice deepening surgery may be considered for:
- Cisgender men with an unusually high voice.
- Transgender men whose voice remains high despite testosterone therapy.
- Non-binary individuals seeking a more masculine speaking voice.
- Patients with mutational falsetto when voice therapy has not been successful.
Voice deepening surgery
Voice deepening surgery, also called Type III thyroplasty, lowers voice pitch by modifying the thyroid cartilage of the larynx.
During the procedure, the anterior part of the thyroid cartilage is pushed backward, shortening the laryngeal framework and relaxing the vocal folds. This allows them to vibrate at a lower frequency and produce a deeper voice.
The surgery is usually performed under local or general anaesthesia and takes about 1–2 hours.
A small incision is made in a natural skin crease on the front of the neck. The cartilage is repositioned and stabilized with sutures. Patients are usually discharged the same day.
Recovery and results
The procedure is generally well tolerated, and postoperative pain is minimal. Temporary hoarseness, mild throat discomfort, or neck swelling may occur.
Most patients return to normal daily activities within a few days. The voice gradually stabilizes over several months, with final results typically seen after 6–8 months. The result is permanent.
Spasmodic dysphonia is a neurological voice disorder in which involuntary spasms of the laryngeal muscles cause a strained, effortful, or interrupted voice.
Treatment is performed with botulinum toxin (Botox) injections into the affected vocal muscles. Botox temporarily relaxes the overactive muscles and helps restore smoother voice production.
In many cases, injections are done with extremely thin needles or transnasal intralaryngeal injections are used. In this way, very small and precise amounts of Botox are injected directly into the targeted muscles.
The procedure is performed in an outpatient setting without sedation and usually takes only a few minutes.
The therapeutic effect typically lasts around three months, after which the injection can be repeated if necessary.
Many procedures on the vocal folds no longer require general anesthesia. With modern endoscopic technology, interventions such as injections, bopsies and laser treatments can be performed safely and comfortably in the office. Patients remain awake, and recovery is rapid, eliminating the need for sedation or hospital stays.
Range of office-based phonosurgery under local anesthesia, including transnasal laser removal of laryngeal papillomas. A huge range of procedures are offered from vocal folds lesions, papillomas, reinke’s edema, vascular changes to scarring and chronic inflammation.
After the procedure, the patient is discharged almost immediately without need for supervision at night or inpatient care.
Implant thyroplasty, also called medialization thyroplasty, is a surgical technique used to move a vocal fold toward the midline, improving glottic closure and voice quality. The procedure involves a small opening in the thyroid cartilage, through which an implant—such as Gore-Tex , Montgomery or adjustable VOIS implants —is inserted. It can be performed under local or general anesthesia, either as an outpatient or short inpatient procedure.
This operation is primarily indicated for unilateral vocal fold paralysis, paresis, atrofic dysphonia or after tumour surgery. By medializing the affected vocal fold, the procedure enables near-complete closure of the glottis, resulting in a stronger, clearer voice with minimal hoarseness.
Zenker’s diverticulum is a pouch that forms at the back of the throat due to weakness of the muscular wall near the upper esophageal sphincter, often causing difficulty swallowing, regurgitation, or chronic cough. Cricopharyngeal stenosis, a narrowing of the upper esophageal sphincter, can lead to similar symptoms, including choking, aspiration, and impaired swallowing.
Surgical treatment aims to restore normal swallowing by relieving the obstruction and, in the case of Zenker’s diverticulum dividing the pouch. Procedures can be performed using minimally invasive endoscopic techniques, allowing to access the area through the mouth without external incisions. For cricopharyngeal stenosis, targeted myotomy of the constricted muscle can significantly improve swallowing function. These interventions can often be done under general anesthesia, and in selected cases, even with local anesthesia.
With extensive experience in pharyngoesophageal surgery, we tailor the procedure to each patient’s anatomy and condition, ensuring safe, effective, and lasting results. Our approach prioritizes minimal discomfort, rapid recovery, and the best possible restoration of normal swallowing.
Subglottic stenosis is a narrowing of the airway just below the vocal folds, which can cause difficulty breathing, noisy breathing, or a persistent cough. Treatment aims to widen the airway and restore normal breathing while minimizing trauma to the delicate laryngeal tissues.
Several techniques are available depending on the severity and cause of the stenosis. Laser surgery can precisely remove scar tissue and open the airway, balloon dilatation can gently expand the narrowed segment, and corticosteroid injections can help reduce inflammation and prevent scar recurrence. These procedures can often be performed endoscopically, avoiding external incisions and allowing for quicker recovery.
The treatment is customized to each patient, combining these approaches when needed to achieve optimal airway enlargement and long-lasting results. With extensive experience in endoscopic airway surgery, we prioritize safety, minimal discomfort, and effective restoration of normal breathing.
Advanced examination techniques enable a precise assessment of the vocal folds and larynx, identifying both structural changes and functional limitations. Treatments and interventions are tailored to address these issues while accommodating the unique demands of professional singing, helping the voice perform at its peak.
Following the examination, the recommended course of action is based on the condition of the larynx and the behavior of the vocal folds during vibration. Care may also include strategies to optimize vocal performance, ensuring that singers can perform safely and effectively.
Sleep apnea is a condition in which breathing is repeatedly interrupted during sleep, often leading to snoring, daytime fatigue, and long-term health risks such as high blood pressure or heart problems. While lifestyle changes and devices like CPAP (continuous positive airway pressure) can be effective, some patients may benefit from surgical options.
Surgical treatments aim to remove or reduce obstructions in the airway, improve airflow, and restore normal breathing patterns during sleep. Procedures may target the soft palate, uvula, tonsils, tongue base, or nasal structures, depending on the site of obstruction. Careful assessment using advanced endoscopic techniques ensures that surgery is tailored to the individual, maximizing effectiveness while minimizing risks.
A personalized approach allows patients to achieve better sleep quality, reduce symptoms, and improve overall health.