Office-Based Surgery

Office-Based Surgery
The physicians at The Voice Clinic of Indiana are the only specialists in the state with fellowship training and extensive experience in office-based surgery for voice, swallowing, and airway disorders.  Office-based surgery provides patients with outstanding outcomes with a level of convenience and patient safety that is unsurpassed.  The procedures described below are commonly performed by the laryngologists at The Voice Clinic of Indiana in the clinic setting using local anesthesia.  Many of these procedures are performed under general anesthesia in the operating room by other providers.

 

Laryngeal and Cervical Botulinum Toxin Injection
Neurolaryngologic voice disorders such as spasmodic dysphonia and vocal tremor can be ameliorated by the use of Botox injected into specifically targeted muscle groups.  Laryngologists at The Voice Clinic of Indiana have specialized training in the diagnosis of neurolaryngologic voice disorders as well as laryngeal electromyography ((LEMG).  By combining Botox needles with LEMG technology, patients can be treated in minutes during an in-office procedure that leads to symptom improvement in just a few days.  Additionally, movement disorders and some pain syndromes of the head and neck can be helped by botulinum toxin injection.  Such treatments may be effective for oromandibular dystonia, blepharospasm,cervical dystonia, palatal myoclonus, facial spasm or synkinesis, temporomandibular disorders, and some types of headaches and facial pain syndromes.

 

Office-Based Esophagoscopy and Tracheo-Bronchocopy
Traditionally, visualization and instrumentation of the swallowing tube (esophagus) and airway (larynx and trachea) has required either general anesthesia or, at least, medications that lead to conscious sedation.  Both anesthetic techniques, while safe, can be burdensome to patients’ lives and add potentially unnecessary risk and cost.  At The Voice Clinic of Indiana, topical anesthesia is utilized to perform these office-based evaluations.  Not only does this add efficiency for patients by consolidating the office appointments with the procedure in a single visit, but patients can resume their lives essentially immediately following the visit.  In addition to visualizing these anatomical areas, the following procedures, which are typical done in an operating-room setting by other doctors, can be added if necessary:

 

  • Upper airway or esophageal biopsy: To obtain tissue for diagnosis

 

  • Esophageal balloon dilation: To provide immediate relief for swallowing problems (dysphagia) related to esophageal narrowing (stricture or stenosis) or an abnormally functioning upper esophageal sphincter, or cricopharyngeus

 

  • Botulinum toxin (Botox) injection into the upper esophageal sphincter, or cricopharyngeus: To provide relief for swallowing problems related to an abnormally functioning upper esophageal sphincter

 

  • Esophageal foreign body removal: To provide immediate relief for select cases of foreign bodies lodged into the throat or esophagus (swallowing tube)

 

 

Office-Based Laryngeal Surgery
One of the significant advances in the treatment of voice, swallowing, and airway disorders has been by way of office-based surgical techniques.  The advanced training of the laryngologists at The Voice Clinic of Indiana has allowed for full implementation of office-based laryngeal surgical procedures, a skill set that is unsurpassed in the state of Indiana.  Patients can arrive at clinic, receive in-office treatment under topical and/or local anesthesia, and travel immediately back to work or home.  The advantages of office-based surgery for patients are numerous, but include efficiency, avoidance of general anesthesia, and immediate results.  Common surgical procedures performed at The Voice Clinic include:

  • Injection medialization laryngoplasty: Injection of materials into the space adjacent to the vocal cords provides immediate restoration of voice, cough, and/or swallowing for patients with bilateral vocal cord weakness (paresis), vocal cord bowing, or unilateral vocal cord paresis or paralysis.
  • Photoangiolytic laser surgery: Abnormal growths in the voice box (larynx), including recurrent respiratory papillomatosis and pre-cancerous lesions (dysplasia) have abnormal blood vessel formations that contribute to their growth.  At The Voice Clinic of Indiana, pulsed photoangiolytic laser therapy provides in-office targeted ablation of these abnormal tissues and their underlying blood supply to achieve improved resolution, while providing maximal preservation of the underlying tissues that are vital for voice production.Office-based biopsies: When a growth in the throat or voice box (larynx) is seen on examination in clinic, it is often unclear if that growth is benign (non-cancerous) or if it is cancer. While many surgeons will have patients go to the operating room to be placed under general anesthesia to obtain “samples” or biopsies, The Voice Clinic of Indiana routinely performs these biopsies under local anesthesia alone in a clinic setting.  This allows us to get a diagnosis while saving the patient a trip to the operating room.  In many cases, if the growth is benign, we can manage it with office laser surgery.  In contrast, if it represents a cancer, patients can often go directly to definitive treatment (surgery, radiation, or chemoradiation) without delay.
  • Other Therapeutic injections: Patients with abnormal growths of the larynx, called recurrent respiratory papillomatosis, often respond well to therapeutic injections with substances such as Cidofovir or Avastin.  For cases that respond well to these injections, we can inject the patient regularly in a clinic setting under local anesthesia alone, keeping the disease under control and avoiding trips to the operating room.

Office-Based Procedures for Snoring
Snoring is an under-treated problem, largely because if there is no sleep apnea, then insurance often does not cover treatments, which are very expensive in hospitals and surgery centers.  Dr. Parker offers several office-based procedures aimed at reducing snoring, treatments that are offered in very few offices around the Midwest.  These procedures typically target the soft palate, though a targeted evaluation is necessary to ensure the correct procedure is chosen.  If palatal stiffening procedures are deemed the best treatment option, these are done in a separate office visit and performed with only local anesthesia.  Discomfort is minimal and results are often excellent.