An Interdisciplinary Voice and Swallowing Program
WMCHealth Physicians Advanced ENT Services, under the leadership of laryngologist David Garber, MD, brings interdisciplinary voice and swallowing care to the Hudson Valley. This team of specialists provides a critical service to individuals with disorders of the voice, upper airway and trachea.
Dr. Garber works in collaboration with Christine Murphy Estes, a specialized speech-language pathologist, in providing comprehensive medical and behavioral evaluations. Voice, swallowing and respiratory retraining therapy is available to patients in-person or via telehealth.
For Information or to Schedule An Appointment, Call 914.693.7636.
Voice and Swallowing Conditions Managed
Advanced ENT's interdisciplinary voice and swallowing team provides care for a variety of voice, swallowing and airway disorders. We manage individuals' conditions with the goal of restoring the ability to communicate, breathe comfortably, sing, eat and drink.
Conditions managed may include, but are not limited to:
Services offered may include, but are not limited to:
For more information or to schedule an appointment, please select the Contact Us tab above.
Vocal fold paresis and paralysis
Vocal fold paresis and paralysis occurs when there is damage or disruption to the nerves that control the muscles of the vocal cords. Paralysis is the complete immobility of the vocal fold, while paresis is a partial paralysis or motion impairment. Symptoms can include hoarseness, difficulty speaking, and shortness of breath. Causes of vocal fold paresis and paralysis include virus, injury, surgery, or underlying medical conditions such as stroke. Treatment options depend on the severity of the condition and may include voice therapy, and in some cases, surgery. If you or your loved one is experiencing these symptoms, help is available at Advanced ENT Services. Request an appointment to start the process and prevent long-term damage to the vocal cords.
Care of the professional voice and singing difficulties
For voice professionals, care of the voice is paramount to maintaining a performing career. Simple steps like staying well-hydrated, avoiding smoking and excessive alcohol consumption, and warming up the voice before speaking or singing can help prevent voice injury. Still, sometimes an injury may happen during a performer's career. Seeking prompt medical attention for any changes in voice quality or discomfort can help prevent long-term damage. Voice therapy is often recommended to help improve your vocal health and rehabilitate voice injury. If you are a voice professional, speak with a provider at Advanced ENT Services about how you can prioritize your vocal health.
Laryngeal cancer
Laryngeal cancer is a type of cancer that affects the larynx or voice box. Symptoms of laryngeal cancer can include hoarseness, difficulty swallowing, and persistent coughing. Risk factors for laryngeal cancer include smoking, excessive alcohol consumption, and exposure to certain chemicals. Treatment options for laryngeal cancer depend on the stage and may include surgery, radiation therapy, or chemotherapy. If you or a loved one is experiencing these symptoms, see a provider at Advanced ENT Services for diagnosis and determining the best course of treatment. Early detection is key to successful laryngeal cancer treatment and can improve outcomes.
Vocal fold lesions, edema and scarring (i.e. nodules, polyps, cysts, polypoid changes)
Vocal fold lesions, edema, and scarring can occur due to overuse or misuse of the voice, or from an underlying medical condition. These conditions can include nodules, polyps, cysts, or polypoid changes. Symptoms may include hoarseness, difficulty speaking, and discomfort. Treatment options for vocal fold lesions, edema, and scarring may include voice therapy, medication, or surgery. Prevention is key. Stay hydrated, avoid smoking and excessive alcohol use. For more information, including diagnosis and determining the best course of treatment, see a laryngologist at Advanced ENT Services.
Laryngopharyngeal Reflux Disease (LPR)
Laryngopharyngeal Reflux Disease (LPR) is a type of acid reflux that affects the throat and larynx (voice box). Symptoms of LPR include hoarseness, coughing, and throat clearing, which can be mistaken for other conditions such as allergies or asthma. LPR is caused by stomach acid backing up into the throat; it can be triggered by certain foods, alcohol and smoking. Treatment options for LPR include lifestyle changes such as avoiding trigger foods, elevating the head while sleeping, and medication to reduce stomach acid. If you or a loved one are experiencing these symptoms, request an appointment with a specialist at Advanced ENT Services.
Dysphagia
Dysphagia is a medical term used to describe difficulty in swallowing food or liquids. There are many potential causes of dysphagia, including neurological disorders, cancer, or throat conditions. It's important to see a physician for proper diagnosis. Symptoms of dysphagia include choking, coughing, and regurgitation, which can lead to malnutrition and dehydration. Treatment options for dysphagia depend on the underlying cause and may include changes in diet, medication, or swallowing therapy. In some cases, surgery may be required. Talk to a provider at Advanced ENT Services to learn more.
Zenker's diverticulum
Zenker's diverticulum has several signs, including difficulty swallowing or causing regurgitation of food or liquids. This is a rare condition in which a pouch forms in the esophagus, which results in food becoming stuck, leading to discomfort and aspiration. Zenker's diverticulum is typically seen in older adults and may be related to muscle weakness in the throat. Treatment options may include surgery to remove the pouch or endoscopic procedures to close it off. If you or your loved one is experiencing these symptoms, see a provider at Advanced ENT Services for the expert care you need.
Recurrent laryngitis
Repeated episodes of hoarseness, coughing, or throat irritation could be indicators of recurrent laryngitis. This condition is caused by inflammation of the vocal cords. It can be triggered by a number of factors or combination of factors, such as excessive voice use, allergies, acid reflux, or illness. Treatment options may include voice rest, voice therapy, and medications to reduce inflammation. Providers at Advanced ENT Services can evaluate symptoms and recommend treatment options for recurrent laryngitis.
Tracheal or glottic stenosis
Tracheal or glottic stenosis is a condition where the windpipe or voice box narrows. This can make breathing and speaking difficult. Tracheal stenosis can be caused by injury, infection, or scarring. Its symptoms may include shortness of breath, wheezing, hoarseness, and difficulty swallowing. If you or a loved one are experiencing any of these symptoms, it's important to seek medical attention immediately. Treatment options may include medication, surgery, or a combination of both. Our team of experienced healthcare professionals at Advanced ENT Services is dedicated to providing compassionate and personalized care to help manage your symptoms and improve your quality of life.
Tracheostomy care
A tracheostomy (an incision made in the neck to allow breathing) is commonly used in patients who require long-term mechanical ventilation or who have difficulty breathing. Tracheostomy care refers to the cleaning and maintenance of this opening. Proper tracheostomy care is essential to prevent infection and other complications. Providers at Advanced ENT Services routinely care for patients with tracheostomy. Our providers also offer training and information related to cleaning and monitoring for signs of infection. Good tracheostomy hygiene is foundational for good health. Let us help you at Advanced ENT Services.
Laryngeal trauma
Laryngeal trauma refers to an injury to the larynx (voice box). Trauma may result from an accident, violence, or medical procedure. Laryngeal trauma can cause pain, hoarseness, and difficulty breathing or speaking. This serious condition requires immediate medical attention. Diagnosis may involve a laryngoscopy or other imaging tests. Treatment at Advanced ENT Services will depend on the severity and type of injury, and may involve medications, surgery, or other therapies. Recovery time may vary depending on the extent of the injury. With proper care, many people who experience laryngeal trauma can recover fully and regain their normal voice and breathing.
Chronic cough
Chronic cough is a persistent cough that lasts for eight weeks or longer in adults or four weeks or longer in children. It can be caused by a range of underlying conditions, such as asthma, allergies, gastroesophageal reflux disease (GERD), and chronic obstructive pulmonary disease (COPD). A thorough evaluation by a healthcare provider is necessary to diagnose the underlying cause of the chronic cough. At Advanced ENT Services, treatment may involve medication, lifestyle modifications, cough suppression therapy, and/or respiratory retraining therapy. Effective management of chronic cough can help improve quality of life and reduce associated complications.
Paradoxical Vocal Fold Motion Disorder (PVFM) / Vocal Cord Dysfunction (VCD)
Paradoxical Vocal Fold Motion (PVFM), sometimes called Vocal Cord Dysfunction (VCD), is a condition in which the vocal folds (also known as vocal cords) close instead of opening when breathing in, leading to difficulty breathing. This can be a frightening and distressing experience. PVFM can be caused by several factors, including anxiety, acid reflux, or exposure to irritants. Diagnosis of PVFM requires an examination by a laryngologist at Advanced ENT Specialists, who will perform a videostroboscopic examination to assess your larynx (voice box). Treatment may involve voice therapy with respiratory retraining relaxation techniques, and medication to manage underlying conditions. With proper care, patients with PVFM can find relief from their symptoms and return to normal activities.
Exercise-Induced Laryngeal Obstruction (EILO)
Difficulty breathing during exercise may be due to exercise-induced laryngeal obstruction (EILO). EILO occurs when the muscles around the larynx (voice box) tighten, making it harder to breathe. This condition can be alarming and may affect your ability to participate in physical activities. Fortunately, EILO is treatable with proper diagnosis and management. A specialist at Advanced ENT Services can perform diagnostic tests to confirm EILO and create a personalized treatment plan. This may include breathing exercises, voice therapy, and in some cases, surgery. With the right care, you can overcome EILO and enjoy a more active lifestyle.
Pediatric voice disorders
Pediatric voice disorders refer to any condition that affects a child's ability to produce sound normally. The most common causes of pediatric voice disorders are vocal cord nodules, which are growths that form on the vocal cords due to overuse or misuse of the voice. Other causes include allergies, acid reflux, and neurological disorders. Symptoms of pediatric voice disorders may include hoarseness, breathiness, a raspy voice, or complete loss of voice. If you notice any of these symptoms in your child, it's important to seek medical attention from a pediatrician or an otolaryngologist. Early intervention and treatment can help prevent long-term damage to the vocal cords and improve your child's ability to communicate effectively.
Voice disorders related to Parkinson's disease
Many individuals with Parkinson's disease may experience voice disorders as the disease progresses. Parkinson's disease affects the part of the brain that controls movements, including the muscles involved in speech. As a result, patients with Parkinson's disease may experience a soft, monotone voice, slurring of speech, or difficulty initiating speech. These symptoms can make it challenging for patients to communicate with others and may lead to social isolation. Treatment options for voice disorders related to Parkinson's disease include voice therapy, medication, and surgical interventions. It's important for patients to seek medical attention from a neurologist, laryngologist, and speech-language pathologist to develop a customized treatment plan that meets their specific needs.
Neurological voice disorders (e.g. tremor, spasmodic dysphonia)
Neurological voice disorders, such as tremor and spasmodic dysphonia, can affect a person's ability to speak clearly and confidently. These disorders are caused by a disruption in the signals between the brain and the muscles involved in speech production. Tremors can cause a shaky, unsteady voice, while spasmodic dysphonia can cause a strained or strangled-sounding voice. Treatment options for neurological voice disorders may include voice therapy, medications, or Botox injections to help relax the vocal folds. A laryngologist and speech-language pathologist at Advanced ENT Services can help by developing a personalized treatment plan suited to your needs.
Chronic throat pain
Chronic throat pain can be debilitating, impacting every aspect of life. This common condition can be caused by a variety of factors, including acid reflux, chronic sinusitis, and allergies. Chronic throat pain may also be a symptom of a more serious condition, such as cancer. Our providers are dedicated to helping patients find relief from chronic throat pain. We use advanced diagnostic tools to accurately diagnose the underlying cause of the pain and develop individualized treatment plans that may include lifestyle modifications, voice therapy, medication, and surgery if necessary. If you or a loved one are experiencing chronic throat pain, please don't hesitate to contact Advanced ENT Services to schedule an appointment with one of our specialists.
Age-related voice change
As we age, our bodies go through a variety of changes, including changes to our voices. Age-related voice changes are common and may include a hoarse or weak voice, decreased vocal range, difficulty projecting or speaking loudly, and feeling fatigued when talking. These changes can be caused by a variety of factors, including changes in the vocal cords and muscles that control the voice, as well as underlying conditions of the larynx (voice box), such as dryness, vocal fold thinning, edema, or excess mucus. Treatment options may range from voice therapy to in-office procedures to surgery. If you or a loved one are experiencing changes in your voice, our team of laryngologists at Advanced ENT Services can help diagnose the underlying cause and recommend appropriate treatment options.
Voice therapy
Voice Therapy is a specialized form of therapy designed to help individuals improve their vocal function and communication. It involves a range of techniques and exercises aimed at addressing underlying issues or disorders that may be affecting the voice, such as hoarseness, pitch problems, breathiness, and vocal fatigue. Voice therapy is provided by a licensed speech-language pathologist (SLP) who has specialized training in voice disorders, often called a "voice therapist." The therapy process begins with an evaluation to identify the specific issues that the patient is experiencing, including medical conditions, lifestyle factors, or habits that may be contributing to the problem. Based on this evaluation, the SLP will develop a personalized treatment plan that may include breathing techniques to support efficient vocal production, exercises to improve vocal control and strength, strategies to manage occupational demands that may affect the voice, and ways to optimize the voice in day-to-day communication. Voice therapy can be beneficial for a wide range of individuals, including singers, actors, public speakers, and anyone who relies on their voice for their profession or daily communication. It can also be helpful for individuals who have experienced trauma or injury to the voice, or who have underlying medical conditions that affect vocal function. Overall, voice therapy is a valuable tool for individuals who want to improve their vocal function, enhance their communication abilities, and maintain optimal vocal health over time. Our multidisciplinary voice care team at Advanced ENT Services can help you get control of your voice again.
Behavioral cough suppression therapy
Behavioral cough suppression therapy is a form of treatment aimed at reducing the frequency and severity of coughing in individuals with chronic cough. Chronic cough is defined as a cough that persists for more than eight weeks and is often associated with underlying medical conditions such as asthma, gastroesophageal reflux disease (GERD), chronic obstructive pulmonary disease (COPD), or post-nasal drip.
The goal of behavioral cough suppression therapy is to help you reduce the urge to cough and the frequency of coughing, which can be disruptive to daily activities and can cause discomfort, fatigue, hoarseness, and many other debilitating symptoms. It involves a range of techniques and strategies to help reduce the urge to cough and increase control over coughing. Along with this, individuals with chronic cough learn to use their voice and breathing patterns more effectively, which may reduce the likelihood of coughing and improve overall vocal fold health. Behavioral cough suppression therapy is typically provided by a speech-language pathologist with specialized training in voice and upper airway disorders, commonly called a "voice therapist."
Behavioral cough suppression therapy can be an effective treatment option for individuals with chronic cough, helping to reduce the frequency and severity of coughing, improve quality of life, and manage underlying medical conditions. If you are experiencing chronic cough symptoms, contact Advanced ENT Services and our clinicians will help determine the best treatment plan for you based on your individual needs and underlying medical conditions.
Respiratory retraining therapy
Respiratory retraining therapy is a form of treatment aimed at improving breathing patterns in individuals with upper airway conditions such as Inducible Laryngeal Obstruction, sometimes called Paradoxical Vocal Fold Motion Disorder or Vocal Cord Dysfunction, laryngospasm, or other respiratory conditions. The goal of this therapy is to help individuals breathe more efficiently, reduce symptoms such as shortness of breath, stridor, and coughing, and improve overall quality of life. This training may also help individuals with voice problems caused by inefficient breathing patterns, and poor breath coordination with speech.
Respiratory retraining therapy typically involves a combination of exercises and techniques designed to strengthen the muscles involved in breathing, increase lung capacity, and improve oxygen uptake. These techniques may include:
- Diaphragmatic breathing techniques for efficient breath management
- Pursed-lip breathing to control the rate of breathing, reduce shortness of breath, and increase the amount of oxygen reaching the lungs
- Breathing exercises to help strengthen the muscles involved in breathing, improve lung function, and increase endurance
- Posture and relaxation techniques to improve breathing mechanics and reduce stress and anxiety
Respiratory retraining therapy is typically provided by a licensed speech-language pathologist (SLP) who has received specialized training in voice disorders and respiratory retraining techniques, commonly called a "voice therapist." The therapy process begins with an evaluation to identify the specific respiratory and vocal issues that the patient is experiencing, followed by a personalized treatment plan that may include a combination of the above techniques. Our providers at Advanced ENT Services can evaluate your concerns and help develop a personalized treatment plan to give you control over your symptoms.
Gender and identity affirming behavioral voice treatment
Gender and identity affirming behavioral voice treatment is a specialized form of therapy designed to help transgender and non-binary individuals achieve a voice that is more congruent with their gender identity. The therapy is aimed at addressing the physical and behavioral aspects of voice production to help individuals feel more comfortable with their voice and improve their overall sense of self. This treatment is typically provided by a speech-language pathologist (SLP) with specialized voice training, commonly called a "voice therapist." The therapy process begins with an assessment of the individual's current voice and goals for voice modification, followed by a personalized treatment plan that may include a combination of techniques, such as:
- Resonance training: This technique involves adjusting the "placement" of the voice to achieve a more gender-affirming resonance through various vocal tract shaping techniques.
- Pitch training: This technique involves adjusting the pitch of the voice to achieve the individual's desirable speaking range, which may involve raising or lowering the pitch depending on the individual's goals.
- Articulation and intonation: These techniques involve practicing clear and precise articulation, as well as intonation patterns that are associated with the individual's gender identity.
- Social communication training: This may include exploring the psychological and social aspects of gender identity and how they relate to vocal expression.
Advanced ENT Services is proud to offer gender and identity affirming behavioral voice treatment to help individuals who are seeking to align their voice with their identity.
Swallowing therapy
Swallowing therapy, also known as dysphagia therapy, is a type of therapy designed to help individuals who have difficulty swallowing food or liquid. Dysphagia can occur for various reasons, including neurological disorders, stroke, cancer, and other medical conditions.
The therapy is usually carried out by a speech-language pathologist (SLP) who specializes in swallowing disorders. The therapist evaluates the individual's swallowing function through a series of tests and assessments. Once the evaluation is complete, the SLP develops a personalized treatment program, which may include exercises to strengthen the muscles involved in swallowing, postural adjustments during eating and drinking, and modifications to the texture and consistency of food and liquids. Swallowing therapy also focuses on improving the individual's awareness and control of the swallowing process, as well as strategies to minimize the risk of aspiration, which occurs when food or liquid enters the lungs instead of the stomach.
Overall, swallowing therapy aims to improve the individual's ability to safely and effectively swallow, which can improve their quality of life and reduce the risk of complications such as malnutrition, dehydration, and pneumonia.