Our Voice Clinic in Colorado

The swallowing mechanism involves a series of highly coordinated muscle movements. These movements can be divided into 4 phases:

1. Oral preparatory phase: food is chewed and mixed with saliva, forming into a cohesive collection called a “bolus.” This bolus is positioned on the tongue for the next phase.

2. Oral transit phase: the tongue pushes the prepared bolus from front to back into the pharynx, where the next phase is automatically triggered.

3. Pharyngeal phase: an automated sequence of muscle contractions occurs which lifts the larynx and pulls it forwards, closes the vocal cords, closes a flap called the epiglottis over the vocal cords and airway, directs the food bolus towards the opening of the esophagus and opens the sphincter at the upper end of the esophagus to allow the bolus to pass.

4. Esophageal phase: slowest phase (can take up to 20 seconds). Bolus is transferred from the upper end of the esophagus to the stomach. Gravity helps with this process, as well as coordinated muscle movements in the esophagus called peristaltic waves.

A comprehensive evaluation by an ENT doctor can often determine the cause of swallowing trouble. In addition to a thorough exam, a procedure called fiberoptic laryngoscopy will likely be recommended. During this simple office procedure, a flexible scope with camera is inserted through the nose to examine the throat and voice box. The patient may be given some different substances to swallow during this test, in which case the test is termed Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

If a cause still cannot be determined, a transnasal esophagoscopy (TNE) may be recommended. During this procedure, a specialized scope is placed through the nose and all the way down the esophagus to the stomach. Traditionally, gastroenterologists perform similar upper-GI endoscopies (Esophagogastroduodenoscopy or EGD) under sedative anesthesia which requires close monitoring and extended recovery time. Otolaryngologists with special training now perform this procedure in the office with minimal discomfort. TNE has proven useful for diagnosing esophageal disorders such as strictures (narrowing), infectious/inflammatory diseases and abnormal pre-malignant or malignant lesions at the gastro-esophageal junction (Barrett’s Esophagus and carcinomas).

Surgery to remove the tonsils and/or adenoids is usually recommended to treat persistent, serious, or recurring infections of these tissues, or to address obstruction caused by excessive enlargement of these tissues. There are many methods to perform surgery, but typically a cautery device is used to remove each tonsil through the mouth, cutting the tissue and sealing off bleeding. The adenoids are removed with a similar method, also through the mouth. Most commonly, no stitches are placed. The open areas heal on their own. During the healing phase, the areas will become covered with a scab or “eschar,” which will thicken and may change colors over the first few days. These eschars then dissolve and slough off several days after surgery.

Overall risks related to surgery are low, however the recovery period is predictably long and rough. A severe sore throat is to be expected, which typically gets worse before it gets better, peaking around day 6 or 7 on average. Recovery is usually worse and longer in teenagers and adults than in younger children. Typically children will need about 1 week off from school to recover. Adults may need 2 weeks off work. Heavy physical activity and sports should be avoided for 2 weeks.

The surgeons at Peak ENT will be with you every step of the way during the recovery process. One of our four physicians is always on call and reachable for the group, 24 hours a day, 7 days a week. We do not share calls with other groups, nor do we have residents or mid-level providers covering our calls.

Tonsils and Adenoids are similar to lymph nodes (sometimes erroneously called “glands”) in the neck, groin and armpits. Tonsils are two round lumps in the back of the throat on each side of the tongue. Adenoids are high in the back of the throat behind the palate and are not normally visible through the mouth. Both tonsils and adenoids “sample” bacteria and viruses that enter the mouth or nose and are part of the immune system. Sometimes however, they can do more harm than good.

Every year, more than 55,000 Americans will develop cancer of the head and neck, including throat cancer. Around 13,000 Americans die every year from these types of cancer. Smoking and other forms of tobacco use are the main risk factor for developing cancer of the mouth and throat, though these cancers can also develop in nonsmokers. A significant cause of these cancers in nonsmokers as well as younger patients is Human Papilloma Virus (HPV). Like many other types of cancer, treatment is most successful when the cancer is caught early.

• A lump in the neck. Any lump in the neck that persists more than 2 weeks should be evaluated by your physician. Sometimes a lump in the neck may be the first and only sign of an otherwise undetected cancer of the throat.
• Changes in the voice. Hoarseness or changes in the voice that persist more than 2 weeks should be evaluated. The physicians at Peak ENT utilize high definition endoscopes to provide the most accurate diagnosis of vocal cord disorders, including detection of early vocal cord cancers.
• Growth in the mouth. Any sore or growth in the mouth that does not go away in a week or two should be evaluated.
• Coughing up blood, or blood in the sputum. If this persists beyond a few days, you should see your doctor. An endoscopic exam by an ENT may be necessary to determine the cause.
• Trouble swallowing. A tumor in the throat can cause difficulty swallowing by obstructing the passage of food and/or liquids. The providers of Peak ENT have the ability to diagnose and treat a number of swallowing disorders.
• Persistent earache. Branches of the same sensory nerves go to the ear as well as the throat. Therefore, sometimes throat problems (infection or cancer) are felt in the ear, sometimes even without any throat symptoms. Any persistent and unexplained ear pain deserves a thorough evaluation of the throat by a qualified ENT physician.

Chronic cough is a common, often frustrating problem we see among our patients. Cough can have a variety of causes, including allergies, sinus or throat infections, asthma, acid reflux, lung disease, problems with nerves to the throat, and side effects of certain medications.

The physicians at Peak ENT will perform a thorough examination of the nose, sinuses and throat to help determine the likely cause(s) of your cough.

Peak ENT offers allergy testing if allergies are suspected as a cause of your cough.

Many patients with chronic cough will benefit from voice therapy. The providers at Peak ENT work closely with Julie Artigliere, Ph.D, a speech and language pathologist specializing in voice disorders and cough.