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Voice and Swallowing Disorders

Philip Weissbrod, MD, is a fellowship trained laryngology physician. He and his team provide expert behavioral and surgical care of voice and swallowing disoders at UC San Diego Health. 

A regional center of excellence, UC San Diego Health's Voice and Swallowing Center offers a multidisciplinary approach to care for complex disorders of the voice and swallowing systems. At the forefront of clinical research, our team offers a wide range of state-of-the-art surgical and behavioral therapy options to help restore and optimize the ability to talk, eat and breath.

Consultation

During your initial consultation, you will undergo a comprehensive evaluation that will include:

  • Complete medical history
  • Physical examination
  • Possible endoscopic evaluation of the vocal fold (either transoral or transnasal endoscopy or videostroboscopy) 

Our team will use this information to create a diagnostic and therapeutic plan tailored to your specific needs.

Learn about all of the voice and swallowing disorders we treat by clicking the tabs below.

Voice Disorders

A voice disorder is a voice that sounds out of the ordinary or calls attention to itself due to problems with pitch, loudness or quality. Many things can cause vocal changes including growths, overuse, neurological disorders, and post-surgical effects.

Common voice disorder symptoms:

  • Hoarseness
  • Strain
  • Throat pain
  • Recurring voice loss
  • Breathiness
  • Change in pitch range
  • Change in pitch steadiness
  • Pitch breaks
  • Fatigue after speaking
  • Inability to speak loudly
  • Running out of air when speaking
  • Frequent cough, throat clearing
  • Sudden inability to breathe in

Our multidisciplinary team treats a wide range of voice disorders including:

  • Benign vocal fold lesions
  • Chronic cough
  • Professional voice and singing difficulty
  • Laryngeal tumors and dysplasia
  • Laryngitis
  • Laryngopharyngeal reflux
  • Neurological voice abnormalities (vocal tremor, spasmodic dysphonia)
  • Paradoxical vocal fold movement / vocal cord dysfunction
  • Vocal fold immobility (full and partial paralysis)
  • Vocal fold atrophy

If diagnosed early, most voice disorders can be successfully treated. We utilize lifestyle changes, medicines, leading-edge therapy, and minimally invasive surgery to address voice disorders. Your tailored treatment plan may include:

  • Medication management of reflux, allergies, candidiasis, laryngitis, or cough
  • Voice therapy techniques:
    • Laryngeal desensitization
    • Reconditioning vocal tone and range
    • Biofeedback endoscopy
    • Changing voice prostheses
    • Heart rate variability biofeedback
    • Myofascial release
    • Neurological regimens (LSVT)
    • Identification and remediation of habits that worsen the voice
    • Modifying technique of how voice is produced to improve tone, quality, throat comfort, speaking endurance, and singing ability
  • Minimally invasive and office-based procedures, such as:
    • Laryngeal electromyography
    • Laryngoscopy and tracheobronchoscopy
    • Videostroboscopy
    • Vocal fold injection medialization
    • Laryngeal Botox for laryngeal dystonia and tremor
    • KTP laser treatment for papilloma, glottic dysplasia/cancer, granuloma
    • Microflap excision of laryngeal lesions

Swallowing Disorders

The act of swallowing involves the passage of saliva, liquid and food through the mouth, throat and esophagus.

A swallowing disorder is an impairment of the ability to pass saliva, liquid and food through the digestive tract. This can have a significant impact on your nutritional impact. Swallowing difficulty may be associated with a variety of medical conditions including neurologic disorders (stroke, Parkinson's disease), head and neck cancer, pulmonary disease (COPD), or any other condition that may cause generalized weakness. Disorders of the esophagus, such as strictures or pockets can also affect swallowing ability.

Swallowing disorders can have a profound impact on how and what you eat. In some cases, patients will require placement of a feeding tube in order to manage their nutritional needs. Multidisciplinary management techniques can identify the source of the problem as well as the appropriate treatment regimen for safer and more efficient swallowing ability.

Common symptoms of a swallowing disorder:

  • Gagging
  • Coughing
  • Choking
  • Food entering the windpipe (going down the wrong way)
  • Lung infections (bronchitis, pneumonia)
  • Painful swallowing
  • Weight loss
  • Food sticking or coming back up
  • Dependence on feeding tube

Our team treats swallowing disorders with minimally invasive, office-based procedures:

  • Fiberoptic endoscopic evaluation of swallowing
  • Modified barium swallowing study
  • Transnasal esophagoscopy
  • Esophageal dilations
  • Esophageal Botox
  • Zenker's diverticula repair
  • Vocal fold medialization

We also offer swallowing therapy techniques including:

  • Strengthening exercises for the lips, tongue, palate and throat
  • Compensatory maneuvers to improve safe ingestion of food and liquid
  • Modification of dietary textures
  • Endoscopic swallowing biofeedback
  • Management of swallow and tracheostomy
  • Transition off feeding tubes
  • Respiratory training
  • Electrical stimulation
  • Comprehensive patient and family education regarding swallowing impairment and treatment

Airway Disorders

The airway is composed of structures that include the pharynx (back of the nose and mouth), trachea (windpipe), larynx (voice box), and the bronchi (lung passages). Conditions that can lead to an airway disorder include:

  • Narrowing or scarring of the pharynx, larynx, subglottis and trachea
  • Post radiation airway narrowing
  • Bilateral vocal cord paralysis

If you have an airway disorder you may experience:

  • Wheezing, stridor (noisy breathing)
  • Shortness of breath

Some airway disorders may improve with behavioral breathing and voice therapy. We also offer office-based, minimally invasive and open surgical procedures such as:

  • Laryngoscopy and bronchoscopy
  • Airway dilation
  • Modification of vocal cord position to open airway (cordotomy, arytenoidectomy, stitch lateralization)
  • Tracheal resection

Feeding Disorders

We provide care for infant feeding disorders with dual specialty of speech-language pathology and lactation consultation.

Symptoms of a feeding disorder include:

  • Latching difficulty
  • Infant weight loss
  • Need for breastfeeding supplementation
  • Sore nipples
  • Inverted, flat or short nipples
  • Tongue tie
  • High palate
  • Feeding fatigue
  • Low milk supply
  • Nipple vasospasm
  • Thrush
  • Engorgement

Depending on the symptoms and cause of the feeding condition, our team may include one or several of the following therapies in your treatment plan:

  • Latching assistance
  • Measuring breast milk intake
  • Managing appropriate infant weight gain
  • Supplemental nursing regimens
  • Rental of hospital grade scales and pumps
  • Increasing milk supply
  • Transition to full oral and breast feeds after NICU
  • Frenulum resection
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