In addition to providing general adult and pediatric otolaryngology services, the Head & Neck Institute provides several highly specialized tertiary care services through its various sections.
Hearing and Speech
The Sections of Audiology and Speech-Language Pathology address speech, language and hearing disorders in a patient population ranging from neonatal to geriatric. Residents rotate through the sections observing all facets of Speech-Language Pathology and Audiology in an integrated, allied health/medical team approach. Residents are exposed to state-of-the-art instrumental techniques, including acoustic and aerodynamic assessment of the vocal tract, videostroboscopy, basic audiometry, tympanometry, otoacoustic emissions, evoked potentials, cochlear implant surgery, real ear measurements, hearing aids and assistive listening devices. Research in communicative disorders is welcome.
Head and Neck Surgery
Specialists in the Section of Head and Neck Surgery evaluate and treat a large volume of patients with a variety of head and neck malignancies. All patients are seen jointly by the surgeons, radiation therapists and oncologists. Weekly Tumor Board ensures communication among team members. Research protocols are in constant use and development. Residents are part of the decision-making team and are actively involved in all facets of patient care.
The Section of Laryngotracheal Reconstruction is dedicated to the management of laryngeal airway obstruction, upper and lower respiratory foreign bodies, esophageal reflux, tracheal aspiration, and voice preservation and rehabilitation. The section has achieved international status in pioneering new techniques for managing tracheal and laryngeal stenosis, and long-term/permanent tracheostomy. Ongoing research should provide better control of intractable aspiration and more effective rehabilitation of laryngeal dysfunction.
The section sponsors a yearly resident endoscopy course for rigid and fiber optic removal of foreign bodies of the airway, tracheostomy and cricothyroidotomy.
Nasal and Sinus Disorders
Nasal and sinus disease is very common in Northeast Ohio, creating a large patient volume for this section. Patients are evaluated by appropriate clinical and radiographic workup, including endoscopy, CT scanning and allergy assessment, then offered medical and/or surgical therapy. Residents learn functional endoscopic sinus surgery as well as other, more traditional techniques in managing these patients.
The section also is committed to managing snoring and sleeping disorders associated with obstruction of the upper airway. Treatment options include out-patient laser-assisted surgery.
The Section of Otology-Neurotology provides comprehensive care of all forms of otologic disorders, including middle and posterior cranial fossa surgery for cerebellopontine and skull base tumors. Nearly 500 surgical cases per year provide the in-depth experience that enables resident graduates to treat otologic disorders with confidence. Research interests in the section include molecular biology of deafness (immune-mediated inner ear disease), Meniere’s disease and cochlear implant surgery in adults and children. Staff otologists assist residents in clinical and basic science research in auditory, vestibular and temporal bone disorders.
The section offers total medical and surgical management of pediatric otolaryngologic disorders, from infancy through adolescence, with more than 400 surgical procedures each year.
Designated outpatient clinics, including a Cleft Palate Clinic, provide comprehensive pre- and postoperative care.
Cleveland Clinic includes a Children’s Hospital, a Pediatric Intensive Care Unit, and numerous pediatric tertiary care specialists to help manage the most complex otolaryngologic problems of infancy and childhood.
Vestibular and Balance Disorders
The Section of Vestibular and Balance Disorders provides laboratory diagnosis, medical neurotology and vestibular rehabilitation of patients with dizziness, disequilibrium and imbalance. An outpatient clinic manages self-referred patients and those referred from Otolaryngology, Neurology, Internal Medicine and other departments. Residents rotate through the Section of Vestibular and Balance Disorders to learn about test administration and interpretation.
The section has state-of-the-art, computer-based electronystagmography and rotational chair and posturography, with the world’s largest database of laboratory test results. As Northeast Ohio’s only comprehensive laboratory, the section offers regional referral laboratory services for physicians outside Cleveland Clinic.
Clinical and basic science research is ongoing, particularly in the areas of vestibular evoked potentials, outcome of home-based vestibular rehabilitation, and genetics of motion sickness.
Excerpt from "Otolaryngology at Cleveland Clinic: 1921-2007"
From the very beginnings of modern medicine, the territory beneath the brain and above the collar bone has had more occupiers than Poland. Its component parts have been claimed and fought over by ophthalmologists, thoracic surgeons, plastic surgeons, otolaryngologists, and a legion of subspecialties. This dispute does not, however, carry over to Cleveland Clinic.
An academic medical center, where 1,200 staff physicians practice in 120 specialties and sub-specialties, Cleveland Clinic is home to one of the most distinguished Head and Neck Institutes in the country. Here, more than 32 faculty care for the full range of disorders of the ear, nose and throat, in adults and pediatric patients, in collaboration – not competition – with complementary medical specialties.
Today, the Institute is ranked among the 10 best otolaryngology services in America in U.S. News & World Report’s annual “America’s Best Hospital” survey. Its faculty members contribute hundreds of articles to scientific publications and peer-reviewed medical journals, are appointed to offices in national societies and journals, receive numerous awards and grants and serve frequently as visiting professors.
How the Head & Neck Institute of Cleveland Clinic achieved this eminence is an instructive story. It shows how the combined influences of medical practice, institutional culture, advances in medical technology, and human personality, have affected the growth and development of otolaryngology at Cleveland Clinic.
If you are interested in reading more about our history, we have a limited supply of books available.
You can request one by calling us locally at 216.444.6686 or toll-free 800.223.2273 ext. 46686.
Have You Lost Your Voice?
Douglas Hicks helps people, including famous performers, get their voices back.
By Linda Formichelli
Douglas Hicks, PhD, has a great appreciation for the human voice: He’s seen how a voice problem can shatter a person’s self-image and shut down a social life. As Director of the Voice Center at Cleveland Clinic, he helps ordinary citizens and famous performers get their voices back.
Here are Dr. Hicks' answers to some common questions about restoring patients' voices.
- »What are some medical causes of voice problems?
- There are many organic explanations: injuries, illnesses and diseases that can affect the larynx, or voice box. But there are also non-organic causes that have to do with bad habits of voice use, like bad technique or too much tension, that make the voice box operate inefficiently.
- »What are some clues that you might have a voice problem?
- Any changes in quality, pitch (how high or low the voice is), resonance (how nasal it is) or loudness are signals that something’s wrong. For example, if you’re suddenly unable to speak as loudly as you would normally speak, if your pitch starts to go really low, or if your quality is off, like you have hoarseness — that could be a problem.
- »Can you tell us about the Voice Center?
The Voice Center has two major components: speech-language pathology; and ear, nose and throat, or otolaryngology. We deal with voice disorders, which have to do with quality, pitch, loudness and resonance. While caring for the professional and the performing voice is one of the specialties of the Voice Center, our typical patient is the average person struggling with a voice disorder.
Our approach is to do a very careful evaluation so we can match the problem with the best treatment. The four treatment options for any voice disorder are surgical, medical, behavioral voice therapy or a combination of those three.
- »What makes a good voice?
- The expression “It’s in the ear of the beholder,” as opposed to “the eye of the beholder,” is relevant here. The criteria for a good voice vary by the individual, their culture and where they live. For example, in Western culture, a low pitch is viewed as more desirable. But in Asian culture, a slightly higher pitch is valued more. However, there are standards across cultures; if you’re too far outside the norm in quality, pitch, loudness or resonance, that would trigger a reaction in people that something is wrong.
- »How can voice problems affect a person’s life?
- Voice is key to an individual’s self-concept and self-confidence. It’s the way we present ourselves to the listening world. When we have problems with our voice, our image in the world, our ability to carry on our professional requirements, and even our social and recreational activities are all affected. For example, if you’re a sports fan, you need to be able to talk over a crowd, and if you’re into martial arts, you need to be able to yell.
- »So it’s not just an issue for performers?
- There are lots of non-entertainment, non-celebrity occupations that rely heavily on speaking, like teachers, preachers, telephone operators, telemarketers, salesmen, police dispatchers, and on and on. When they get into voice trouble, all of a sudden they’re caught in a world that they don’t understand. It’s frightening and disorienting. That’s why they seek help.
- »Can you tell us about a celebrity you treated at the Voice Clinic?
- We treated Tom Hamilton [who completed his 21st season of calling Cleveland Indians baseball games on the radio in 2010]. He’s in a very high-demand voice situation, and there are times that his voice has given him trouble. He has been very generous with his compliments about working with the voice team. For International World Voice Day on April 16, Mr. Hamilton interviewed me in the booth during a night game.
- »How about a case involving a nonperformer?
- Our phone is ringing off the hook because of a recent story about my partner, Dr. Claudio Milstein, who was interviewed on NPR. We had a patient who had so much tension in her neck and voice box that she could hardly produce any voice at all. This isn’t as uncommon as you’d think: Some people carry their stress in the neck, which is the home of the voice box. In less than 10 minutes, using some tension-unloading techniques that are like massage or muscle manipulation in the neck and upper shoulder area, she regained her voice completely. The patient said that Dr. Milstein returned not just her voice, but her life.
- »You have a very deep and rich voice. Were you born with it, or did you have to work on it?
- It’s more heredity. An individual’s voice is in some ways like a fingerprint. You didn’t cultivate your fingerprint. You can take care of your hands, you can take care of the skin, but you still have to deal with what you were given.
- »Does that mean there’s no hope for you if you aren’t born with a good voice?
- Some people’s instrument is different from the masses. For example, Pavarotti had an unusually large breathing capacity that contributed to his unique performance. However, you can take an average person and make them sound much better through training. That’s why there’s training in broadcasting, classical singing, popular singing and theater.
- »Who do you think has the best voice?
- It wouldn’t be good for a voice professional to pick favorites. Plus, there isn’t one standard of what makes a good voice. But one routinely viewed as good is James Earl Jones. He has a wonderfully rich, robust, resonant, deep voice that carries whatever message he’s trying to communicate, whether he’s doing a radio spot, an advertisement or Darth Vader. He carries this incredible impact to the listener.
Dr. Hicks offers these tips for a healthy voice:
- Avoid screaming or talking over loud noise, which can strain the voice.
- Cut down on alcohol and caffeine. These substances dry up the moisture needed to lubricate your voice box.
- If you smoke, stop. Smoking is harmful to the upper airway, including the voice box.
- Drink plenty of water to keep the voice box lubricated and healthy.
- Avoid frequent throat clearing or harsh coughing, which can damage the voice box.
- If you experience unexplained changes to your voice that last more than a couple of weeks, see your doctor for evaluation.
Published December 2010