Overview
Your voice is an essential part of your identity and it may be crucial to how you make a living. Issues with voice quality can be nagging and uncomfortable, but many are common and treatable. However, they may represent a more serious medical condition.
If you’re having problems with the quality of your voice, a specialist can help. At Cleveland Clinic in Florida, you have access to subspecialists in the human voice. We can evaluate and treat a variety of voice issues and the anatomical structures that produce your voice.
Why Choose Cleveland Clinic in Florida for Voice Care?
- Specialized knowledge: The physicians and therapists in our Voice Center have specialty training in laryngology and voice care. This helps us hear, see and diagnose issues that other healthcare providers may not notice. Meet our team.
- Caring approach: We are passionate about voice health. Perhaps other doctors have told you that you’re just hoarse and have not looked any further. It’s important to us to find the cause of your symptoms. We then offer options to improve your voice or professional performance.
- Comprehensive treatment: Voice problems may be associated with underlying medical conditions, such as autoimmune disorders, neurological disease or cancer. We work closely with our colleagues in other specialties to provide comprehensive care for the whole person and improve quality of life. Your team may include neurology, gastroenterology, endocrinology, allergy, pulmonary medicine, oncology and clinical psychology/psychiatry experts.
- Convenient care: We see most patients within a week, which gets you a diagnosis and treatment plan as soon as possible. In addition, we offer translation services for visits. This improves communication with our patients and helps achieve better outcomes for people whose primary language is not English.
- Patient-centered care: We understand that your voice can be essential to your work. We listen to your needs and provide a customized treatment plan for your voice demands.
- Specialized equipment: We use in-office high-definition stroboscopy to get a detailed look at your vocal cords.
Voice Problems
If you have a voice disorder, you may experience some of the following symptoms:
- Breathy, raspy voice or one that sounds strained.
- Changes in volume, clarity or pitch.
- Constant clearing of your voice.
- Discomfort when talking or singing.
- Extra effort required to use your voice.
- Hoarse voice.
- Loss of singing or speaking control.
- Shaky voice quality (tremor).
Symptoms may have a variety of causes, such as:
- Aging.
- Conditions in the esophagus such as esophageal diverticulum or reflux.
- Damage from prior surgery or medical procedure.
- Early stage laryngeal cancer (cancer in the voice box).
- Laryngitis, or swelling of the voice box.
- Muscle tension or excessive strain in the neck.
- Spasmodic dysphonia, a neurologic speech disorder.
- Subglottic stenosis (narrowing of the airway), which may be caused by trauma or autoimmune disease and is often misdiagnosed as asthma.
- Vocal cord dysfunction.
- Vocal cord lesions, such as polyps, cysts or papillomatosis (warts).
A voice disorder specialist who can examine the mouth, nose, throat and voice box carefully should evaluate voice symptoms. Learn how we diagnose and treat voice disorders.
Diagnosing a Vocal Disorder
Our voice specialists begin their assessment by talking with you. We want to learn about your symptoms, including how they affect your life and work. We listen to the quality of your voice and observe how you breathe when speaking. We may record your voice for additional analysis. Then we conduct a head and neck exam.
We also may order some specialized tests, such as:
- Laryngoscopy: During a laryngoscopy, we use a small, flexible tube with a light and camera at the end to look at your larynx.
- Stroboscopy: During a laryngoscopy, we also use a special strobe light to examine your vocal cords and folds. This helps us assess vibration of the vocal cords and how they close.
- Electromyography (EMG): EMG involves inserting tiny needles through your skin into your larynx (voice box). It measures activity of your laryngeal muscles while you are not using them and while you are speaking.
This detailed assessment by a subspecialist may find issues that general practitioners and even otolaryngology specialists might miss.
Treating a Vocal Disorder
We may recommend one or more types of treatment depending on your diagnosis. Your plan may include medications, voice therapy, in-office procedures or surgery. We do our best to get you back to your daily routine as quickly as possible.
Medications or injections
Some voice conditions can be treated with medications, such as corticosteroids, antibiotics and reflux medications.
We also often recommend vocal cord injections for certain types of diagnoses. One type of injection involves fillers similar to what a dermatologist or plastic surgeon would use to plump up wrinkles. A filler can improve voice quality by adding volume to thin vocal cords or to those that cannot close well. Another type of injection is Botox (botulinum toxin). This can relax vocal cord muscles and stop spasms.
Voice therapy
Many of our patients benefit from noninvasive voice therapy. We teach you exercises and behavioral changes that can:
- Control the way you breathe to provide breath support to your voice.
- Eliminate harmful behaviors.
- Improve vocal health.
- Increase the power behind your voice for increased volume.
- Relax tension in your vocal muscles.
- Use your voice more efficiently.
In-office procedures or surgery
We can treat many voice problems successfully without surgery. We use special equipment, such as lasers, and delicate microsurgery techniques whenever possible. This can reduce the risk of harm to surrounding tissues and expedite healing.
We do most procedures while you are under general anesthesia, and most patients go home the same day or after a short hospital stay.
Our voice procedures and surgeries include:
- Laryngeal microsurgery, when a surgeon corrects abnormalities using a microscope in the operating room.
- Laser therapy to treat abnormal tissue or vocal cord lesions.
- Medialization laryngoplasty (thyroplasty), a procedure that includes placing an implant in the vocal cord to change its position and improve voice quality.
Our Team
Laura Dominguez, MD
Head of Laryngology
Laura M. Dominguez, MD is Head of Laryngology at Cleveland Clinic Florida and serves as director of the Cleveland Clinic Florida Voice Center. She is certified by the American Board of Otolaryngology.
She is originally from south Texas where she was born and raised. After graduating from Rice University she attended medical school at the University of Texas Health Science Center in San Antonio. She became interested in the ear, nose, and throat specialty and found her passion for treating patients with voice and swallowing disorders. She completed residency training at Virginia Commonwealth University in Richmond, VA before returning to UT San Antonio for fellowship training in Laryngology under world-renowned laryngologist Dr. Blake Simpson. She spent this year learning to treat complex disorders involving the voice, esophagus and the airway. She then joined the faculty at UT as an associate professor where she spent 5 years treating patients and training resident physicians and fellows.
She joined the Department of Otolaryngology at Cleveland Clinic Florida in June 2020 to help build a multidisciplinary voice center. Her clinical interests include hoarseness, dysphagia, and airway disorders. This includes vocal fold paralysis, vocal fold lesions, laryngeal papillomatosis, airway stenosis, autoimmune laryngeal disease, and neurologic disorders of the larynx. Her clinical expertise has expanded patient access to office-based laryngeal procedures including videostroboscopy, bronchoscopy, vocal fold injections, and laser treatments.
She maintains a strong presence in the academic community and is a member of the American Academy of Otolaryngology, American Laryngological Association, and American Broncho-esophagological Association. She has published numerous articles in highly respected medical journals and has lectured nationally and internationally on topics specific to voice disorders. She has also been named to Texas Monthly Magazine Super Doctor/Rising Star list in 2019 and 2020.
Resources
- World Voice Day.
- American Academy of Otolaryngology Head and Neck Surgery.
- American Laryngological Association.
- American Speech-Language-Hearing Association.
- International Essential Tremor Foundation.
- Lee Silverman Voice Therapy (for voice problems related to Parkinson's Disease).
- National Spasmodic Dysphonia Association.
- Recurrent Respiratory Papillomatosis Foundation.
- Voice Foundation.
Support
Voice health tips & assessment
More information
If you would like to be evaluated by a voice specialist at Cleveland Clinic in Florida, please call 954.518.7500.
