Issue link: https://viewer.e-digitaledition.com/i/111490
"Patients with voice disorders may have diabetes or asthma or hypertension as well," says Dr. Benninger. "So we work as a team with endocrinologists, allergists, pulmonologists, etc., to resolve those issues." State-of-the-Art Facilities and Technology If expertise is the primary reason physicians refer patients to the Voice Center, its facilities and technology are the second. According to Dr. Benninger, very few voice centers have the breadth and depth of technology available at Cleveland Clinic. "We have videostroboscopy, high-speed vibration assessment, functional voice analyses and high-definition imaging technology," he says. Videostroboscopy units are available at the main campus in Cleveland and at family health and surgery centers in Beachwood, Twinsburg and Westlake. "This is our most valued tool, because it allows us to examine the larynx and look at vocal folds vibrating while producing voice," says Dr. Hicks. He points out that the technology at all four sites is linked electronically for easy collaboration on cases among center staff. "We also have color high-speed video endoscopy, which few clinics have," says Dr. Benninger. "Where stroboscopy simulates vocal fold vibration by flashing a strobe light at it, high-speed video captures 500 wave forms per second. And we can actually look at each individual wave form." The Voice Center at main campus has a minor procedure room equipped with innovative laser technology. This includes an angiolytic laser that can remove lesions from the vocal folds and a KTP (potassium titanyl phosphate) and pulse-dye lasers for vascular abnormalities within the vocal folds. Both lasers minimize tissue injury, which is of prime importance, especially for singers. A Recording Studio for Professional Voice Problems Perhaps most innovative is a professional recording studio recently built by the Voice Center in partnership with Yamaha Music and Wellness Institute in Meadville, PA. The studio, Dr. Benninger's brainchild, is primarily for professional singers with voice problems and for professional instrumentalists with lip and tongue problems. The studio is outfitted with professional-grade acoustics and isolation and state-of-the-art voice analysis software and industry-standard microphones that permit high-definition recording of patients' voices. All of this allows professionals to simulate in the Voice Center a performance or recording session in a private soundproof environment for more accurate diagnosis. "One patient, a Las Vegas performer, developed voice problems after five or six songs," says Dr. Benninger. "We examined her, put her in the voice studio, let her sing away, then examined her again. And we could pinpoint the problem." The studio also has telemedicine capabilities that will affect continuing education and consultation. Participants at conferences have already watched evaluations in real time, including videostroboscopy, and have been able to interact with staff. "The technology is being refined to the point where we could Douglas Hicks, PhD, and Michael S. Benninger, MD, observe a patient in the Voice Center's new professional recording studio. Here, professional singers with voice problems and professional instrumentalists with lip and tongue problems can be observed and recorded for more accurate diagnosis. potentially connect with another clinic across the country or around the world and do a remote live evaluation," says Dr. Hicks. Education and Access An important focus of the Voice Center is educating patients about wellness and voice-injury prevention. "The new model is to be proactive and disciplined to stay healthy," says Dr. Hicks. "This is in contrast to the old model, which was, 'Don't think about it until you're sick and then get the doctor to help you recover.'" Patients can attend to a whole host of lifestyle, behavioral, environmental and mental factors, says Dr. Hicks. "We encourage a 'voice box-friendly' lifestyle, in which patients get enough sleep, drink enough water and don't smoke." Prompt access to care, when vocal injury or other problems develop, is important to patients. Cleveland Clinic offers same-day appointments for Voice Center specialists. Referring and collaborating physicians also find ready access to Voice Center specialists via phone. Digital and mobile capabilities will further extend the benefits of a Voice Center evaluation for Cleveland Clinic patients. "In the past, patients were given a disk of their audio and video records to take to appointments," says Dr. Benninger. "They'll soon be able to pull up their audio and video, and all of their medical records, via smartphone, tablet or desktop. We're working on this with Microsoft, and it's amazing." To learn more about Cleveland Clinic's Voice Center, visit clevelandclinic.org/voice. To refer a patient, call (216) 445-TALK or 1-800-223-2273, ext. 58255/5TALK. n MARch -APRil 2013 n MdnEwS.coM n md news Cleveland/Akron/Canton | 29