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James Arnold, MD, University Hospitals (UH) chair of Otolaryngology, is shown here with Nicole Russell, MA, CCC-SLP, in UH Laryngology and Voice Disorders Center. are often high-volume voice users, including vocal performers, teachers, attorneys, nurses, customer service representatives and others in related occupations. Many are concerned about abnormal changes in their voice. "Most of our patients use their voices frequently but don't realize quite how much," says Dr. Maronian. "They are at risk for the problems we commonly see here, including lesions, hoarseness, chronic cough and throat clearing." She notes that previously ignored difficulties with swallowing are also an increasingly recognized problem for middle-aged and elderly adults. "In the past, we would tell people, 'This is a just a part of getting older,'" she says. "But individuals with swal- lowing problems, who cough and choke with meals, are very much in need of the flexible evaluation of swallowing function that we offer." The center's team also provides successful treatment of other conditions, such as vocal cord paresis and paralysis, spasmodic dysphonia, dysphagia, organ preservation surgery for laryngeal carcinoma, Zenkers diverticulum, cricopharyngeal spasm, vocal cord lesions, and tracheal narrowing. Video Stroboscopy Is Key to Diagnosis A significant part of the center's suc- cess rests in its state-of-the-art video stroboscope, which allows physicians to view vocal cords in slow motion and check for vibration, structural anomalies, symmetry, amplitude, closure patterns and compression. During the stroboscopy, patients are awake, able to speak and participate fully in the exam. Together with the physician, patients can observe on a monitor the appearance and function 16 | Cleveland-Akron-Canton MD NEWS MDNEWS.COM SEPTEMBER-OCTOBER 2011 of their own pharynx, larynx and other areas related to the upper respiratory and digestive systems. "This type of assessment cannot be duplicated with the traditional scope through the nose," says Dr. Maronian. "It is an invaluable diagnostic tool for the physician and teaching tool for the patient." Electromyography, or a neuromus- cular assessment of the strength of the vocal folds, can also be performed in patients that have vocal cord weak- ness, spasmodic dysphonia or other neurological disorders. If needed, vocal cord injection to correct a weakened voice from paralysis can be done right in the office. Another new procedure encompasses injections of laryngeal botulinum toxin (BOTOX) to relax neurologic spasms. In the center, FEES (fi ber-optic endo- scopic evaluation of swallowing) and transnasal esophagoscopy to examine the