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PHOTO © JOE SMITHBERGER PHOTOGRAPHY, NORTH CANTON esophagus and stomach can be perfomed when needed. Patients are awake and asked to eat certain foods while their swallowing function is evaluated. Videolaryngoscopy and evaluation of the oral cavity and pharynx are the primary services the UH Laryngology and Voice Disorders Center provides for pediatric patients, many with speech, hearing, breathing or swallow- ing disorders. Dr. Arnold uses pediatric-sized technol- ogy, including pediatric-sized endoscopes, to perform a variety of evaluations on his young patients. He says, "We bring many of our patients with craniofacial issues to the voice center to check their palate, swallowing, breathing symptoms and speech production — including pattern, voice quality and fl uency. Kids love the video aspect of it, and that helps them tolerate the process." The pediatric program also includes collaboration with experts in other dis- ciplines, including pediatric neurology, pediatric plastic surgery and pediatric speech therapy. Dr. Arnold stresses the importance of teamwork between hospital departments. "At UH, I feel we're pretty unique in that we offer all of these services for adults and children essentially in one place," he says. In-Offi ce Endoscopic Procedures Depending on the diagnosis, treat- ment may occur during or immediately following the stroboscopy. Vocal cord polyps and cysts are surgically treated — usually in the ORs at UH Case Medical Center or, for pediatric patients, in the ORs at UH Rainbow Babies & Children's Hospital. However, many endoscopic proce- dures are performed in-office at the UH Laryngology and Voice Disorders Center. For example, small lesions in Nicole Maronian, MD, is a board-certifi ed otolaryngologist and director of UH Laryngology and Voice Disorders Center. the vocal cord resulting from overuse can be easily removed using a fiber- optic laser that's only 0.4 millimeters in diameter. This f lexible fiber is inserted into the endoscope which is passed through the patient's nose. "The patient is awake in the chair, watching everything on the screen and actually helping me by controlling his or her breathing as I remove the lesion," Dr. Maronian explains. "The patient then walks out the same day and doesn't lose any time from work. Previously, this procedure was done more invasively and recovery time lasted between one and five days." Both the office-based laser and injection treatments are cutting edge and reportedly unique to UH in Northeast Ohio. Other outpatient options include office-based bron- choscopy and dilations to open up scar tissue in the airway.