Our Program

Voice-rev

The USC Voice Center is an interdisciplinary center of excellence offering innovative options for treatment for a variety of voice and swallowing disorders. Our team understands the demands of vocal athletes like singers, teachers, business executives, and clergy. Together with our patients, we work towards optimizing vocal performance and vocal health. Our treatment approach to care for swallowing problems treats the whole person understanding that nutrition is the key to health but providing options for improving swallowing skill and safety is the gateway to maintaining a healthy social and emotional lifestyle.

Offering urgent appointments for injured singers. Call (800) USC-CARE

 

Our Approach

Our physicians utilize cutting-edge technology to evaluate, properly diagnose and treat voice and swallowing problems. The use of these technologies results in improved diagnoses for our patients and ultimately results in better outcomes from treatment. An accurate and timely diagnosis allows our physicians to deliver effective and personalized treatment promptly. All of our physicians are fellowship-trained laryngologists otolaryngologists (ENTs) with advanced training in medical and surgical methods to preserve and restore voice and swallowing function. State of the art therapies including Awake Laser Therapy (Pulsed KTP Laser Therapy), vocal fold injections for vocal fold paralysis/paresis or vocal fold atrophy/presbyphonia, Botox TM injections for spasmodic dysphonia, tremor, chronic cough, or granuloma and thyroplasty for vocal cord paralysis are a few of the enhanced treatments that set the USC Voice Center apart from many other otolaryngology practices in Southern California.


 

Our team of speech language pathologists with expertise in voice and swallowing care provides exceptional treatment of voice and swallowing problems (dysphagia) in close collaboration with our physicians. Our center is one of a small number of centers in the United States, and the only center in Southern California, that provides true clinical and scholarly collaboration between the physician and speech language pathologist. Our approach to care of the professional voice is to work closely with our patient’s voice trainers and singing teachers to ensure continuity of care and optimal outcomes. Our clinicians are expert at treating the issues experienced by professional and occupational voice users understanding the importance of maintaining entertainment, business and professional commitments while ensuring health and longevity of voice use.

Conditions

Associated with voice problems

Chronic cough is an upper airway problem that results from irritation to the voice box. It can be quite debilitating for people. It is well treated with medication to reduce the irritation and voice therapy to eliminate the behavior of throat clearing and cough.
Dysphonia (hoarseness) is usually a symptom of a problem with the vocal cords characterized by weak or scratchy vocal sounds.
Granuloma is a lesion usually found on the vocal folds that may be the result of vocal use, laryngopharyngeal reflux and throat clearing, or after surgery that requires an intubation tube for anesthesia. Often people feel pain on one side of the throat and may even sense the lesion.

Granuloma

Granuloma

Hemorrhage (vocal fold bleed) is a true vocal emergency where a forceful vocal event like yelling, a hard cough, a very strong sneeze or even external injury to the neck causes the vocal cords to fill with blood. Treatment is complete voice rest and medication. If you experience is sudden voice change after a forceful vocal event, stop talking and see one of our physicians immediately.
Laryngitis is the swelling or irritation of the larynx – the voice box that contains the vocal cords. This condition is most commonly caused by a virus and may result from an upper respiratory infection.
Laryngopharyngeal reflux (LPR) or gastroesophageal reflux disease (GERD) is a condition in which stomach contents travel back into the throat causing tissue injury. Symptoms include hoarseness, throat clearing and increased phlegm and cough.
Leukoplakia/dysplasia is a precancerous condition of the vocal cords. It is seen as white patchy areas on the vocal cord tissue. Leukoplakia can be caused by smoking and alcohol but can appear on the vocal cords of non-smokers. Leukoplakia is not painful but causes changes in the voice that may be heard as mild to severe hoarseness. People who experience voice changes for greater than 2-3 weeks that is not due to a cold should be seen by our physicians immediately.
Larynx cancer is cancer of the vocal cords or voice box. Risk of larynx cancer increases with smoking or tobacco use and excessive alcohol consumption over a long period of time.
Muscle tension dysphonia (MTD) is the most common voice problem and results from muscle misuse. MTD can accompany any vocal cord lesion or can occur by itself. Treatment for MTD is voice therapy.
Papilloma (recurrent respiratory papillomatosis/RRP) is a form of human papilloma virus that is found on the vocal cords and surrounding tissue. RRP is treated with close monitoring and either surgical removal or awake KTP laser surgery.

Papilloma

Paradoxical vocal fold motion is a voice disorder categorized by episodes in which the vocal cords close when they should open. Most of the time, the vocal cords function as they should. Paradoxical vocal fold motion is sometimes mistaken for asthma, as it may lead to wheezing or difficulty breathing.
Presbyphonia (age related voice changes) is a voice disorder causing atrophy or thinning of the vocal cords and results in lower vocal volume and increased effort to talk. Presbyphonia often occurs as a natural part of aging in people over the age of 60 years.
Reinke’s Edema is the collection of fluid or swelling within the vocal cords, usually due to irritation from smoking or reflux.

Reinkes Edema

Reinkes Edema

Scarring/sulcus is a result of life long vocal overuse, high vocal demand, and loss of the pliability of the vocal folds. Scarring can also happen after surgery if care is not taken to protect the delicate tissues of the vocal folds.
Spasmodic dysphonia is a neurological disorder characterized by involuntary spasms of the muscles of the larynx, which cause difficulty speaking.
Tremor (essential voice tremor) is a neurological condition affecting the vocal cords that may also affect the voice box, throat, tongue and palate in some cases. Rhythmic movements of the affected areas cause voice problems. Treatment may be the use of medication and/or Botox™ injections to reduce the tremors.
Vocal cord cysts are fluid filled lesions within the vocal cords. They are often caused by high vocal demand and may require surgery and voice therapy for relief.

Vocal Cord Cysts

Vocal Cord Cysts

Vocal cord nodules are lesions of the vocal cords caused by voice overuse. Vocal cord nodules are treatable with voice therapy in most cases.

Vocal Cord Nodules

Vocal Cord Nodules

Vocal cord paralysis is caused by injury to one or both of the nerves attached to the vocal cords. Paralysis is the interruption of nerve signals resulting in no movement of the affected vocal cord(s).
Vocal cord polyps are lesions on the vocal cord usually caused by vocal overuse or a chronic irritant. Vocal cord polyps may require surgery but are often treated with voice therapy.

Vocal Cord Polyps

Vocal Cord Polyps

Associated with swallowing problems

Dysphagia is the term for trouble swallowing. Dysphagia in adults may be caused by tumors, gastroesophageal reflux disease or conditions that cause the throat or esophagus to narrow or weak.
Diverticulum is a weakness in the wall of the esophagus (food tube leading to the stomach) that results in the development of a pouch that can trap food and cause pain and discomfort with swallowing.
Esophageal dysmotiility when there is a problem with moving the food through the esophagus from throat to stomach. The esophagus is the muscular tube leading from the throat to the stomach. Normally, contractions move food from the throat to the stomach through the esophagus.
Laryngopharyngeal reflux (LPR) or gastroesophageal reflux disease (GERD) is a condition in which stomach contents travel back into the throat causing tissue injury. Symptoms include hoarseness, throat clearing and increased phlegm and cough.
UES dysfunction occurs when the upper esophageal segment (UES) – the muscular segment separating the throat from the esophagus – is either open or too loose, which allows food to back up into the throat from the esophagus or too tight, which prevents food from moving from the throat to the stomach.

Associated with breathing problems

Subglottic stenosis or upper airway scarring is the narrowing and scarring of your upper trachea, which may cause difficulty breathing.

Diagnostics

Our medical team utilizes cutting-edge technology to evaluate, properly diagnose and treat voice and swallowing problems. The use of these technologies results in improved diagnoses for our patients and ultimately results in better outcomes from treatment. An accurate and timely diagnosis allows our physicians to deliver effective and personalized treatment promptly.

Laryngeal videostroboscopy allows in-office visualization of the vocal cords with high-resolution magnification and illumination. This procedure is completed in the office with little to no discomfort and provides the physician a detailed image of the health of the vocal folds. The examination may be completed by the physician or the speech language pathologist at each visit to the USC Voice Center.
Laryngeal electromyography is an in-office test provides diagnostic information about the neuromuscular function of the vocal cords. Electrodes measure electrical activity during muscle activity while the patient performs various vocal tasks.
Instrumental assessment of voice is a computer-based non-invasive assessment of voice quality and respiratory capacity to produce voice. The speech language pathologist utilizes computer-based systems to assess vocal capabilities and to design therapy based on objective measures, which leads to better overall outcomes from therapy.
Flexible endoscopic evaluation of the swallowing (FEES) provides the opportunity for the patient, physician and speech language pathologist to observe real time swallowing function in the office and to evaluate the health of the vocal cords at the same time. Often, FEES leads to an immediate determination of the cause of the swallowing problem and methods to treat, eliminate, or compensate for swallowing problems during the office visit.
Modified barium swallow is a study conducted in collaboration with radiology to observe the swallowing function of multiple consistencies from mouth to stomach. Minimal exposure fluoroscopy provides real-time opportunities to assess function and to determine the usefulness and safety of compensatory swallowing maneuvers to reduce or eliminate the swallowing problem. The use of real foods that are a problem for the patient means that the speech language pathologist completing the study can actually observe swallowing problems that correspond to the patient history.

Treatments

Our surgeons utilize state of the art therapies to optimize treatment outcomes including awake laser therapy (Pulsed KTP Laser Therapy); vocal cord injections for vocal cord paralysis/paresis or vocal fold atrophy/presbyphonia; Botox TM   injections for spasmodic dysphonia, tremor, chronic cough, or granuloma; and awake thyroplasty to treat vocal cord paralysis and other conditions.

Vocal-cord injection (vocal fold augmentation/laryngoplasty) is a procedure in which gel-like filler is injected directly into the vocal cord. It is used to reposition the vocal cords and improve the voice and often the ability to swallow. While this procedure has been historically performed in the operating room under general anesthesia, our physicians can perform this procedure using local anesthesia in an office setting allowing the patient to avoid general anesthesia and in most cases return home the same day as the surgery.
Awake laser therapy, also known as Pulsed KTP Laser Therapy is a technology that allows our physicians to treat vocal cord lesions, such as papilloma, polyps, hemorrhage and early vocal cord cancers, as an outpatient treatment without anesthesia. The vocal cord laser procedure allows patients to be treated with less damage to the underlying tissue with less chance of scarring and voice damage. For patients with reoccurring conditions that require regular treatment, such as laryngeal papilloma or laryngeal pre-cancerous lesions, this treatment is a welcome innovation as historically these patients had to undergo frequent surgical procedures that were performed in the operating room and required general anesthesia. The pulsed KTP laser treatment requires only topical anesthesia, poses minimal risk of damage to vocal cord tissue, and allows patients to return to their normal routines often the same day as the procedure.
Thyroplasty is a procedure used to treat vocal cord paralysis, paresis (weakness) or age-related changes to the voice, in which the vocal cord is repositioned with an implant, which results in immediate improvement in voice and often swallowing. The procedure, while performed in the operating room and requiring a one-night stay in the hospital, does not require general anesthesia, thus reducing the risks often associated with surgery.
Voice therapy, provided by the speech language pathologists, uses therapeutic exercises that are tailored to the individual’s specific vocal capabilities and vocal needs. Therapy can often be completed in 4-6 therapy sessions over a 2- month period with guided home practice. Our therapists are skilled at work with all voice disorders from older adults with changes due normal aging to children and teenagers with voice voice and airway problems that impact their academic and social lives, to occupational and professional voice users. Voice therapy is used in the comprehensive care of most medical and surgical treatments at our center. Voice therapy is a collaborative effort between the patient, speech language pathologist and physician to optimize outcomes and improve care with improved communication. Our interprofessional practice makes communication between the patient, physician, and therapist fluid.
Swallowing therapy, provided by the speech language pathologists, uses strengthening exercises, dietary modification and compensatory techniques to optimize the potential for safe swallowing and allow the patient to eat as normal a diet as possible. Every attempt is made to assist the patient with returning to safe swallowing for nutritional support while allowing a return to socialization and enjoyment. Close communication with multiple medical professionals including gastroenterology, pulmonary, and dietary specialists are conducted to improve patient outcomes.
Botox therapy for laryngeal disorders is sometimes used to treat spasmodic dysphonia, to stop involuntary movement of the larynx muscles.

Resources

American Academy of Otolaryngology Head and Neck Surgery
entnet.org

American Speech-Language-Hearing Association
asha.org

International Essential Tremor Foundation
essentialtremor.org

Lee Silverman Voice Therapy
Lsvtglobal.com

National Spasmodic Dysphonia Association
dysphonia.org

Recurrent Respiratory Papillomatosis Foundation
rrpf.org

Voice Foundation
voicefoundation.org

World Voice Day
entnet.org/worldvoiceday

Support Program

Spasmodic Dysphonia Support groups of Southern California
dysphonia.org/support-groups

News & Stories

Protecting Singers’ Most Precious Instrument

Picture a pair of tiny violin bows, each no longer than a thumbnail clipping, lodged horizontally in your windpipe. Halfway between the chin and collarbone, they dance and vibrate at your command. For higher pitches, they stretch thin. For lower tones, they shorten.

Read more »

Our Leadership

The USC Voice Center is led by Michael Johns, III, MD, a fellowship-trained voice expert. He leads an integrated and interdisciplinary team of voice and swallowing experts who are devoted to providing patients with a coordinated, cohesive and unique experience to optimize outcomes and satisfaction.

Our Team

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Practicing Locations

USC Healthcare Center 4

Specializing In

Speech-Language Pathology

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Practicing Locations

Keck Medicine of USC - Downtown Los Angeles
USC Healthcare Center 4
USC Otolaryngology Associates – Glendale
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Practicing Locations

Keck Medicine of USC - Downtown Los Angeles
USC Healthcare Center 4
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Practicing Locations

Keck Medicine of USC - Downtown Los Angeles
USC Healthcare Center 4
USC Otolaryngology Associates – Glendale
USC Otolaryngology Associates – La Cañada Flintridge
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Practicing Locations

Keck Medicine of USC - New Downtown Los Angeles
USC Healthcare Center 4
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Practicing Locations

USC Healthcare Center 4

Additional Team Members

Melody Ouyoung, MS, CCC-SLP
Brenda Villegas, MS, CCC-SLP