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JULY • 2009

EAR, NOSE & THROAT SERVICES At the TTSH Ear, Nose & Throat (ENT) Clinic, patients are sometimes referred to an on-site speech therapist for an assessment of their speech, swallowing or voice problems. Screening can be done for speech related problems such as articulation imprecision or stuttering. Depending on the diagnosis, therapy may be offered subsequently. Occasionally, the patient may be referred to another service provider that specializes in an area of sub-specialty such as childhood syndrome disorders or aphasia (acquired language disorders after CVA or TBI).

EVENING CLINICS Figure 1: Laryngoesophageal Reflux.

Figure 2: Muscle Tension Dysphonia Note the squeezing of the larynx when person phonates.

Figure 3: Vocal Nodules.

Figure 4: Normal vocal folds at rest.

Voice problems such as hoarseness, vocal fatigue, strained and painful throat after a vocal event are common problems that the Speech Therapist at TTSH ENT clinic treats. Before undergoing therapy, the patient’s larynx is examined using videostroboscopy. This examination is important in being able to visualize the integrity of the vocal folds’ structure, and more importantly the mucosal wave during phonation. Treatment plans are then laid out, involving medication, surgery, voice therapy, or a combination of any of these. Voice therapy involves teaching the patient exercises to mobilize the vocal folds in a more efficient manner to facilitate repair of micro injury and strengthening. Besides basic warm-ups like lip trills, patients also have to learn voice projection techniques. Therapy often takes an average of 6 sessions. Results are good especially for functionally caused problems like vocal nodules, and muscle tension dysphonia.

EAR, NOSE & THROAT SERVICES VOICE DISORDERS: SPEAK UP FOR THE HOARSE PATIENT EVENING CLINICS

For dysphagia or related problems, the patient is firstly assessed clinically. He may then be referred for further instrumental procedures such as Videofluoroscopy or Fibreoptic Endoscopic Evaluation of Swallowing (FEES). If a patient is diagnosed to have swallowing difficulties, therapy will begin immediately. All the patients are referred by doctors from the ENT clinic, with a high percentage of patients having had treatments for head and neck diseases / conditions. At this clinic, the therapists also rehabilitate patients who require voice restoration services. These include counselling, assessment and prescribing / supplying the different options for voice restoration after total laryngectomy. ** Our speech therapists accept referrals for the above services through our ENT doctors. If you have a patient with a voice disorder, you can make the appointment directly with our Voice Clinic, which runs twice a week.

About Francoise Lim MS, CCC-SLP Francoise graduated in 1992 from the University of Oregon with a Master of Science degree in Communication Disorders and Sciences. She has worked with both adults and children with speech, language and swallowing disorders. She has been with Tan Tock Seng Hospital, ENT department for the past 11 years, specialising in voice disorders. Together with an ENT doctor, she runs a weekly Voice Clinic where stroboscopic laryngeal assessments are conducted. Apart from working directly with patients, Francoise is also involved in voice education through organising and conducting workshops.

9666 6698 DIRECT APPOINTMENT HOTLINE

TTSH SPECIALIST APPOINTMENTS

About Susan Goh Susan graduated in Australia and has been in Speech Therapy for more than 10 years. She started out working at a special school for a year and a half before switching to a hospital. Her special interests include voice rehabilitation and head / neck dysphagia, including post laryngectomy rehab.

9666 6698 DIRECT APPOINTMENT HOTLINE


EAR, NOSE & THROAT SERVICES

VOICE DISORDERS: SPEAK UP FOR THE HOARSE PATIENT!

EVENING CLINICS

Voice disorders are increasingly common, and often go unrecognised and untreated. People who use their voice in their profession, such as teachers and sales persons, are susceptible to an array of voice problems. They affect the quality of life of sufferers. Amongst smokers, a subtle change in voice may be the only tell-tale sign of early laryngeal cancer.

In our effort to meet the needs of patients who are unable to come during the day, several TTSH Departments have extended their clinic operating hours from 6pm - 9pm, on appointment basis only

Within ear, nose and throat surgery, the subspecialty of voice or laryngology has flourished with the development of new tools for diagnosis and treatment. No longer is the larynx examined with a mirror and headlight! We are now able to assess the larynx more accurately – both structurally and functionally – with video stroboscopy. Voice science has progressed significantly in recent years, and we now recognise the cause of many common voice and throat complaints (see table 1). Speech therapy which is the mainstay of treatment can now offer a wide range of treatments which offer significant benefit. Where speech therapy fails, surgery may be necessary. This may involve simple procedures such as botox injections, endoscopic laryngeal microsurgery with or without laser or open laryngeal framework surgery or thyroplasty. At Tan Tock Seng Hospital, we offer a state-of-the-art voice service within the Department of Otorhinolaryngology. We run two voice clinics a week, supported by four surgeons and two speech therapists. We possess the latest equipment and aim to provide a comprehensive service to our patients.

6357 8384 DIRECT APPOINTMENT HOTLINE CLINIC 1B

Figure 1: Verrucous carcinoma of the larynx.

VOICE DISORDERS: SPEAK UP FOR THE HOARSE PATIENT!

Figure 2: Endoscopic Laryngeal Microsurgery (ELMS).

Figure 3: Reinke’s oedema of the larynx. Often due to smoking.

Laryngopharyngeal reflux (LPR)

This is a common but under-recognised condition that cause hoarseness, a dry cough and throat irritation which leads to a throat-clearing habit.

Vocal fold nodules

These nodules develop on vocal folds following inappropriate voice use.

Vocal fold paralysis

This causes hoarseness, and may be idiopathic or be due to a bronchial or thyroid cancer.

Intracordal cysts

These cysts within the vocal fold can cause intractable hoarseness. They can only be diagnosed by stroboscopy and will require surgery.

Vocal fold dysplasia and cancer

Hoarseness may be due to a cancer or pre-cancerous lesion. Persistent hoarseness, particularly in a smoker mandates an urgent ENT referral.

Muscle tension dysphonia

This condition causes hoarseness due to inappropriate funtioning of the larynx. Diagnosis relies on stroboscopy and treatment is usually with speech therapy.

Spasmodic dysphonia

The muscles that move the vocal folds may be in spasm causing either a ‘tight’ or ‘breathy’ voice. Botox injections into the larynx prove to be effective.

About Dr Jeevendra Kanagalingam

6357 8384 DIRECT APPOINTMENT HOTLINE

Dr Jeevendra Kanagalingam is an Associate Consultant in the Department of Otorhinolaryngology. His interests are in Laryngology and Head and Neck Surgery. He trained in London at the Royal National Throat, Nose and Ear Hospital, and the Royal Marsden Hospital. He received the Gold Medal in the intercollegiate fellowship exams of the Royal College of Surgeons in 2006, and has over 20 peer-reviewed publications. He completed HMDP training at the Princess Alexandra Hospital in Brisbane before joining Tan Tock Seng Hospital in 2008.

DEPARTMENT

AVAILABILITY OF NIGHT SESSION

LOCATION

Eye

Monday to Friday

TTSH Eye Centre, Level 1

General Surgery

Tuesday

Clinic B1B, Level B1

Urology

Tuesday

Clinic B1B, Level B1

Orthopaedic Surgery

Tuesday

Clinic B1B, Level B1

Ear, Nose & Throat

Monday, Wednesday and Thursday

ENT Clinic, Level 1

Physiotherapy

Monday, Wednesday and Thursday

B1, Level B1

COMPLEMENTARY INTEGRATIVE MEDICINE CLINIC TTSH Complementary Integrative Medicine Clinic has extended its hours, on appointment basis only. New opening hours: Monday, Tuesday & Thursday : 8am - 5pm Wednesday & Friday : 8am - 9pm (last appointment 8.30pm) Saturday : 8am - 5pm (full day service) Direct Appointment Hotline

6357 2146 We are located at Level B2, TTSH Medical Centre (Next to Pre-Admission Counselling Evaluation)

OUR 24 HRS TTSH SPECIALIST APPOINTMENT HOTLINE Call

9666 6698+

for your direct access privileges: • • • • •

Specialist Appointments Direct Ward Admissions Physiotherapy Occupational Therapy Dietetics & Nutrition

• • • •

Podiatry Speech Therapy Smoking Cessation Programme Weight Management Programme

Other options at your fingertips: Tel 6357 8000 Fax 6357 7011 / 7001* Email gp@ttsh.com.sg* Voice Mail*

8am - 9pm (Mon - Fri) 8am - 3pm (Sat) 24 Hours Daily 24 Hours Daily 24 Hours Daily

+ Please note that the above appointment number applies for TTSH patients only. For NNI appointments, please call 9637 9718. * All emails, faxed, voice and message taking requests will be replied on the next working day. HP-BDU-ED-JUL-09-1.5K 159/04/2009

2009 July Aug GP Buzz  

EAR, NOSE & THROAT SERVICES About Susan Goh TTSH SPECIALIST APPOINTMENTS EVENING CLINICS DIRECT APPOINTMENT HOTLINE DIRECT APPOINTMENT H...

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