In the last decade, otolaryngologists have begun to treat conditions of the voice box and vocal cords using in-office minimally invasive techniques. This allows patients to be treated awake and avoid general anesthesia.

The USC Voice Center offers several in-office interventions to diagnose and treat a variety of conditions. Physicians at the USC Voice Center performed over 500 in-office procedures in 2015.

Physicians at the USC Voice Center can perform in-office, minimally invasive procedures to treat voice disorders in the awake patient. Many patients with voice disorders are excellent candidates. After obtaining the diagnosis, appropriateness for awake treatment is determined based on a patient’s anatomy and preference. Vocal cord injections, biopsies and laser procedures can be performed awake and in the office.

Treatment options

  • Biopsies

Biopsies of the vocal cords and tissues of the voice box can be performed in-office to obtain a diagnosis or rule out malignancy. This approach still offers the benefit of avoiding general anesthesia, and it speeds time to diagnosis.

  • Vocal cord injection augmentation

Vocal cord injection augmentation can be used to treat patients with vocal cord aging, weakness or paralysis. The procedure is achieved by injecting bulking materials into the vocal cords. In the hands of the fellowship trained physicians at the USC Voice Center, unsedated vocal cord injections have a high rate of success, and most patients tolerated the procedures well.

  • Lasers

Lasers are used to treat several laryngeal conditions, including papillomas, precancerous and vascular lesions of the larynx. The laser energy is delivered through a flexible endoscope to the tissue.

Several different lasers are used for these procedures and are selected on the basis of the type of tissue being treated and the desired effect. Outcomes for in-office, unsedated laser procedures for the larynx are comparable to traditional laser procedures that are performed in the operating room.

  • Botox injections

Injections of botulinum toxin are also performed as in-office, unsedated procedures to treat spasmodic dysphonia, essential tremor, and bilateral vocal card paralysis. The injection is typically guided by electromyography. Effects last 3 to 6 months.

  • Transnasal esophagoscopy

Transnasal esophagoscopy is another procedure offered in-office to diagnose dysphagia and disorders of the esophagus. This is a well tolerated procedure that avoids sedation associated with traditional esophagoscopy.

Outcomes and Benefits

These procedures offer several benefits over traditional procedures. Unsedated, in-office procedures allow for real-time analysis of the patient’s vocal production and quality during the procedure. The patient doesn’t require general anesthesia or sedation, thereby improving safety and taking less time to perform the procedure. The in-office, unsedated procedures improve time to treatment and offer less downtime for the patient and their family. Physicians of the USC Voice Center will consult with each patient to determine which procedures may be appropriate.