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 off ered 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).

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 effi cient 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.

For dysphagia or related problems, the patient is fi rstly

assessed clinically. He may then be referred for further

instrumental procedures such as Videofl uoroscopy or

Fibreoptic Endoscopic Evaluation of Swallowing (FEES).

If a patient is diagnosed to have swallowing diffi culties,

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 diff erent

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.

EAR, NOSE & THROAT SERVICES

Figure 1: Laryngoesophageal Refl ux. 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.

JULY • 2009

EAR, NOSE & THROAT SERVICES

VOICE DISORDERS: SPEAK UP FOR THE HOARSE PATIENT

EVENING CLINICS

About Francoise Lim MS, CCC-SLPFrancoise 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.

About Susan GohSusan graduated in Australia and has

been in Speech Th erapy 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.

EVENING CLINICS

9666 6698 DIRECT APPOINTMENT

HOTLINE

9666 6698DIRECT APPOINTMENT

HOTLINE

TTSH SPECIALIST APPOINTMENTS

EVENING CLINICSIn our eff ort 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

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

HP-BDU-ED-JUL-09-1.5K

159/04/2009

OUR 24 HRS TTSH SPECIALIST APPOINTMENT HOTLINE

Other options at your fi ngertips:

Tel 6357 8000 8am - 9pm (Mon - Fri) 8am - 3pm (Sat)Fax 6357 7011 / 7001* 24 Hours DailyEmail gp@ttsh.com.sg* 24 Hours DailyVoice Mail* 24 Hours Daily

Call 9666 6698+

+ 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.

for your direct access privileges:• Specialist Appointments• Direct Ward Admissions• Physiotherapy• Occupational Therapy• Dietetics & Nutrition

• Podiatry• Speech Therapy• Smoking Cessation Programme• Weight Management

Programme

VOICE DISORDERS: SPEAK UP FOR THE HOARSE PATIENT!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 aff ect the quality of life of suff erers. Amongst smokers, a subtle change in voice may be the only tell-tale sign of early laryngeal cancer.

Within ear, nose and throat surgery, the subspecialty of voice or laryngology has fl ourished 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 signifi cantly 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 off er a wide range of treatments which off er signifi cant benefi t.

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 off er 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.

About Dr Jeevendra Kanagalingam 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 Th roat,

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.

Laryngopharyngeal refl ux (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 eff ective.

Figure 1: Verrucous carcinoma of the larynx. Figure 2: Endoscopic Laryngeal Microsurgery (ELMS). Figure 3: Reinke’s oedema of the larynx. Often due to smoking.

6357 8384 DIRECT APPOINTMENT

HOTLINECLINIC 1B

EAR, NOSE & THROAT SERVICES

6357 8384DIRECT APPOINTMENT

HOTLINE

VOICE DISORDERS: SPEAK UP FOR THE HOARSE PATIENT!

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)

COMPLEMENTARY INTEGRATIVE MEDICINE CLINIC