Fiberoptic endoscopic evaluation of swallowing (also called FEES) is a procedure that helps your doctor assess how well you swallow. Fiberoptic endoscopic swallow evaluation is typically done if you're experiencing coughing while eating, a sensation of food getting stuck, unexplained voice changes, or if you're at risk of aspiration (food or liquid going into your airway). During this test, a thin, flexible camera is passed through your nose to look at your throat and vocal cords while you swallow different types of food and liquids. The entire exam is recorded and reviewed in detail.
This procedure is done right in the office and takes about 15–20 minutes. A numbing spray may be used in the nose to reduce discomfort, but most people tolerate the test very well. You'll be seated upright and asked to swallow liquids, puree, and solid foods dyed with food coloring so the swallowing process can be clearly visualized. You can speak and breathe normally during the test. No recovery time is needed — you can return to normal activities immediately. Occasionally, patients may feel mild nasal irritation or sneeze briefly afterward. It is a very safe, low-risk procedure and an excellent tool for diagnosing swallowing issues and guiding therapy.
Fiberoptic tracheobronchoscopy is a procedure that allows the doctor to look directly at your windpipe (trachea) and the breathing tubes of your lungs (bronchi). It diagnoses airway conditions like narrowing, inflammation, scarring, tumors, or foreign bodies. This procedure is particularly helpful for patients with chronic cough, noisy breathing, difficulty breathing, or a history of airway trauma.
In the office, a thin, flexible scope with a light and camera is gently inserted through the nose and passed down the throat into the windpipe. The procedure usually takes less than 15 minutes. Numbing medication is applied to minimize discomfort, and while it can feel strange, most patients tolerate it very well. You may cough briefly during the exam, but it's not painful. There is no need for sedation; you can leave shortly after the exam. Some people experience a mild sore throat or hoarseness for a few hours. This is a very safe procedure with minimal risks. It provides crucial real-time information about your airway and is often the first step toward treatment planning or monitoring airway conditions over time.
Videostroboscopy is a specialized imaging test that closely examines how your vocal folds (vocal cords) move during speech. If you're experiencing hoarseness, vocal fatigue, loss of range (especially in singers), or a voice that just "doesn't sound right," this is a key diagnostic tool. It uses a camera and strobe light to create a slow-motion view of your vocal fold vibrations, helping your doctor identify even subtle problems like nodules, polyps, stiffness, or scarring.
The procedure takes about 10–15 minutes in the office. A small scope is passed through your mouth or nose while you make various vocal sounds. It is not painful, though the nose may be numbed with spray to improve comfort. You'll be asked to say "eeee,” glide your pitch, or speak briefly while the vocal folds are recorded. You can return to speaking and normal activity immediately after. There is no downtime or recovery. The results help guide voice therapy, surgical decisions, or ongoing care. Videostroboscopy is highly effective and safe, and in many cases, only one session is needed for diagnosis — though it may be repeated over time to monitor progress.
High-speed imaging of the vocal folds is a cutting-edge tool that captures the vibration of the vocal cords in extreme detail—up to thousands of frames per second. It's especially useful when standard video stroboscopy doesn't provide enough information, such as in cases with irregular or asymmetrical vibration, vocal tremor, or subtle scarring that may not be seen with slower imaging methods. This test is ideal for singers, performers, or anyone with complex or persistent voice problems.
The procedure is done in the office and usually takes about 10–20 minutes. A small endoscope is placed through the mouth or nose while you perform specific vocal tasks. It is not painful, but you might feel a bit of pressure or discomfort, especially if done through the nose — numbing spray helps reduce this. The actual imaging part is quick and safe, with no sedation needed and no recovery time. You can speak normally afterward. The high-resolution video gives your doctor valuable insight into the precise mechanics of your voice and helps shape a personalized treatment plan. This test carries minimal risk and often complements other voice evaluations like stroboscopy or acoustic analysis.
Laryngeal electromyography (LEMG) is a diagnostic test that evaluates the nerve and muscle function of the voice box. LEMG is used when there's concern about vocal fold paralysis, weakness, or abnormal movement. By placing small needles into the larynx muscles, the doctor can measure how well the nerves are firing and whether the vocal folds receive the proper signals. LEMG helps diagnose conditions like vocal fold paresis, nerve injury, or movement disorders such as spasmodic dysphonia.
The procedure takes about 30 minutes and is performed in the office. A topical anesthetic is used on the skin, and fine needles (similar to acupuncture needles) are inserted into the neck to reach the laryngeal muscles. You'll be asked to make vocal sounds during the test. While the sensation can be uncomfortable, most patients tolerate it well. There may be mild soreness or bruising in the neck afterward, but no significant recovery time is needed. Results can help guide surgical or voice therapy planning. LEMG is safe and effective when performed by experienced specialists.
This noninvasive, in-office test measures various characteristics of your voice using specialized microphones and software. It analyzes pitch, volume, vocal range, steadiness, and other parameters to give a detailed profile of how your voice is functioning. It helps track vocal improvement over time, diagnose disorders like hoarseness or vocal fatigue, or evaluate professional voice users such as singers, teachers, or public speakers.
The test takes about 10–15 minutes and is completely painless. You'll speak, sing, or sustain certain sounds into a microphone while the software records and analyzes your voice. There's no anesthesia, scope, or discomfort involved. It's often done in combination with a physical exam or stroboscopy. You can speak and return to normal life right away. Results help guide voice therapy, surgical decisions, or rehabilitation for those recovering from voice disorders. It's also an excellent way to document progress during treatment. No risks are associated with this test, and it can be repeated.
Aerodynamic evaluation is a noninvasive test that measures how air flows through your voice box during speaking and breathing. It gives your doctor important information about how efficiently your lungs, vocal cords, and mouth work together to produce sound. It's often used to assess voice disorders, breathiness, vocal fatigue, or coordination issues in singers and professional voice users.
This test is quick — typically 10–15 minutes — and done entirely in the office. You’ll wear a small mask over your mouth and nose while performing simple vocal tasks such as sustained vowels or speaking into a microphone. The equipment measures airflow, pressure, and volume. There's no discomfort, no anesthesia, and no recovery time. You can speak and eat usually afterward. The safe test may be repeated periodically to track progress in therapy or recovery from a condition. The results help determine whether your voice issue stems from airflow problems, vocal fold weakness, or inefficient voice use, guiding personalized treatment.
A brush biopsy is a simple, minimally invasive way to collect surface cells from suspicious areas in the larynx (voice box) or pharynx (throat). It's often done when a small lesion or irregular tissue is seen during an endoscopy. Instead of removing tissue with forceps, a tiny brush is used to scrape the surface cells gently. The cells are then analyzed for abnormalities, including precancerous or cancerous changes.
The procedure is done in the office using a flexible scope and typically takes under 10 minutes. The throat is numbed with spray, and the brush is passed through the scope to collect a sample. Patients may feel a brief tickle or urge to cough, but the procedure is generally well tolerated. There's no need for sedation or downtime afterward — you can speak, eat, and return to daily activities immediately. It's a safe, low-risk way to screen suspicious lesions, especially for patients not yet ready for a surgical biopsy. While not a replacement for a full tissue sample if needed, brush biopsies offer a quick and effective first look at potential problems.
An office biopsy involves taking a small tissue sample from a visible lesion or abnormal area in the larynx or pharynx using a flexible scope and biopsy forceps. This procedure is typically done to rule out or confirm cancer, chronic inflammation, or infections in patients with hoarseness, pain, or visible growths. Unlike surgical biopsies done in the operating room, this procedure can be performed right in the office without general anesthesia.
The throat is numbed with spray, and a flexible endoscope is used to visualize the area. A small biopsy tool is passed to gently remove a tiny piece of tissue through a working channel in the scope. The procedure usually takes 10–15 minutes. Some patients feel slight pressure or irritation, and there may be a brief sore throat or a tiny amount of bleeding afterward, but most people tolerate it well. You can speak and eat usually shortly after the procedure. Biopsy results typically return within a week and guide the next steps. Office biopsy is safe and efficient and often avoids needing a trip to the OR — though some findings may still require follow-up surgery depending on results.
Blue laser ablation is a highly precise, in-office procedure used to treat a wide variety of vocal fold and airway lesions — including benign growths (like polyps or nodules), fluid swellings (Reinke’s edema), fragile blood vessels (varices), inflammatory tissue (granulomas or granulation), scars, papillomas, and mild narrowing (stenosis). The laser’s wavelength targets blood-rich tissue while minimizing injury to the surrounding healthy structures, which helps preserve voice quality.
The procedure is performed through a flexible scope inserted via the nose, usually with local anesthesia to numb the throat and nose. It takes about 15–30 minutes, and while patients may feel some pressure or warmth, it’s generally well tolerated. You may be asked to limit speaking for 1–3 days afterward, and some throat irritation or mild hoarseness is normal for a few days. Most people can return to work the next day. Multiple treatments may be required for conditions like papilloma or scar tissue, but many patients experience noticeable improvement after just one session. Risks are low and include temporary voice changes, swelling, or rare minor bleeding. The biggest benefits are improved voice clarity and less invasive treatment — all done right in the office.
The KTP laser (potassium titanyl phosphate) is a versatile, office-based laser used to treat a variety of voice, airway, and nasal conditions. It’s especially effective for treating vascular lesions like varices or papillomas, inflammatory growths like granulomas, and benign vocal fold lesions like nodules and polyps. It’s also used in the nasal cavity to stop bleeding (epistaxis) or reduce enlarged turbinates, which improves nasal breathing.
The procedure is usually done in the office using a flexible scope, with topical anesthesia to keep you comfortable. A thin laser fiber is threaded through the scope to deliver gentle pulses of light energy directly to the lesion. Most sessions take 20–30 minutes. You may feel heat, pressure, or the urge to cough briefly, but the discomfort is minimal for most patients. Some voice rest is usually recommended for 1–3 days, and mild hoarseness or sore throat can last up to a week. Conditions like papillomas or chronic lesions may require multiple sessions spaced weeks apart. The KTP laser is highly effective and precise, with a very low risk of scarring or tissue damage, and it allows for outpatient treatment without general anesthesia.
The Nd: YAG (neodymium-doped yttrium aluminum garnet) laser is used to treat chronic inflammation of the throat (pharyngitis) or tonsils (tonsillitis) when other treatments, like antibiotics or lifestyle changes, have failed. It reduces inflammation and vaporizes infected or hyperactive tissue, often helping patients with persistent sore throats, throat clearing, and bad breath caused by tonsil crypts or low-grade infections.
This procedure is typically done in the office under topical anesthesia. A laser fiber is passed through a flexible scope or directly to the tonsils or back of the throat. Patients may feel some warmth or irritation during the treatment, but it is generally brief and tolerable. The session lasts about 15–20 minutes. Afterward, you may experience a sore throat for a few days. Over-the-counter pain relief and saltwater rinses can help. Most patients are back to normal activity within 24–48 hours. Depending on the condition, one to three treatments may be needed. Benefits include reduced throat infections, better breath, and less discomfort long-term. Risks are minimal and may include temporary throat dryness or swelling.
This procedure combines a photosensitizing agent (alpha levulinic acid) with KTP laser treatment to target leukoplakia and other premalignant lesions on the vocal folds or pharynx. Alpha levulinic acid is absorbed by abnormal cells, making them more responsive to laser energy. When activated by the laser, it destroys damaged or precancerous tissue while preserving healthy structures. This targeted approach is ideal for managing high-risk lesions in patients who want to avoid traditional surgery.
The treatment is done in the office in two stages. First, the alpha levulinic acid is applied topically to the affected area and allowed to incubate for a short period (usually 180 minutes). Then, a flexible scope with a KTP laser fiber activates the treatment area. The entire session for the procedure takes about four hours and 20 minutes for the KTP laser. Patients may feel a mild burning or tingling sensation during laser activation, but numbing medication is used to reduce discomfort. After treatment, some hoarseness, burning, or soreness is expected for a few days. Voice rest is recommended for 2–3 days. Most patients need only one or two sessions, though close monitoring is essential for high-risk lesions. The procedure is safe, highly effective, and allows for early intervention without hospitalization or sedation. Risks are minimal and include temporary voice change, redness, or swelling.
Botox (botulinum toxin) injection is one of the most effective treatments for spasmodic dysphonia, a voice disorder caused by involuntary spasms of the vocal cords during speech. It’s also used for laryngeal spasm or paradoxical vocal fold motion, where the vocal cords close when they should be open, causing breathing difficulty or noisy breathing. Botox gently weakens overactive muscles to reduce spasms and restore more natural voice or breathing.
The injection is done in the office under local anesthesia. A small needle is carefully guided into the vocal fold muscle through the neck, using a combination of electromyography (EMG) or endoscopic guidance. Most patients say the procedure is brief and tolerable — lasting about 15–20 minutes from start to finish. You may notice temporary breathiness, a weaker voice, or mild swallowing difficulty for a few days, but this usually improves within 2 weeks. The therapeutic effect begins after 3–7 days and lasts around 3–4 months, at which point repeat injections are typically scheduled. Botox is extremely effective for managing symptoms and has helped thousands of patients regain control of their voice and breathing with minimal risk.
A superior laryngeal nerve block is a quick, in-office procedure for treating chronic throat pain, laryngeal hypersensitivity, chronic cough, and vocal fold spasms. This nerve can become irritated or inflamed due to reflux, viral illness, or nerve trauma, leading to symptoms like throat tightness, sharp pain with speaking, or uncontrollable coughing. A nerve block interrupts this overactive signal pathway, offering both relief and diagnostic information.
The procedure takes about 10 minutes and is done while you're seated in the exam chair. After numbing the skin, a small injection of local anesthetic (sometimes combined with steroid) is placed near the nerve through the front of the neck. Most patients report only mild discomfort — like a pinch or pressure — and relief can be almost immediate or occur over several days. You may feel a temporary numb sensation in the throat or voice weakness for a few hours. Results may last days to weeks; for some, one block is enough, while others may need a series of injections spaced apart. Risks are very low and include brief voice changes or mild swelling at the injection site. The benefit is often dramatic, especially for cough and throat pain that hasn't responded to other treatments.
Steroid injection is a targeted treatment used to reduce inflammation, swelling, and scarring in the vocal folds or airway. It’s most commonly used for vocal fold scarring (which can cause hoarseness or a tight-sounding voice) or subglottic stenosis (narrowing just below the vocal cords that may cause breathing symptoms). Injecting a small dose of corticosteroid directly into the affected area can soften scar tissue and reduce swelling, improving both voice and airflow.
The procedure is performed in the office with a flexible or rigid laryngoscope. After numbing the throat and nose, the doctor uses a thin needle passed through the scope or neck to deliver the medication precisely where needed. The injection takes about 10–15 minutes and is generally well tolerated — patients may feel pressure or brief discomfort but usually no significant pain. You can return to work or normal activities the same day, although voice rest for 24 hours is often recommended. Most patients begin to notice improvement within days to a week. You may need one or more injections over time, depending on your condition. Risks are very low and include temporary irritation or minor voice changes.
Hyaluronic acid is a naturally occurring gel-like substance that can be injected into the vocal folds to treat vocal fold atrophy (thinning), paresis (weakness), or paralysis. These conditions can lead to a breathy or weak voice, difficulty projecting, or vocal fatigue. The injection aims to bulk up the vocal fold, improve closure, and restore a stronger, more efficient voice.
This procedure is done in the office using a flexible scope and local anesthesia. The vocal fold is visualized with a camera, and a fine needle injects hyaluronic acid through the mouth or neck. The injection takes about 15–20 minutes. Some patients may feel a brief pinch, fullness, or urge to cough, but the procedure is usually well tolerated. You may be advised to rest your voice for a day, but normal speaking usually resumes quickly. The improvement is often immediate or noticed within a few days. Results typically last 3–6 months, though some patients experience more extended benefits. For long-term results, repeat injections or fat transfer may be considered. Risks are minimal and include temporary hoarseness or instability in the voice as the material settles.
PRP (Platelet-Rich Plasma) injection is a regenerative treatment that uses a patient's blood to stimulate vocal fold healing. It's beneficial for treating vocal fold atrophy, scarring, and sulcus vocalis — a groove or depression in the vocal fold that can cause a weak, breathy, or strained voice. PRP contains concentrated growth factors that promote collagen remodeling, reduce inflammation, and help restore pliability to the vocal tissue.
The procedure is done entirely in the office. A small amount of your blood is drawn and processed in a centrifuge to separate the PRP. Then, using a flexible scope for guidance, the PRP is injected into the vocal folds through either the mouth or the neck. The full appointment takes about 45–60 minutes, with the injection itself lasting only 10–15 minutes. Most patients describe the sensation as a brief fullness or mild pressure. Some localized pain at the injection site may be expected. Voice rest is usually recommended for 24–48 hours, with a gradual return to speaking afterward. Depending on the condition, a series of 1–3 treatments may be suggested. Because it's your own tissue, there's virtually no risk of allergic reaction. PRP is a safe, natural option that may be combined with voice therapy or other injections for longer-lasting results.
Below, you can hear two Before and After PRP injection samples.
Sample 1
Sample 2
Nanofat injection is a next-generation vocal fold treatment that uses highly refined fat from your own body — processed to retain powerful healing factors while removing the bulkiness of traditional fat. It’s used to treat vocal fold atrophy and paresis (weakness), especially in patients seeking natural, regenerative options to restore fullness and elasticity to the voice.
The procedure starts with a small amount of fat gently harvested from an area like the abdomen or thigh — often using a mini-liposuction technique. The fat is then emulsified into a smooth, injectable form rich in stem cells and regenerative proteins. In the same visit (or occasionally a follow-up), the nanofat is injected into the vocal folds using a flexible laryngoscope and fine needle. The process takes about 60–90 minutes total. Most patients tolerate it well, with only minor soreness at the donor site and a full sensation in the throat for a day or two. Voice rest is usually recommended for 2–3 days. Results are often longer-lasting than those of synthetic fillers, and many patients notice gradual improvement in strength, range, and clarity over several weeks. This procedure is low-risk, with the added benefit of using your own tissue for natural, biocompatible healing.
Microfat injection is a well-established technique for treating vocal fold atrophy and paresis, particularly when more lasting volume restoration is needed. Unlike nanofat (which is processed to remove fat cells), microfat preserves whole fat cells, providing both bulk and regenerative support. It's ideal for patients with longstanding hoarseness, voice fatigue, or breathy voices looking for a natural, long-term solution.
A small amount of fat is harvested from your abdomen or thigh under local anesthesia. After light processing to remove excess fluid, the fat is injected into the vocal fold muscle using a fine needle under endoscopic guidance. The procedure takes around 60–90 minutes from start to finish. There may be slight swelling or soreness at both the donor site and the throat for a few days. Voice rest for 3–5 days is usually recommended to help the fat "settle" and integrate into the tissue. Results can last a year or longer, though touch-up procedures may occasionally be needed. Because it's your own fat, there's no risk of allergic reaction. The benefits include improved vocal strength, less fatigue, and a more stable voice — particularly for those whose voice has changed with age or after surgery.
