JULY • 2009
EAR, NOSE & THROAT SERVICES
EAR, NOSE & THROAT SERVICES
VOICE DISORDERS: SPEAK UP FOR
THE HOARSE PATIENT
EVENING CLINICS
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 EVENING
as articulation imprecision or stuttering. Depending on CLINICS
the diagnosis, therapy may be offered subsequently.
Occasionally, the patient may be referred to another service Figure 2: Muscle Tension Dysphonia -
Figure 1: Laryngoesophageal Reflux.
provider that specializes in an area of sub-specialty such Note the squeezing of the larynx when
person phonates.
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
9666 6698
Figure 3: Vocal Nodules. Figure 4: Normal vocal folds at rest.
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 DIRECT APPOINTMENT
medication, surgery, voice therapy, or a combination of any About Francoise Lim MS, HOTLINE
of these.
CCC-SLP
Voice therapy involves teaching the patient exercises Francoise graduated in 1992 from the
to mobilize the vocal folds in a more efficient manner to University of Oregon with a Master
facilitate repair of micro injury and strengthening. Besides of Science degree in Communication
basic warm-ups like lip trills, patients also have to learn Disorders and Sciences. She has worked
voice projection techniques. Therapy often takes an average with both adults and children with speech, language
of 6 sessions. Results are good especially for functionally and swallowing disorders. She has been with Tan Tock
caused problems like vocal nodules, and muscle tension Seng Hospital, ENT department for the past 11 years,
dysphonia. specialising in voice disorders. Together with an ENT
doctor, she runs a weekly Voice Clinic where stroboscopic
For dysphagia or related problems, the patient is firstly
laryngeal assessments are conducted. Apart from working
assessed clinically. He may then be referred for further
instrumental procedures such as Videofluoroscopy or
directly with patients, Francoise is also involved in voice TTSH SPECIALIST
education through organising and conducting workshops.
Fibreoptic Endoscopic Evaluation of Swallowing (FEES). APPOINTMENTS
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 About Susan Goh
of patients having had treatments for head and neck
diseases / conditions.
Susan graduated in Australia and has
been in Speech Therapy for more than
At this clinic, the therapists also rehabilitate patients who 10 years. She started out working at
require voice restoration services. These include counselling, a special school for a year and a half
before switching to a hospital. Her
assessment and prescribing / supplying the different
special interests include voice rehabilitation and head /
options for voice restoration after total laryngectomy.
neck dysphagia, including post laryngectomy rehab.
9666 6698
** 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.
DIRECT APPOINTMENT
HOTLINE
 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 In our effort to meet the needs of patients who are unable
profession, such as teachers and sales persons, are susceptible to an array of voice problems. They affect the quality of life of to come during the day, several TTSH Departments have
sufferers. Amongst smokers, a subtle change in voice may be the only tell-tale sign of early laryngeal cancer. 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
EAR, NOSE & for diagnosis and treatment. No longer is the larynx examined with a mirror and headlight! We are now able to assess the larynx DEPARTMENT AVAILABILITY OF NIGHT SESSION LOCATION

THROAT SERVICES more accurately – both structurally and functionally – with video stroboscopy. Voice science has progressed significantly in
Eye
General Surgery
Monday to Friday
Tuesday
TTSH Eye Centre, Level 1
Clinic B1B, Level B1
recent years, and we now recognise the cause of many common voice and throat complaints (see table 1). Speech therapy Urology Tuesday Clinic B1B, Level B1
which is the mainstay of treatment can now offer a wide range of treatments which offer significant benefit. Orthopaedic Surgery Tuesday Clinic B1B, Level B1
Ear, Nose & Throat Monday, Wednesday and Thursday ENT Clinic, Level 1
Where speech therapy fails, surgery may be necessary. This may involve simple procedures such as botox injections, endoscopic
Physiotherapy Monday, Wednesday and Thursday B1, Level B1
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. COMPLEMENTARY INTEGRATIVE
MEDICINE CLINIC
6357 8384
TTSH Complementary Integrative Medicine Clinic has
extended its hours, on appointment basis only.
DIRECT APPOINTMENT New opening hours:
HOTLINE Monday, Tuesday & Thursday : 8am - 5pm
CLINIC 1B Wednesday & Friday : 8am - 9pm (last appointment 8.30pm)
Saturday : 8am - 5pm (full day service)
Direct Appointment Hotline
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 2146
Laryngopharyngeal reflux (LPR) This is a common but under-recognised condition that cause hoarseness, a dry cough We are located at Level B2, TTSH Medical Centre (Next to
and throat irritation which leads to a throat-clearing habit. Pre-Admission Counselling Evaluation)
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 OUR 24 HRS TTSH SPECIALIST
VOICE DISORDERS: diagnosed by stroboscopy and will require surgery. APPOINTMENT HOTLINE
SPEAK UP FOR THE Vocal fold dysplasia and cancer Hoarseness may be due to a cancer or pre-cancerous lesion. Persistent hoarseness,
HOARSE PATIENT! particularly in a smoker mandates an urgent ENT referral. Call 9666 6698+
Muscle tension dysphonia This condition causes hoarseness due to inappropriate funtioning of the larynx. Diagnosis for your direct access privileges:
relies on stroboscopy and treatment is usually with speech therapy. • Specialist Appointments • Podiatry
• Direct Ward Admissions • Speech Therapy
Spasmodic dysphonia The muscles that move the vocal folds may be in spasm causing either a ‘tight’ or ‘breathy’ • Physiotherapy • Smoking Cessation Programme
voice. Botox injections into the larynx prove to be effective. • Occupational Therapy • Weight Management
• Dietetics & Nutrition Programme

Other options at your fingertips:

About Dr Jeevendra Kanagalingam
Dr Jeevendra Kanagalingam is an Associate Consultant in the Department of Otorhinolaryngology. His Tel 6357 8000 8am - 9pm (Mon - Fri)
interests are in Laryngology and Head and Neck Surgery. He trained in London at the Royal National Throat, 8am - 3pm (Sat)
Fax 6357 7011 / 7001* 24 Hours Daily

6357 8384
Nose and Ear Hospital, and the Royal Marsden Hospital. He received the Gold Medal in the intercollegiate Email gp@ttsh.com.sg* 24 Hours Daily
fellowship exams of the Royal College of Surgeons in 2006, and has over 20 peer-reviewed publications. He Voice Mail* 24 Hours Daily
DIRECT APPOINTMENT completed HMDP training at the Princess Alexandra Hospital in Brisbane before joining Tan Tock Seng + Please note that the above appointment number applies for TTSH patients only.
HOTLINE Hospital in 2008. 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