Question:
We have a patient with post-intubation tracheal stenosis 3cm below glottic level,2cm long segment,Montgommary T-tube inserted.
What further option you have for this patient as definitive procedure?
We can send this patient to you,if better option available in your centre.
Dr.Raheel
Answer:
Dr.Raheel
First of all, thanks for your note. We would be happy to see your patient and help in his or her care. It sounds like the defect does not involve the subglottis, which makes the repair easier. While there are many options for repair of a tracheal stenosis, I would likely recommend tracheal resection with end to end anastamosis. Depending on the patient’s age and habitus, one may or may not need a tracheal release to afford anastamosis without tension for a 3 cm lesion. Other options are available for anterior only, soft tissue or longer defects- such as cartilage grafting, flap reconstruction and mesh staged reconstructions, but are all less ideal and probably not the best intervention in this case.
Robert L. Pincus MD
Dr. Victoria Epstein received her undergraduate degree at the University of California, Berkeley. She earned her medical degree from the University of California, San Diego ranked in the top 20 by America’s Best Graduate Schools, 2011 Edition by U.S. News & World Report. She completed her internship in general surgery and postgraduate residency in Otolaryngology- Head & Neck Surgery at Northwestern University Feinberg School of Medicine. Board certified in Otolaryngology – Head & Neck Surgery, Dr. Epstein also completed advanced fellowship training in revision sinus surgery and minimally invasive endoscopic skull base surgery at the Sinus & Nasal Institute of Florida under the tutelage of Dr. Donald Lanza, internationally recognized as an innovator of surgical procedures for the nasal passages and the paranasal sinuses.
Dr. Epstein is a member of the American Academy of Otolaryngology-Head and Neck Surgery, the American Rhinologic Society, and the American Medical Association. Dr. Epstein’s bibliography includes both articles in peer reviewed journals and textbook chapters. She has presented her research at numerous regional & national meetings, and was a recipient of the Research in Otolaryngology & Allergy Development grant. Dr. Epstein’s clinical interests and expertise are in surgical and medical treatment of nasal and sinus disorders including the management of advanced rhinologic problems such as cerebrospinal fluid leaks, anterior skull base defects and tumors, frontal sinus pathologies, and revision sinus surgery. Although she is a subspecialist, she also treats children and adults with general ear, nose, and throat problems. Dr. Epstein is fluent in Russian and is proficient in Spanish.
Question: My 3 year old son speaks with an extremely hi-pitched voice. (he did that from when he was an infant) He does sometimes talk with a normal voice tooo,but very little. I don’t know if he can imitate a deep voice at all. He was just seen by a local voice therapist who told us that he is too young for voice therapy and his voice might change over the next year or two. I am wondering:
a. At what age is it recommended to start therapy for a hi-pitched voice?
b. Won’t his vocal chords get strained if continues talking like this?
c. Why can’t we start therapy now even if his voice might change later?
Can therapy at a young age be counter-effective? Thank you very much! H.B.
Answer: Thank you for your question- and again- please note that I can’t give a specific medical answer to your individual questions without examining your child- Please consult with your physician for specifics.
An unusually high pitched voice in a child should be evaluated by your pediatrician and a competent ear nose and throat physician- It rarely may be a symptom of a serious medical problem- anything from a paralyzed vocal cord- to problems in the central nervous system or brain..
Once we are assured that this is not the sign of anything worrisome, I would not suggest therapy at an early age for a high pitched voice. This may be normal and hereditary in a child- and speech therapy is unlikely to be effective for this at an early age. It seems unlikely that a three year old, let a lone an infant, would be speaking primarily at other than his or her normal pitch.
Voice is a complex tone comprising many frequencies. The lowest frequency, in Hz, is what we perceive as pitch. As we know, the vocal pitch changes dramatically in boys around the time of puberty- and only if it persists at that point would I suggest speech therapy. Therapy at a young age is unlikely to be successful, and likely to bring attention to the issue- and make the child feel more self conscious about his voice. If this is becoming a difficult social issue among his peers (not his parents) I would then consider speech therapy at an earlier age. Young adults have a frequency range of 2 and a half to 3 octaves. Therapy would be aimed at having one speak at the lower end of his range.
Today, there is also a simple out patient surgical procedure that relaxes the vocal cord (type III thyroplasty) and can effectively lower one’s fundamental frequency (nomal pitch). This would only be offered to adults because of the likelihood of maturational changes in voice. You can contact us at the NY Voice Center for more information..
Robert L. Pincus MD
Dr. Scott Gold started the as a single doctor practice after finishing his residency in 1983. In 1993 Dr. Robert Pincus merged his practice with Dr. Gold, forming NYOG- The New York Otolaryngology Group- NY’s premier Ear Nose and Throat practice. Their goal was to offer the expertise of the best academic practice, with the personalized, caring services of the best private offices.
Dr. Hrishali Sule-Talathi is the senior audiologist at the New York Otolaryngology Group providing the Neuromonics Tinnitus Treatment and Canalith Repositioning Therapy for benign positional vertigo. Dr. Sule-Talathi started her career in audiology and speech pathology over twelve years ago in Bombay, India where she provided audiological services for hearing impaired adults and children in the city’s leading hospital and clinical programs. She also was a leading voice pathologist treating professional voice disorders.
Since moving to the United States, Dr. Talathi has focused on audiology with a keen interest in tinnitus and balance disorders. Dr. Talathi is a certified Neuromonics treatment provider in the New York region. She has also undergone extensive training in the evaluation and treatment of balance disorders. Dr. Talathi’s knowledge, training and expertise in the field’s of tinnitus and balance disorders along with her commitment to her profession and to helping patients suffering from tinnitus and dizziness make her a valuable addition to our team at the New York Otolaryngology Group.
Dr. Talathi received her Bachelor of Science degree in Audiology and Speech Pathology from Bombay University, Master of Science in Audiology from Bloomsburg University, and Doctor of Audiology from Salus University (formerly the Pennsylvania College of Optometry), G. Osborne School of Audiology. Dr. Talathi is a licensed audiologist and hearing instrument dispenser in the state of New York and a fellow of the American Academy of Audiology and the New York Association of Audiology.
Dr. Julie Glick is the Director of the Hearing Instrument Division at The New York Otolaryngology Group. Dr. Glick started her career in audiology twelve years ago in a private practice in Beverly Hills, California. She then went on to train fellow audiologists on all of the latest advancements of digital hearing technology. Dr. Glick also specializes in hearing conservation and optimization of the live performances of today’s leading musicians and television personalities with custom in ear monitors and hearing protection products. Dr. Glick’s knowledge and expertise of the technical aspects of hearing instruments coupled with her commitment to audiology makes her a valued asset to our goals of providing continued quality service.
Dr. Glick received her Bachelor of Arts degree in Speech and Hearing Science from The Ohio State University, Master of Science in Communicative Disorders from California State University, Northridge and Doctor of Audiology from the Pennsylvania College of Optometry, School of Audiology. Dr. Glick is a licensed Audiologist and Hearing Instrument Dispenser in the state of New York and a Fellow of the American Academy of Audiology.
Doctor Jason Mangiardi completed his undergraduate studies at the University of Michigan in Ann Arbor and received his medical degree from the University of Pittsburgh School of Medicine. He completed his internship in general surgery and residency training in Otolaryngology / Head and Neck Surgery at SUNY-Downstate Brooklyn Medical Center.
He focuses on head and neck surgery in adults and children including minimally invasive sinus surgery, endocrine, and pediatric surgery as well as complaints of the ears and voice. Dr. Mangiardi is an assistant attending physician at a number of hospitals in New York City including Beth Israel Hospital in Manhattan and Staten Island University Hospital. He is a member of the American Academy of Otolaryngology / Head and Neck Surgery and the Medical Society of the State of New York.
Dr. Sheila Apicella received her undergraduate degree at Barnard College in New York City. She then earned her medical degree from New York University School of Medicine. After a pre-residency fellowship in Otolaryngology-Head and Neck Surgery at St. Luke’s/Roosevelt Hospital in New York, Dr. Apicella continued her post-graduate training at SUNY-Stony Brook. She completed her residency at the University of Pittsburgh Eye and Ear Institute (recently ranked one of the top five programs in the country by U.S. News & World Report magazine).
Board certified in Otolaryngology-Head and Neck Surgery, Dr. Apicella focuses on minimally invasive endoscopic sinus surgery, management of sinus disease, head and neck surgery, sleep-disordered breathing, diseases of the ear and pediatric otolaryngology. She is an Assistant Attending physician at several New York City hospitals including Beth Israel Medical Center and St. Vincent’s Hospital. She is also an Associate Attending at St. Barnabas Hospital in the Bronx where she is involved in the education of students and residents.
Dr. Apicella is member of the American Academy of Otolaryngology-Head and Neck Surgery, The American Medical Association, and the Bronx County Medical Society. She has been repeatedly recognized in the Guide to America’s Top Physcians in the New York Metro area.
Dr. Burnett trained at the New York University School of Medicine. He completed a residency in Otolaryngology at the Milton S. Hershey Medical Center/Penn State College of Medicine and another in Internal Medicine at the Hospital of the University of Pennsylvania. Dr. Burnett recently completed a fellowship for Head and Neck Oncologic and Reconstructive Surgery at the Medical University of South Carolina.
Dr. Burnett is a member of American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Board of Internal Medicine, and the American Medical Association.
An accomplished medical writer, Dr. Burnett co-authored the chapters titled “Evaluation of Neck Masses” and “Small Nasal Defects” in Textbook of Primary Care Medicine and Management of Facial Cutaneous Defects. He was also guest editor of an issue of Facial Plastic Surgery; he also contributed an article titled “Outcomes Research in Facial Plastic Surgery” to that issue.
As a medical student (confirm) at NYU, Dr. Burnett launched NYU School of Medicine’s African Medical Textbook Project, which aimed to provide African medical schools and libraries with new and used science textbooks. During the four years that he directed the program, more than 14,000 much-needed textbooks were sent to medical institutions in Liberia, Kenya, Uganda, Nigeria and Zimbabwe. The ongoing program is now a joint venture of the NYU School of Medicine, U.S. State Department, textbook publishers, and corporate philanthropists. In 1992, Dr. Burnett won the NYU President’s Award for Volunteerism and Community Service. Two years later he was awarded the Alex Rosen Award for Excellence in Medicine and Humanities.
Doctor Robert Pincus is a founder of the New York Sinus Center and one of Manhattan’s most highly regarded, board-certified otolaryngologists.
Dr. Pincus earned his medical degree from the University of Michigan Medical School. He completed his training at New York’s Lenox Hill Hospital and Mount Sinai Medical Center.
In addition to his private practice work, Dr. Pincus is an Associate Professor in the Department of Otolaryngology at New York Medical College and a Lecturer at Mount Sinai School of Medicine. Earlier in his career, Dr. Pincus was Vice Chairman at New York Medical College, Director of the Department of Otolaryngology at New York’s Lincoln Medical and Mental Health Center, and Director of the Head and Neck Service at the New York Eye and Ear Infirmary. He has extensive teaching experience.
Dr. Pincus is a Fellow in the American College of Surgeons, the American Academy of Facial Plastic and Reconstructive Surgery, The American Rhinological Society, and the American Society for Head and Neck Surgery, as well as a Diplomate with the American Academy of Otolaryngology – Head and Neck Surgery. He is currently an active member in numerous professional associations, including the American Broncho-esophagologic Association; Physicians for Social Responsibility; Society for Ear, Nose and Throat Advances in Children; and Association of Physicians in AIDS Medicine.
Dr. Pincus has authored more than 40 articles and book chapters in the field of otolaryngology and shared his insights in presentations before dozens of prestigious professional organizations and medical staffs. He has frequently been recognized as one of metro New York’s leading otolaryngologists and sinus specialists by New York magazine, Castle Connelly Medical LTD, and Super Doctors.
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