Dr. Randal Paniello

Every day, we communicate with the people around us in various ways: We make business phone calls, create plans for the future, and tell our loved ones how much we care. “The voice is very important—communication is key to interacting with other people; and those who can’t communicate get isolated. It affects their whole way of life,” says Dr. Randal Paniello of Washington University’s Voice and Airway Center. “Voice problems are quite common and they’re nothing to be ashamed of. But there are effective treatments for most, if not all, different types of voice problems once we make a diagnosis.”

In his practice, Paniello sees patients of all sorts—those who use their voices as a part of their profession, from teachers and lawyers, to singers and TV and radio personalities—as well as average individuals having trouble with their airway or voice. “We first make the diagnosis, and that starts with a videostroboscopy,” Paniello says. “We put a scope in the throat to look at the vocal cords, and flash a strobe light on the vocal cords at approximately the same rate as they vibrate. Then we can see them moving in slow motion, and that gives you information you can’t really get any other way about the condition of the vocal cords and other diagnoses we might otherwise miss.”

Some voice problems are as simple as acid reflux that can make the throat hoarse, Paniello notes, which can be treated with dietary changes and medications. For those who use their voice professionally, overuse can lead to lesions. “Oftentimes, those lesions will improve if we do behavioral therapies to stop the overuse,” he says. “That doesn’t mean they need to stop talking—just to talk more efficiently.” For that, the center has a team of speech pathologists to work with patients.

Another less common diagnosis is spasmodic dysphonia, which some people may recognize as the condition that NPR broadcaster Diane Rehm has struggled with. “The most common type, which affects 90 percent of patients, causes the vocal cords to squeeze too tightly when they talk, so the voice sounds very squeezed and strained,” Paniello says. “It’s not due to any kind of virus or systemic disease that we’re aware of. People get it for no particular reason.”

Paniello treats this disorder using Botox injections, which relax the vocal cords. Many of his patients travel from as far as Joplin, Arkansas and southern Illinois because this type of treatment is hard to find, he says. “We also are working on some alternative treatments in the laboratory that we’re not quite ready to roll out yet,” he says. “We’re trying to find a surgical solution that would be a one-time operation, rather than the repeated injections.” Paniello has been nationally recognized for his research involving treatments for vocal cord paralysis and spasmodic dysphonia, including the American Laryngological Association’s prestigious Casselberry Award.

The Voice and Airway Center will be expanding this summer, with the addition of Dr. Joe Bradley, who did his residency at the practice before leaving for additional specialty training at Emory University. Together, they will open a second location on Old Ballas Road in West County to better serve their patients.

On the Cover: Washington University’s Voice and Airway Center, located at the 4921 Parkview Place, Ste. 11A, offers a variety of surgical and nonsurgical approaches to treating disorders of the voice and airway. Its new location at 605 Old Ballas Road, Ste. 100, will open later this summer. Pictured on the cover: speech-language pathologists Archie Harmon and Linda Neal with Dr. Randal Paniello. For more information, call 362-7509 or visit oto.wustl.edu.

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