The RNTNEH is a national and international multidisciplinary centre for voice disorders. The voice clinic at the RNTNEH is one of the oldest in the UK. Nationally, we run the highest number of clinics per week, with two to three times the national average of patients seen per clinic. We see voice problems of all types ranging from subtle performance issues to vocal fold paralysis and cancer.
The team includes four surgeons, five speech therapists, a specialist technician and specialist nurses. The majority of cases referred to the clinic have already been seen at other centres and are referred for expert second opinion and management.
Voice disorders (eg hoarseness, lost voice or discomfort on speaking) are common. One in 25 of the general population and one in five teachers in the 'frontline' of voice use, will suffer some form of voice problem. It is estimated the cost of voice disorders to the British economy is £200m a year.
Everyone needs a voice, in order to both work and play, including children, 20% of whom will have problems with their voice, and older people who, if they cannot be heard, risk social isolation. These factors, among others, have led to the voice becoming recognised as an important speciality within ENT in both the UK and in Europe.
The voice clinic at the RNTNEH provides the highest level of expertise which results in a change of diagnosis or additional findings in 33% of patients (2004 audit) referred from other centres. This often results in avoiding surgery, or in finding lesions that previously were mis-identified, including precancerous changes.
The voice clinic specialises in disorders of the professional voice (eg singers, actors, barristers), voice disorders related to hormonal problems, asthma, allergy, excessive stomach acid and neurologically-related voice disorders.
We have recently taken part in a national broadcast to attempt to raise the public's awareness of spasmodic dysphonia, which is extremely disabling but can be treated with laryngeal injections, allowing people to return to normal life.
The voice clinic is actively involved in teaching, audit and research. The clinic runs the longest running annual phonosurgery course in the UK, and is actively involved in a MSc in voice pathology. Much pioneering work in voice disorders has come out of the voice clinic at the RNTNEH. Mr John Rubin, consultant ENT and head and neck surgeon, and Dr Ruth Epstein, consultant speech and language therapist, are past presidents of the British Voice Association.