Fortunately there are many ways to improve the voice. At the DEUTSCHE STIMMKLINIK patients will receive individual, high quality voice assessment and diagnostics as a basis for decision-making for individual voice coaching, voice rehabilitation, or voice therapy. Within voice problems, we always assess the larynx with its vocal folds, phonation, breathing, posture, and voice imaging with state of art examination techniques. Our ambulatory multidisciplinary assessment may lead to recommendations such as vocal hygiene, logopedic voice therapy, osteopathy, all the way up to phonosurgery, if needed. As a rule of thumb, we always consider surgery being at the end of a conservative therapeutical measures.
Our multidisciplinary team consists of medical doctors trained in ENT as well as phoniatrics, phonosurgery, osteopathy, logopedics, singing pedagogy, speech coaches and encompassing all current voice therapy techniques. If there still is a problem that cannot be solved by our team, we will take advantage of our very active network to find the best solution for any problem related to voice. Connecting to our academic and clinical networking in national and international societies (e.g. BDG, CoMeT, DBL, DGPP, DGHNO, EAV, ELS, IALP, IAP, PEVOC, UEP and many more) as well as health professionals we are able to find solutions for almost every patient with a voice problem.
Close collaboration and cooperation of voice doctors and logopedists is mandatory for voice therapy. More than 50 different voice therapy methods are known worldwide. At our clinic, we are not restricted to any definitive method and we select the best techniques and strategies from all of the established voice therapies. We strongly believe that voice therapy cannot be solely applied on a telemedicine platform without personal contact. However, after a comprehensive assessment at the DEUTSCHE STIMMKLINIK we will set up an individual treatment plan which may include follow-up sessions via internet platforms such as Skype or other interactive communication channels.
A well adapted breathing technique is mandatory for any kind of physiologic, long term voice use. All singers and actors rely on their individual breathing techniques, which are based on essential physiologic pulmonary, postural, and musculo-skeletal principles that can be assessed, measured and trained. Experience shows that in professional voice users, inadequate breathing patterns frequently cause problems related to voice use. Our team is capable of assessing all of the breathing techniques and training / treating patients how to optimize breathing for their speaking and singing voice. We frequently use proven techniques derived from semi-occluded voice therapy methods from Denizoglu, LaxVox, Fussi, Titze, Schlaffhorst-Andersen, Lieberman, Coblenzer-Muhar and many more.
Our long-lasting cooperation with world renown osteopath and psychotherapist Jacob Lieberman helped us substantially to learn how to treat many kinds of musculo-skeletal diseases and disorders related to voice problems, laryngeal disorders and neck pain. Muscular tension, repetitive strain injury (RSI), globus, frog-in-the-neck, lump in the throat, tenderness of laryngeal and paralaryngeal muscles are only a small part of the spectrum that can be treated with specific treatment techniques according to Jacob Lieberman. Furthermore chronic cough and problems with throat secretions as part of a complex syndrome of tenderness and throat clearing can also be significantly improved by these techniques.
Related to osteopathy, but methodologically different are treatments based on physiotherapy, chiropractice, manual medicine and muscular releasing techniques. We take advantage of some of these therapeutic techniques, e.g. in treating problems related to ‚repetitive strain injuries' (RSI). When comprehensive therapy in this field is needed, we refer to our associated partners for treating patients with voice disorders on a regular basis.
Singers with a classical repertoire as well as singers in the contemporary commercial music field need a proper singing technique to perform over a long time without getting voice problems. Nowadays, the demands for singing are getting tougher resulting in the need for singers to adapt adequately so to continuously perform well in their occupational environment. Our long-term experience with singers and actors shows that only with a good singing (and speaking) technique, including control over breathing, resonance, posture and psychological coping strategies enable performers to acquire stamina, retain their voice quality and survive in the highly competitive market of the performing arts. We coach, teach and train all fields in the wide spectrum of classical singing, contemporary commercial music not restricted to jazz, pop, rock, but also in the field of overtone singing, yodeling and many more varieties within the singing spectrum.
What ever professional voice users need for using their speaking voice, be it acting, working as a teacher or in showbusiness, survival of the voice is more needed than ever before. Our logopedic therapy, vocal coaching and speaking pedagogy is capable of adapting techniques from the medicine and arts to enhance the stamina and durability of our client’s and patient’s voices. Voice therapy and coaching encompasses not only on-site therapeutic sessions, but it also integrates telemedicine follow-up as well as single person and group training sessions.
Almost all patients seeking our advice and treatment have gone through some kind of alternative medicine pathways. There are too many aspects to be listed here. According to our experience, we certainly believe in the power of support and healing capabilities that lie in this broad field. Our therapeutic armamentarium has many treatment options, on the one hand traditional Chinese medicine, Thai Chi, Chi Gong, as well as yoga and up to food additives or inhalation with herbs.
The DEUTSCHE STIMMKLINIK offers coaching for professional voice users, voice tuning, counseling for individuals (teachers, moderators, actors, managers etc.), voice rehabilitation programs for performers ‚on tour’, choir singers, vocal hygiene programs.
If any kind of phonosurgical procedure is advisable, we reassure you that you are in best hands at our voice clinic. Our institution offers all phonosurgery techniques. Not only that we perform highest quality vocal fold surgery in all aspects, but furthermore and since many years we train and teach phonosurgeons how to employ latest surgical techniques for their patients. Prof. Hess is one of the leading phonosurgeons worldwide and belongs to Europe’s top phonosurgeons. He has more than 25 years of experience and performs on a regular basis phonomicrosurgery, injection laryngoplasties (=augmentation), laryngeal framework surgery (mostly thyroplasty), and office based interventions. Cutting edge technology including many kinds of lasers (CO2, diode, KTP, blue angiolytics lasers) are used for the benefit of our patients.
Prof. Hess invented many surgical techniques, introduced new phonosurgical instruments, teaches internationally at surgical conferences, advises academic societies, ENT colleagues, hospitals, insurance companies, offers second opinions, and his patients certainly benefit indirectly from medical doctoral students researching on the problems that are still prominent in laryngology.
Phonosurgery at the DEUTSCHE STIMMKLINIK is offered as ambulatory service. Patients are offered a comprehensive diagnosis in one day to sort it out which problems contribute to the voice problem and which treatment might be beneficial. Office-based phonosurgical interventions can take place on the same day, if indicated and wanted by the patient. In cases of phonomicrosurgery we usually perform a postoperative video-based laryngostroboscopy including voice assessment and counseling directly after the surgical intervention. A follow-up within the next days, weeks or months is always offered, but is not obligatory in all cases. Individual rehabilitation programs will be recommended, depending on the patient’s need. Follow-up is routinely and principally performed by referring ENT doctors. Medical reports from the DEUTSCHE STIMMKLINIK are given to the patient for immediate information of referring doctors.
With the finest instruments for phonosurgical procedures we perform our operations under 25fold magnification with Zeiss microscopes and top notch rigid endoscopes. All surgery is routinely archived as digital imaging document. Phonosurgery in general anesthesia is done at an outpatient anesthesia clinic (Anesthesia Center Hamburg - AZH) three minutes away from our voice clinic. General anesthesia is always performed by highly specialized anesthetists knowledgeable of how to protect vocal falls during anesthesia, using the smallest possible tubes and administering the most comfortable medication. Patients usually wake up minutes after the operation without feeling any pain - and patients are able to leave the outpatient anesthesia clinic after 1 to 2 hours. Surgery itself is performed with the finest microsurgical instrumentation on the surgical market. Prof. Hess also uses some own instruments developed for ultimate precision during the delicate operation. Video clips from office base examinations are always taken to the OR room and are reviewed by the surgeon minutes before the operation takes place, so that the surgeon has the possibility to precisely assess and make decisions for the optimal surgical technique.
Although office-based surgery is more than 100 years old, refinements took place within the last years due to much better endoscopes, instruments, and lasers that have very promising characteristics. World’s best phonosurgeons now switch over doing more and more interventions in the office in topical anesthesia. We are proud to say that our clinic is one of the leading institutes also in this aspect of phonosurgery (cf. presentations on our website). Augmentations for injection laryngoplasty, injections with botulinum toxin, steroids, cidofovir, surgery with 532nm KTP laser and 445nm blue laser and certainly all kinds of excisions and dissections are offered in topical anesthesia with high definition (HD) tip chip flexible videoendoscopes. Office-based surgery can be extremely helpful in patients who (1) want to avoid general anesthesia, (2) are not exposable with instruments in general anesthesia, (3) have a high risk for anesthesia due to other health issues, (4) need multiple, repetitive interventions.
Lasers are tools helping a surgeon to cut, coagulate, and excise tissues. When chosen prudently and for the appropriate problem, laser surgery can be superior to so called ‚cold instrument’ surgery and, in certain cases, will be the most preferable instrument. KTP photoangiolytic (blood vessel coagulation) properties enable disease treatment in deeper layers of the tissue while protecting the surface layer (epithelium). KTP is used in our practice in the office enabling pain-free, rapid therapy within 5–10 minutes for recurrent respiratoy papilloma, Reinke’s edema, vocal fold polyps, enlarged blood vessels and dysplasia. In the USA, KTP laser surgery is an essential and indispensable device in modern state-of-art treatment of laryngeal surgery (cf. publications on our website) and is nowadays applied in laryngeal cancer.
The augmentation of vocal folds is one of our core competences in laryngeal surgery. Having performed hundreds and hundreds of procedures in the office and in general anesthesia with all major implants on the market, we are convinced that injection laryngoplastic surgery is playing an indispensable role in helping patients regaining their voices rapidly and with long-lasting effects. We have thorough experience since more than 20 years with many fillers such as hyaluronic acid, calciumhydroxylapatit (Radiesse voice, Renú voice), collagen, carboxymethylcellulose, silicone (Vox Implants) and autologous fat (from liposuction). All augmentations are done in an ambulatory setting, either in the office or in general anesthesia. Indications are unilateral vocal fold paresis and paralysis, vocal fold bowing, presbylarynx, sulcus vocalis, patients after tumor surgery with chordectomy, and many more. A hospital stay is mostly not necessary. Not only performing these kinds of surgery multiple times per week, we also organize and present tutorial courses at international conferences and we additionally offer surgical training courses at our university medical center Hamburg-Eppendorf regularly. Many publications arise from our experiences, helping colleagues coming from all over the world to learn how to perform vocal fold augmentations. Together with pharmaceutical and medical device companies, we continuously help improving instruments and implants for better treatment of our patients in the future.
In cases where augmentations cannot help appropriately, thyroplasties are the preferred choice. A small bean-sized silicone part is implanted via a percutaneous, open-neck procedure. Mostly performed in cases of unilateral vocal fold paralysis and paresis, medialisation thyroplasty (also called Isshiki type I thyroplasty) is an indispensable technique to correct a vocal fold in its mid position and thus enabling complete vocal fold closure – glottic closure – and leading to a much louder voice. Optimal results make the voice near-normal with hardly any audible hoarseness. We routinely use digital volume tomography (DVT) in order to preoperatively individually calculate the ideal 3-D implant size. Silicone blocks are carved intraoperatively and placed at the previously determined site lateral to the vocal fold resulting in very favorable voice postoperatively. After having performed hundreds of thyroplasties, we are convinced that this method has its important role in the armamentarium of phonosurgery. Together with arytenoid adduction (AA) operations, for instance when applying our string arytenoid adduction (SAA) technique, the combination of both techniques can lead to even superior results (cf. publications on our website). The indication will be made from the phonosurgeon together with the patient during the office laryngeal examination when reviewing all results together with the comprehensive voice assessment. We perform thyroplasties in cooperation with the University Medical Center Hamburg-Eppendorf as an in-house, non-ambulatory procedure.
Botulinum toxin is injected into muscles and leads to temporary muscle relaxation. For medical indications, we inject botulinum toxin with very thin cannulas, comparable to acupuncture needles, into the overly activated and tense muscles. Precision in placements of the botulinum toxin is facilitated by using electromyography (EMG). Smallest amounts – drops! – are applied and usually have an effect lasting for three more months, which is very favorable for patients who are not able to control muscle tension with other therapeutic measures. Injections are performed transcutaneous and take only a few minutes. Indications in our field are spasmodic dysphonia (syn. for focal dystonia), however other indications are also within the field of our therapy such as cervical dystonia, bruxism, dysphagia, muscle tension dysphonia (only in severe cases), and most recently also in chronic sensory cough.
Clients and patients seeking help in transgender issues approach our services for many years. The DEUTSCHE STIMMKLINIK is a member of the multidisciplinary team of the University Medical Center Hamburg-Eppendorf (UKE). We perform phonosurgical procedures such as pitch tuning surgery, including cricothyroid approximation (CTA), glottoplasty with suturing of the anterior commissure of the vocal folds as a phonomicrosurgical surgery in general anesthesia, and chondroplasties with reduction of the so-called Adams apple.