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Otolaryngology – Head and Neck Surgery – Laryngology

Otolaryngology – Head and Neck Surgery – Laryngology

Dr. J.P. Gniady is with a female patient in an exam room. He is sitting wearing a white lab coat with the Penn State Health Milton S. Hershey Medical Center logo on it, a shirt, tie and glasses. The woman is seen from behind with shoulder-length, curly hair. Behind him is a poster illustrating ear, nose and throat structures.

Our expert laryngologist uses the latest techniques to evaluate and treat voice, swallowing and airway conditions.

Laryngology and Voice Disorders

Our voice is one of our most defining characteristics. It allows us to communicate with loved ones and express our emotions. Many people rely on their voice for their livelihood, including singers, actors, teachers, medical professionals, lawyers and salespeople. For most of us, loss of our voice, even for a short time, can be devastating.
    
When you visit Penn State Health Milton S. Hershey Medical Center for a voice, swallowing or airway disorder, you’ll receive comprehensive diagnosis and treatment by a laryngologist, an ear, nose and throat surgeon with expertise in the field of voice. He and other members of our multidisciplinary otolaryngology team will develop a personalized treatment plan that’s right for you.

Symptoms

Voice disorders have many different symptoms, including:

  • Decreased volume or voice projection
  • Loss of vocal range
  • Neck or throat discomfort with use of voice 
  • Persistent hoarseness
  • Voice fatigue

Early Diagnosis

Many patients delay seeking treatment for a variety of reasons. Some just think that losing one’s voice with age is normal or hope that the problem will go away. All too often, patients delay seeking treatment because of fear that they have a cancer in their throat. More often than not, that isn’t the case. But even if it is, catching a cancer at the early stage when it first affects your voice almost certainly means it is readily curable with an excellent voice outcome. This may not be the case if the problem is ignored. 

The majority of hoarseness comes from more common causes such as inflammation due to infections, overuse of the voice or, occasionally, acid reflux. Many patients have noncancerous masses caused by viral infections or the trauma of everyday voice use. The most common cause of hoarseness is simply mechanical, due to people changing the way they use the delicate muscles of the voice box.

Whatever the cause, the first step toward treating a voice problem is establishing an accurate diagnosis with the aid of the latest imaging and voice analysis technology. Our expert laryngologist will examine both the structure and the function of your vocal cords using high-definition video endoscopes with a technique called stroboscopy. This allows both the physician and you to see the details of your vocal cords, as well as their individual vibrations, which are the critical component of sound production. 

Advanced Treatment

Your laryngologist will then discuss a treatment strategy for any medical or surgical therapies that may be recommended. Treatment may include office-based laser treatment, smoking cessation, medication, injections or surgery. He works closely with a speech and language pathologist for treatment of any mechanical issues through a course of voice therapy. The team’s ultimate goal is a positive outcome for restoration of the patient’s voice.

Dr. John Gniady is seen in a professional headshot wearing a white lab coat with the Penn State Health Milton S. Hershey Medical Center logo on it, a shirt, tie and glasses.] John Gniady, MD, FACS

Often taken for granted, our abilities to eat, breathe and talk make up such a vital part of our existence, and even minor impairment can be such a detriment to our quality of life. Helping to restore patients’ capacity to use their voice, enjoy a meal or even just breathe without struggle is one of the most gratifying and fulfilling things that I get to do day in and day out here at Penn State Health.”

John Gniady, MD, FACS

Location

Penn State Otolaryngology – Head and Neck Surgery 
200 Campus Drive
Entrance 2, Suite 400
Hershey, PA 17033

Phone: 800-243-1455
Fax: 717-531-4907

Make an appointment

To make an appointment with the experts in Otolaryngology – Head and Neck Surgery at Penn State Health, call 800-243-1455 or 717-531-6822.

To make an appointment with the experts in Cosmetic Surgery, call 717-531-1386.

To make an appointment with the experts in Facial Nerve Disorders, call 717-531-1405.

Use our Find a Physician online tool to find contact information for specific ear, nose and throat doctors.

View Pediatric Otolaryngology Ear, Nose and Throat

Referring physicians

To transfer or refer a patient, please call 717-531-6822

Conditions

  • Airway disorders
    • Foreign body in throat 
    • Laryngomalacia
    • Laryngotracheal stenosis
    • Masses that narrow the airway 
    • Stridor
    • Vocal cord dysfunction
  • Throat disorders
    • Chronic cough
    • Swallowing problems (dysphagia)
    • Zenker’s diverticulum
    • Vocal cord cancers
  • Voice and speech problems
    • Hoarseness
    • Hypernasal or hyponasal speech
    • Laryngopharyngeal reflux
    • Respiratory papilloma
    • Spasmodic dysphonia
    • Vocal fold lesions, nodules, cysts and polyps
    • Vocal fold paralysis

Laryngology frequently asked questions

Q. Why do I always lose my voice?

A: Many factors can cause loss of voice. Occasional voice loss after an episode of vocal abuse (any behavior that strains or injures the vocal cords) such as during a sporting event is relatively common. As long as the voice returns to normal within a day or two, it is generally nothing to be concerned about. However, some people seem to lose their voices frequently, even after episodes of much less extreme abuse. Some patients report losing their voice completely any time they get an upper respiratory tract infection. Prolonged or frequent episodes of voice loss should be evaluated to ensure there is not an underlying problem with the vocal cords. One of the more common causes of repeated total voice loss is a vocal hemorrhage (bleed). This happens when a fragile blood vessel ruptures due to traumatic voice use or abuse, filling the vocal cord with blood. If not treated, repeated episodes could cause permanent scarring of the vocal cords. 

Q. What makes my voice sound so old?

A: The short answer is that there is nothing about aging that causes any major deterioration of the voice. Age can sometimes be a measure of wear and tear on the vocal folds. It can also be accompanied by other medical problems and general deconditioning, which can certainly affect the voice. However, if people think you are 10 to 20 years older based on the sound of your voice, it may be time to have a provider examine your vocal cords. Like any other muscular system in the body, the voice can almost always be made stronger and more resilient through the use of targeted exercises and occasionally even some minimally invasive procedures.

Q. Why do I always have so much mucus in my throat?

A: Mucus in the throat is probably one of the most common complaints that we see. Many factors can contribute to mucus issues in the throat. Often, the sensation of constant mucus in the throat isn’t due to mucus at all. By evaluating the upper respiratory and digestive tracts, from the nose and mouth all the way down to the windpipe and stomach, we can usually find the true cause of the “mucus” problem. 

Q. I feel like I have a lump in my throat. Could it be cancer?

A: Strange sensations in the throat often lead to concerns about an underlying cancer. The fact that the throat can’t be readily examined by the patient or even their general physician leads to quite a bit of added anxiety regarding any unusual symptoms there. Fortunately, we are able to readily, easily and comfortably evaluate the entire throat with the aid of high-definition video endoscopes, right in the office. The vast majority of the time cancer is not to blame, but you can gain peace of mind by making sure.

Q. Are there alternatives to radiation for throat cancer?

A: Depending on the type, location and stage of your throat cancer, there may be some excellent surgical alternatives to radiation. Small cancers on the vocal cords are perhaps best suited to surgical treatment with state-of-the-art laser surgery. When appropriate, laser surgery may allow for an equally effective treatment of your cancer with significantly fewer side effects and damage to surrounding healthy structures. Because every case is unique, your surgeon and radiation oncologist should work together to help you determine which treatment plan would be best. 

Q. Do you use the KTP laser?

A: Dr. John Gniady trained extensively on the KTP laser under Dr. Steven Zeitels at the Massachusetts General Hospital Voice Center. Zeitels was the first to bring this particular laser to popular use for surgery on the vocal cords. The laser has unique properties based on its specific wavelength (color) that make it ideal for treating both benign and cancerous lesions on the vocal cords. The most common applications are for treating benign vocal cord lesions such as recurrent respiratory papillomatosis (a viral infection related to HPV) or bleeding vessels within the vocal cords. The laser is also used extensively for treatment of precancerous lesions (dysplasia) and early cancers of the vocal cords. The green light of the laser targets the blood vessels that feed these benign and cancerous lesions (think root system), allowing us to thoroughly treat the disease process while minimizing damage to the extremely delicate vocal cord underneath. 

Q. Why do I cough whenever I eat or drink?

A: We all have occasional episodes of coughing associated with eating or drinking. Perhaps we are jostled mid-swallow, overhear a funny joke or get distracted, and something starts to go down the wrong pipe. Our body usually recognizes this immediately and causes us to cough to clear the food or drink. However, if this happens regularly or more often, it may be a cause for concern. Frequent episodes of aspiration (food or drink going down the windpipe) could be a symptom of an underlying medical problem and, regardless of the cause, puts you at risk for episodes of potentially life-threatening pneumonia. If you cough when you eat and drink more than occasionally, discuss the problem with your doctor.

Q. Why does food get caught in my throat?

A: Despite the fact that we typically swallow several times a minute and generally never think about it, swallowing is one of the most complicated neuromuscular processes in the body. As a result, the list of potential causes of problems with swallowing is extensive. Most swallowing problems related to food getting caught or sticking in the throat are very treatable. We use a systematic approach to evaluate the anatomy and function of the swallowing system based on your description of the problems you are having. Once a diagnosis is decided upon, a plan for treatment can be tailored to your individual needs.

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