Category: Throat

Chronic Cough: Signs, Symptoms, & Treatments

A girl experiencing a cough in a light purple sweater sitting on her couch.

This October, flu season, sinus infections, and other seasonal ailments are frequent as we head into the winter months. Many of us experience a cough along with these seasonal sicknesses, and it’s typically nothing to fret about.

But, when is it time to worry about a chronic cough? A cough that just won’t go away can be frustrating and can significantly impact your quality of life. A chronic cough can cause headaches and sleepless nights, and you may wonder if you’ll ever find relief from your pesky cough.

Fortunately, at Excel ENT, our speech-language pathologist, Amy Pittman, encounters many patients who suffer from chronic coughs. Learn more about chronic cough, its common causes, and how Excel ENT’s SLP can help you find a solution.

What is Chronic Cough?

Coughing can help you clear your throat, prevent infections and help protect your airway. But coughs can linger, lasting anywhere from 4 weeks in children and 8 weeks in adults. Usually, a chronic cough is dry and isn’t productive for your airway.

Common Causes of Chronic Cough

Chronic cough can be difficult to diagnose because there are several possible causes. Some of the most common causes include:


When you have asthma, the muscles around your airways constrict. The lining of your airways swells, and your body produces thick mucus in response. Coughing is your body’s way of getting air into those tightened areas. Asthma can be triggered or worsened by infections, weather, stress, allergies, tobacco smoke, medications, exercise, and stress.

Postnasal Drip

One of the most common causes of chronic cough is postnasal drip. Runny mucus drops down your throat if a virus, allergies, dust, chemicals, or inflammation irritate your nasal membrane. The mucus in your throat causes you to cough, and you may experience worsening symptoms at night.


If you’ve recently recovered from a cold, flu, COVID-19, or pneumonia, your cough may remain while your body heals and recovers from the infection. These illnesses can lead to lung inflammation and a lingering cough. To heal itself, your body produces a dry cough to reduce the infection.

Laryngopharyngeal Reflux (LPR)

Laryngopharyngeal reflux (LPR) causes acid from the stomach to travel up the esophagus and into the throat. LPR is commonly confused with gastroesophageal reflux disease (GERD), but if you’re suffering from LPR, you may experience more pain in your throat. LPR may result in many voice problems, like swallowing problems, sinus drainage, and chronic cough.

Irritable Larynx Syndrome (ILS)

Various symptoms, including chronic cough, chronic throat clearing, the feeling of a lump in your throat, and others can be caused by irritable larynx syndrome. In ILS, the larynx (voice box) becomes sensitive to stimuli, including cold air, talking, and more. Common causes of ILS are viral illness, allergies, sinusitis, certain medications, stress, and others.


Smoking negatively affects your lungs, as well as the rest of your body. A chronic cough can be caused by the body attempting to clear out the chemicals that enter the airway and lungs from tobacco. If you stop smoking, you may find relief from your chronic cough and lead a healthier lifestyle.

Testing & Treatment for Chronic Cough

If you’ve been experiencing a cough for longer than 8 weeks, contact your primary care doctor. Regardless of potential causes, if you have a chronic cough that has not been explained or diagnosed, we recommend you seek medical care.

At Excel ENT, our SLP, Amy Pittman, will begin with a consultation to learn the comprehensive history of your chronic cough. For further diagnosis, she may perform a thorough laryngoscopic and stroboscopic examination to examine patterns of vocal fold motion and vocal fold vibration.

Find Relief at Excel ENT

At Excel ENT, we can work to find out what triggers your cough so you can find the relief you deserve. Treatments can vary from medication changes to treatment for medical conditions, such as allergies, asthma, or LPR if those trigger your chronic cough.

The goal of treatment for chronic cough is to give you the tools to manage it better and improve your quality of life, and Amy can teach you more about keeping your vocal cords healthy.

Schedule an Appointment for a Chronic Cough Consultation

Proudly serving the Birmingham area, our team can provide treatment for various ear, nose, and throat ailments. Call us at 205-988-6858 or contact us online to find relief today!

How To Deal With The Feeling That Something Is Stuck In Your Throat

Woman holding her throat and experiencing globus sensation.

There is nothing worse than the feeling that something is stuck in the back of your throat only to find there’s nothing physically there. This sensation, called globus sensation, can be alarming and frequently bothersome.

Most often, there’s no need to fret if you’re experiencing this feeling! Globus sensation is fairly common. Learn from our team at Excel ENT all about globus sensation and when it’s time to speak with a doctor.

What is Globus Sensation?

Globus sensation, also called globus pharyngeus, is the feeling of a blockage, or lump, in the back of the throat, even when there is no physical blockage. The condition used to be called globus hystericus, because doctors thought that people complaining of this sensation were “hysterical”. In today’s world, doctors are more knowledgeable about globus sensation. We now know that the symptoms are very real and that they can be caused by a physical or psychological issue in the body.

Globus sensation can be accompanied by soreness and swelling in the throat, persistent clearing of the throat, hoarseness, or a cough you just can’t shake. Globus sensation is a little different for everyone, and not all symptoms have to be present for the diagnosis of globus sensation.

What Causes Globus Sensation?

The most common causes of globus sensation are anxiety and gastroesophageal reflux disease (GERD). Usually, when a person holds back strong feelings or emotions, the sensation arises and becomes recurrent. Likewise, those dealing with GERD experience their stomach acid traveling up the food pipe and into the throat, which can cause globus sensation. Some other causes of globus sensation include medication side effects, enlarged thyroid gland, or cervical spondylitis. Other reasons for this sensation continue to be discovered, so if you’re experiencing a globus sensation, it’s never a bad idea to speak with a doctor.

How Can I Deal with Globus Sensation?

There isn’t a specific treatment for globus sensation, but that doesn’t mean you don’t have options to ease symptoms. We recommend speaking with your doctor about evaluations for reflux or other potential causes of globus sensation. It may also be worthwhile to speak with a speech therapist about other treatment options for relaxing your throat.

When you encounter symptoms of globus sensation, swallow with or without water, yawn with your mouth wide open, and move your jaw up and down to help with discomfort. Additionally, drinking more water can help relax your throat and decrease the feeling of a mass.

When Should I see a Doctor About the Feeling that there’s Something Stuck in my Throat?

The sensation of a large lump in the back of your throat can be frightening as well as aggravating. If you are feeling an unexplained lump in your throat, we recommend you see a doctor for evaluation. Your provider will use a flexible endoscope that is passed through the nose to examine your throat and be able to provide treatment if necessary.

Find Relief from Globus Sensation

Our physicians at Excel ENT can help evaluate your symptoms and create a treatment plan for many throat conditions, including the globus sensation. There may be an explanation for your discomfort, and our qualified team of professionals is ready to help you get the treatment you deserve. With years of experience, our team of otolaryngologists are knowledgeable about providing quality, effective care.

Heal Voice & Throat Conditions at Excel ENT

Proudly serving the Birmingham area, our team can provide treatment for a variety of ailments, specializing in ear, nose, and throat conditions. Call us at 205-988-6858 or contact us online to find relief today!


What to Do About Frequent Throat Clearing

throat clearing

We all clear our throats sometimes without giving it much thought. We may do it to get someone’s attention, to clear our throats of mucus or the feeling that something’s stuck, or it may be a nervous habit.

While there are several reasons for throat clearing, when it becomes a chronic occurrence, it can cause problems, including damage to your vocal cords. 

So what are the underlying causes of chronic throat clearing, and what can we do about it?

Why We Clear Our Throats & When It Becomes a Problem

When we clear our throats, we are transferring mucus out of our airway and into the throat. It’s normal for us to secrete up to two liters of mucus per day! Throat clearing can become excessive when mucus is too thick or copious. 

When this throat clearing process happens over and over again, it can cause redness and swelling of your vocal cords. If the clearing is very extensive, small growths called granulomas can form. If these granulomas get large, they can affect your breathing and your voice and may require surgery for removal. 

In addition, the irritation and swelling produced by chronic throat clearing can cause even more mucus production, which causes more throat clearing. As you can see, it can become a never ending cycle. Without a conscious effort to break the cycle, chronic throat clearing will likely continue. 

What Conditions Can Cause Chronic Throat Clearing?

Keep in mind that chronic throat clearing itself isn’t really a diagnosis. It’s a symptom of an underlying condition. Some of those might include:

1. Reflux

Laryngopharyngeal reflux (LPR) is a condition in which stomach acid escapes out of the stomach and goes into the esophagus and throat. The acid irritates the throat, the vocal cords, and even the nasal passages. It may result in voice problems, swallowing problems, sinus drainage, and the frequent need to clear the throat. The most effective treatment is usually a combination of medication and lifestyle changes, such as avoiding certain types of food and drink, reducing stress, and losing weight.

2.  Postnasal drainage

Another common cause of throat clearing is postnasal drainage, also called postnasal drip. Postnasal drip happens when your body starts producing extra mucus. You may feel it dripping down your throat from the back of your nose. Other symptoms may include cough, nausea, sore throat, and bad breath. Allergies are a common cause, along with viral infections, sinus infections, dry air, and changes in the weather.

Treatment for postnasal drip varies depending on the cause. If it’s related to allergies, avoiding the allergen or taking medications may stop the drip. Other treatments may include over-the-counter decongestants, antihistamines, saline nasal sprays, and staying hydrated.

3.  Allergies

Nasal allergies and food allergies can contribute to frequent throat clearing. In some cases, a food allergy or sensitivity may cause a tickling in your throat that makes you clear it. Dairy is a frequent cause, but foods such as eggs, rice, and soy may also be culprits. The treatment in such cases is avoiding the food that leads to symptoms.

Nasal allergies occur when the body’s immune system overreacts to the presence of substances, called allergens, that are usually harmless. Common allergens include pollen, dust, and animal dander. Nasal allergies can lead to excess mucus production, which can cause frequent throat clearing. Antihistamines, nasal sprays, and nasal rinsing can help with allergies, as well as avoiding the allergens when possible.

4.  Side Effect of Medication

Some blood pressure medications can cause a tickle in your throat that contributes to chronic throat clearing and chronic cough. If you’re taking blood pressure medication and are frequently clearing your throat, talk to your doctor about a potential substitute.

5.  Habit

Sometimes, there may be no underlying condition causing throat clearing. It can become a habit or something you subconsciously do when anxious or stressed. To break the habit, you can drink more fluids, ask someone to help you monitor your throat clearing, or look for an alternate activity to do when the need to clear your throat arises, such as tapping your fingers. Stress management can also be very helpful.

6.  Swallowing Problems

Swallowing problems can arise for many reasons, and there are many ways to address them, depending on the exact situation. In general, difficulty swallowing can lead to throat irritation and frequent throat clearing as well as hoarseness, coughing, and choking when eating.

7. Vocal Cord Growths

When abnormal growths, such as polyps, nodules, or cysts grow on the vocal cords, you may feel as though something unusual is in the back of the throat. If you do not know that this is a physical growth, you may try to clear your throat in an attempt to dislodge the perceived object.

Causes of these growths can include smoking; allergies; overusing or straining the vocal cords from excessive singing or shouting; and frequent or strenuous coughing.

Treatment for Chronic Throat Clearing

Long-term treatment for chronic throat clearing depends on determining the underlying condition causing it. Treatment may include lifestyle changes, medications, or, in some cases, surgery.

Here are a few general tips for the treatment and prevention of chronic throat clearing:

  • Drink plenty of water to keep the throat moist, which may relieve or lessen the feeling that something has become lodged in the throat. When you feel like you want to clear your throat, take a sip of water instead. Also, increase your water intake to help thin mucus and make it easier to swallow.
  • Eat and chew slowly if you have difficulty swallowing.
  • Use a humidifier to keep the air moist, which may help reduce throat irritation.
  • Clear your throat as few times as possible. Instead of clearing your throat, hold your breath and swallow.

Find the Cause of Chronic Throat Clearing at Excel ENT of Alabama

Our Speech-Language Pathologist, Amy Pittman, is an expert at working with patients to find the cause of chronic throat clearing and treating the underlying condition. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Causes of Chronic Cough

chronic cough

A cough that just won’t go away is one of the most common reasons for a visit to the doctor. Many people initially visit their primary care physician, but if the issue isn’t easily resolved, other doctors and specialists may become involved, such as allergists, pulmonologists, otolaryngologists (ENT), and speech-language pathologists (SLP), such as Excel ENT’s SLP, Amy Pittman.

Amy sees patients often who complain of a chronic cough. It’s annoying for the person experiencing it and others in the home, and it can disrupt sleep and cause headaches. We’re thankful that there are many ways in which Amy can help get to the bottom of the cause and find an effective solution.

Definition & Causes of Chronic Cough

According to the American Speech-Language Hearing Association, coughing helps you clear your throat and lungs and can prevent infection. But sometimes a cough can become chronic, lasting more than four weeks in children and more than eight weeks in adults. Aside from the extended duration of the cough, signs and symptoms include the frequent need to cough and having a rough-sounding voice due to that frequent coughing.

Chronic cough can be tricky because there are several possible causes. Here are the most common ones we see.

Postnasal Drip

Also called upper airway cough syndrome, postnasal drip is a common cause of a persistent cough. When a virus, allergies, dust, chemicals, or inflammation irritate your nasal membranes, they make runny mucus that drips down your throat. This makes you cough, especially at night when you lie down.


When you have asthma, the muscles around your airways tighten, the lining of your airways swells, and cells in your airways produce thick mucus. Coughing is your body’s way of trying to get air into those restricted areas and can be triggered by infections, weather, allergies, tobacco smoke, medications, exercise, and emotions.


After you have recovered from a cold, flu, or pneumonia, you may continue to have a cough as your body completely heals and gets over the infection. COVID-19, the illness caused by SARS-CoV-2, sometimes leads to lasting lung inflammation and a lingering dry cough. The prolonged cough from COVID-19 is no different than any other virus that affects your lungs. The injured parts of your lungs are trying to clear out the infection and heal.

Laryngopharyngeal Reflux (LPR)

LPR, sometimes confused with gastroesophageal reflux disease (GERD), is a condition in which acid escapes from the stomach and goes into the esophagus and throat. This causes irritation to the throat, vocal cords, and even the nasal passages. It may result in voice problems, swallowing problems, sinus drainage, the frequent need to clear the throat, and chronic cough. 

Blood Pressure Medications

ACE inhibitors for blood pressure can cause a chronic dry cough. When a patient has a persistent cough and takes an ACE inhibitor, a slight change in medication often helps resolve the cough.


Smoking damages your lungs, as well as the rest of your body. Smokers often experience chronic cough because chemicals and particles in tobacco smoke irritate the lungs. In response, the body makes mucus to try to get rid of it through frequent coughing. In all situations, we recommend stopping smoking to address a chronic cough and for many other reasons.

Irritable Larynx Syndrome (ILS)

ILS involves a range of conditions including chronic throat clearing, chronic cough, and others. With ILS, the larynx (voice box) becomes very sensitive to stimuli, such as strong smells, cold air, talking, and more. There are several possible causes, including viral illnesses that cause inflammation of the nerve that supplies the voice box, GERD, allergies, sinusitis, certain medications, environmental exposures, and stressful life occurrences.

Symptoms of ILS usually last longer than three weeks and have no other identifiable cause. Symptoms may include frequent non-productive throat clearing, chronic coughing attacks that bring up little or no mucus, and difficulty breathing with the sudden onset of stridor (noisy breathing).

Testing & Treatment for Chronic Cough

Our SLP, Amy Pittman, will likely work with you to get a comprehensive history regarding your chronic cough. She may perform a thorough laryngoscopic and stroboscopic examination to visualize patterns of vocal fold motion and vocal fold vibration. She may also test your voice to see if there are any changes in vocal quality that the cough might be causing.

We can work to find out more about what triggers your cough so that you can avoid those triggers. In some cases, treatment is straightforward, such as recommendations to stop smoking or making changes to medications. In other cases, you may need treatment for medical conditions, such as allergies, asthma, or LPR if those are triggers for your chronic cough. 

Many times, the goal of treatment for chronic cough is to give you the tools to better manage it, and Amy can teach you more about keeping your vocal cords healthy.

Address Chronic Cough with Excel ENT of Alabama

We are happy to answer questions about chronic cough and other ear, nose, and throat issues. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Do You Have Good Vocal Hygiene?

vocal hygiene

When you think of “good hygiene” you may immediately come up with washing your hands, brushing your teeth, showering often, and keeping your nails clipped. But did you realize that there is such a thing as “vocal hygiene,” and that it’s very important for your ability to speak and communicate?

We use our voices constantly, although some jobs, professions, and roles may require more speaking. We all have the risk of developing voice problems, but people who use their voices more often may have an increased risk. An estimated 17.9 million adults in the U.S. report problems with their voice, but some of these disorders can be avoided by taking care of your voice, according to the National Institute on Deafness and Other Communication Disorders.

So what should you be on the lookout for, and how can you keep your voice healthy?

What Is Vocal Hygiene?

Your vocal cords are two tiny muscles covered with layers of tissue, and they are very delicate. When you speak, your vocal cords vibrate to produce sound. Any problems with the vocal cords significantly impact the voice. This might include growths on the vocal cords, infections, or improper use of the vocal musculature.

Good vocal hygiene encourages your vocal cords and voice are working properly with no problems. Signs that you have a voice problem might include:

  • Hoarse or raspy voice
  • Lost ability to hit some high notes when singing
  • Voice that suddenly sounds deeper
  • Throat that often feels raw, achy, or strained
  • Talking has become an effort
  • Repeatedly feeling the need to clear your throat

What Causes Voice Problems?

There are many things that can cause voice problems such as:

  • Upper respiratory infections
  • Inflammation caused by gastroesophageal reflux (sometimes called acid reflux, heartburn, or LPR)
  • Vocal misuse and overuse
  • Growths on the vocal folds, such as vocal nodules or laryngeal papillomatosis
  • Cancer of the larynx
  • Neurological diseases (such as spasmodic dysphonia or vocal fold paralysis)
  • Psychological trauma

Most voice problems can be reversed by treating the underlying cause or through a range of behavioral and surgical treatments. In some cases you have little or no control over what’s happening to your voice, but in other instances, there are several healthy habits that will help you have good vocal hygiene.

Improve Your Vocal Hygiene

  • Stay hydrated — Drink plenty of water, especially when exercising. If you drink caffeinated beverages or alcohol, balance your intake with plenty of water.
  • Take vocal breaks — Rest your voice throughout the day.
  • Use a humidifier in your home — This is especially important in winter or in dry climates.
  • Avoid or limit use of certain medications — Some medications may dry out the vocal folds, including some common cold and allergy medications. If you have voice problems, ask your doctor which medications would be safest for you to use.
  • Don’t smoke and avoid second-hand smoke — Smoke irritates the vocal folds. Also, cancer of the vocal folds is seen most often in individuals who smoke.
  • Avoid spicy foods — Spicy foods can cause stomach acid to move into the throat or esophagus, causing heartburn or laryngopharyngeal reflux (LPR).
  • Eat healthy foods — Include plenty of whole grains, fruits, and vegetables. These foods contain vitamins A, E, and C that help keep the mucus membranes that line the throat healthy.
  • Hand hygiene — Wash your hands often to prevent getting a cold or the flu.
  • Get enough rest — Physical fatigue has a negative effect on voice.
  • Exercise regularly — Exercise increases stamina and muscle tone which will help provide good posture and breathing, which are necessary for proper speaking.
  • Try not to overuse your voice — Avoid speaking or singing when your voice is hoarse or tired.
  • Avoid using the extremes of your vocal range — This includes screaming or whispering, both of which can stress your voice. Consider using a microphone when appropriate.
  • Practice good breathing techniques — When singing or talking, support your voice with deep breaths from the chest, and don’t rely on your throat alone. Talking from the throat, without supporting breath, puts a great strain on the voice.

Let Excel ENT Help You Improve Your Vocal Hygiene

No matter what voice problems you may be experiencing, our Speech-Language Pathologist, Amy Pittman, is experienced in treating voice problems, and she can teach you how to use your voice in a healthy way.

She may conduct an examination using video laryngoscopy to see your throat, larynx, and vocal cords. The short procedure involves putting a tiny camera through the lower nasal passage to reach the throat. You will be awake so that you can speak, which helps Amy see the vocal cords while they vibrate and move. The procedure isn’t painful and lasts less than one minute.

Amy will be able to see if there are any growths or signs of an infection. She also watches how you use your voice and whether there’s tension in the muscles. Then, she’s able to determine whether you would benefit from voice therapy or if other medical or surgical treatment is needed.

If you or your loved one are experiencing voice problems, we can help. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

When Should You See an ENT vs. an Upper GI Doctor for Swallowing Problems?

ENT vs upper GI swalling problems Excel Ent Birmingham Al

By Amy Pittman, Excel ENT Speech-Language Pathologist

You are having trouble swallowing, and maybe you are also experiencing very bad acid reflux. What kind of doctor do you think you should see? For many, the answer is to make an appointment with a gastroenterologist who specializes in the upper gastrointestinal (GI) tract. While they may be able to help you in some instances, it may be that you also need the help of an ENT

It can be difficult to know which type of doctor best suits your needs, and sometimes you may even need both. In this article we will discuss the differences between the two most likely conditions you may have, which are laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD).

ENT vs. Upper GI — Where Is Your Problem?

First, let’s define what LPR and GERD are exactly.

Laryngopharyngeal reflux (LPR) is a condition in which stomach acid escapes out of the stomach and goes into the esophagus and throat. 

The acid irritates the throat, the vocal cords, and even the nasal passages. It may result in voice problems, swallowing problems, and sinus drainage. LPR is often referred to as “silent reflux” since many people with LPR do not experience heartburn. This is because the laryngeal area is much more sensitive to stomach acid than the esophagus.

The symptoms of LPR are felt primarily in the throat and may include the following:

  • Sore throat
  • Mild hoarseness
  • The sensation of a lump in the throat
  • The need to clear the throat
  • The sensation of mucus sticking in the throat, and/or post-nasal drip
  • Chronic (long-term) cough
  • Difficulty swallowing
  • Red, swollen, or irritated larynx (voice box).

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.

Common signs and symptoms of GERD include:

  • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  • Chest pain
  • Difficulty swallowing
  • Regurgitation of food or sour liquid
  • The sensation of a lump in your throat

So when acid repeatedly “refluxes” from the stomach into the esophagus alone, this is GERD. When stomach acid travels up the esophagus and spills into the throat or voice box, this is LPR. People with GERD tend to experience heartburn or a feeling of acid coming up. People with LPR are more likely to have a cough, throat clearing, hoarseness, or a feeling of something stuck in their throat. Of course, some people have both!

What To Do If You Experience LPR or GERD

You should start by examining your symptoms. If your swallowing problems include food feeling stuck in your throat or you are experiencing the regurgitation of food, you may want to start by seeing a GI. You can also come straight to Excel ENT of Alabama for an ENT evaluation. Since GERD and LPR often occur together, we do sometimes collaborate with a GI doctor. The GI will focus on the esophagus and stomach, while we will focus on the throat area.

When it comes to LPR, the most effective treatment is usually a combination of medication and lifestyle changes. Lifestyle changes might include things like avoiding eating right before bed and reducing the intake of problem foods. Acidic foods and drinks are problematic, as well as caffeine, alcohol, carbonated beverages, mint, and high-fat foods.

Discover how the team at Excel ENT of Alabama can help manage swallowing problems, such as LPR.

Don’t put off making an appointment with Excel ENT’s Speech-Language Pathologist Amy Pittman if you are experiencing swallowing problems. Together with Dr. Christopher Davis, Amy can diagnose your issue and develop a treatment plan in no time. Schedule an appointment online, or call to discuss coming in at a time that’s best for you: 205-988-6858.

Speech and Hearing Rehabilitation: Conversations with Excel ENT Experts

speech and hearing rehabilitation excel ent birmingham al

While many ENTs offer services related to speech and hearing, at Excel ENT of Alabama, we offer something that’s a little unique, which is full speech and hearing rehabilitation. But why might someone need these services?

At the very heart of the matter is the word “rehabilitation,” which means to restore abilities through training or therapy. Rehabilitation can be used alongside or instead of other treatments, such as medication or surgery. Some disorders do well with therapy only, and others respond well to a combination of rehabilitation and medical treatment.

To learn more about what’s involved with speech and hearing rehabilitation, we sat down with Excel ENT Speech-Language Pathologist (SLP), Amy Pittman, and our audiologist, Dr. Helen Lee Miles, to ask them a few questions.

Speech Rehab at Excel ENT: A Conversation with Amy Pittman, SLP

What’s different about what you offer at Excel ENT? 

While most ENT physicians have the capability to view someone’s throat and vocal cords with a small endoscope, few partner with a speech-language pathologist to provide a holistic approach that includes both medical/surgical and rehabilitative interventions. Addressing all aspects of a voice disorder can be crucial. For this reason, we have had many patients drive here from hours away, even from other states!

What are some reasons or conditions that might cause someone to need speech rehab? 

Many conditions can cause speech problems, but I specialize in voice disorders. Voice disorders are most often caused by swelling, irritation, or growths on the vocal cords, or problems with coordinating respiratory or laryngeal musculature.

What’s typically involved in terms of evaluation, procedures, and therapy? 

A first step in evaluating a voice disorder is to take a look at the vocal cords themselves. We want to make sure the voice problem isn’t a result of something medically serious, and we also want to determine whether medication or surgery is required. We interview the patient to help us identify the problem and come up with a treatment plan. The duration of voice therapy varies, but it often only takes a few sessions to achieve significant improvement.

What is a strobe voice evaluation, and why might it be needed? 

Stroboscopy refers to a specialized method of examining the vibrating vocal cords, which are too fast for the naked eye to see. A bright flashing light lasting a fraction of a second is used to illuminate the vocal cords, allowing us to evaluate their vibration in a detailed way.

What are the results of speech therapy typically like? 

The outcome really depends on the person and the nature of their condition, but most people see great improvement.

Why would you encourage a patient to go through speech therapy, and what are the biggest benefits or advantages? 

Many people achieve excellent results through voice therapy that they could not achieve any other way. Unlike medication or surgery, there are no risks or side effects. Some people are even able to avoid having surgery for vocal cord polyps or nodules by participating in therapy! Even if surgery is required, voice therapy can help patients learn ways to prevent problems from reoccurring in the future.

Hearing Rehab at Excel ENT: A Conversation with Dr. Helen Lee Miles

What is hearing rehabilitation? 

Hearing rehabilitation, referred to as aural rehabilitation, is the process of identifying hearing loss, providing counseling, managing the hearing loss through use of technology such as hearing aids, cochlear implants, or assistive listening devices; and implementing communication strategies to improve a patient’s overall health, ability to communicate with those around them, and their quality of life.

What are some reasons or conditions that might cause someone to need hearing rehab? 

Each hearing loss is different. It can be caused by aging, exposure to recreational or occupational loud noises, genetics, medications, diseases, and syndromes. Some hearing loss can be idiopathic, which means the cause is unknown. Hearing loss can also stem from a combination of these things. It is important to identify the type and degree of each hearing loss to determine the most appropriate intervention.

What’s typically involved in terms of evaluation, procedures, and therapy? 

Typically, the first part of rehab is the identification and diagnosis of hearing loss which is done through a full audiological evaluation including a hearing test to determine the type and degree of hearing loss. Next, patients must be educated on their hearing loss and the recommendations for “next steps.” 

If their hearing loss warrants hearing aids, we would then meet to discuss their needs and wants to determine the best options for them. Then the patient can be fit with hearing aids based on their audiometric results. From there, the patient will be taught about the use, features, and care of the hearing aids. 

It is really important for people to understand that this is a process and follow-up appointments are important to ensure patient understanding and to adjust the hearing aids as needed for optimal use. It is also important for the patient and their loved ones to be taught communication strategies to be used in conjunction with their technology.

Why would you encourage a patient to go through hearing therapy, and what are the biggest benefits or advantages? 

Hearing loss can be associated with isolation and depression. Aural rehabilitation can improve a person’s quality of life and give them the ability to more effectively communicate with those around them. It can help a person by allowing them to have more ease of  listening and keeping them engaged with the world around them. 

Hearing loss can also be associated with cognitive decline. Treatment of hearing loss is not going to prevent things such as cognitive decline or dementia, but it has been shown to delay onset of symptoms. People who have participated in aural rehabilitation are more likely to report overall better health! 

Discover how the team at Excel ENT of Alabama can help with speech and hearing rehabilitation.

If you have speech or hearing issues, both Amy and Dr. Miles are the absolute best, and they will be happy to help however possible. To schedule an appointment with one of our Birmingham ENT specialists, call us at (205) 988-6858, or send us an appointment request.

All About Swallowing Disorders: Symptoms and Treatment Options

Woman with swallowing trouble

Do you ever feel like you’re choking while you’re eating? Do you sometimes feel like you have a lump in your throat you just can’t swallow away?

If so, you are not alone. It is estimated that nearly 15 million adults in the United States are affected by swallowing problems and disorders. And as scary as it can feel, often it is a relatively easy situation to diagnose and fix.

Amy Schiwitz, ExcelENT’s Speech-Language pathologist (SLP), knows about these challenges too well. She specializes in seeing patients that present with swallowing problems in Birmingham, Alabama and she’s seen it all. Fortunately, Amy is an expert at diagnosing swallowing issues and has helped them go away for hundreds of patients.  

Swallowing problems: how they work, how to diagnose and treat

Swallowing comes so easily to most people that we rarely even think about it. Just like breathing, swallowing is essential to everyday life. In fact, we swallow 500-700 times a day, around three times an hour during sleep, once per minute while awake and even more during meals. 

With all that swallowing, imagine how difficulties swallowing can negatively impact your daily life! 

Occasional swallowing problems, which may occur when you eat too fast or don’t chew your food well enough, are not usually concerning. But if you consistently experience swallowing difficulties, you should consider scheduling an appointment in Birmingham AL with ExcelENT’s Speech-Language pathologist (SLP), Amy Schiwitz.  

How swallowing works, to begin with

While it comes naturally to us, swallowing is a complex process. About 50 pairs of muscles and several nerves work together to receive food into the mouth, prepare it, and move it from the mouth to the stomach in three stages: 

  1. The oral stage: In the first stage, the tongue collects the food and prepares it for swallowing by chewing it until it is the right size and texture to swallow by mixing the food with saliva. Saliva softens and moistens the food to make swallowing easier. 
  2. The pharyngeal phase: In the second stage, the tongue pushes the food to the back of your mouth, which triggers a swallowing response that passes the food through the throat (pharynx). Your voice box (larynx) closes, and breathing pauses to prevent food or liquid from entering your lungs. 
  3. The esophageal phase: In the third and final stage, the food enters the esophagus, which carries the food to the stomach. 

The muscles in your mouth and throat must be strong and coordinated enough to properly complete this process. If you have difficulties at any point during this process, then it might be an indicator that you have a swallowing disorder.

So, exactly what is a swallowing disorder? 

Dysphagia is the medical term that refers to difficulties swallowing. Dysphagia can be the result of muscle damage, nerve damage, or other causes and can occur at any stage of the swallowing process. 

Common symptoms of a swallowing disorder may include:

  • A feeling of food getting stuck.
  • Coughing or choking while eating.
  • Gurgling wet voice quality after swallowing food.
  • Pain while swallowing.
  • Inability to swallow.

How is my swallowing disorder diagnosed? 

First, Amy will perform a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) to see a patient’s swallowing process in action. 

The FEES provides an endoscopic view of the food/liquid moving through the throat. During this procedure, Amy places a very small endoscope in the patient’s nose going down to an area just above the patient’s throat and larynx.  

At this vantage point, you’ll be given small amounts of food or liquid to eat/swallow. Amy can evaluate the timing, speed, and coordination of the food or liquids that are swallowed. She might make positional changes, adjust food consistency, or attempt swallowing maneuvers during the FEES to determine how they affect the patient’s swallowing function. 

The whole thing will be over in about 20 minutes, and you might even get to see a video of the procedure itself!  Based on Amy’s findings, she will make recommendations and discuss treatment options with the patient. 

So, how will you treat my swallowing disorder? 

Amy will determine a patient’s treatment options based on the patient’s complaints and the specific dysphagia dysfunction identified during the evaluation. Each person’s therapy is unique to his or her individual disorder and needs. 

The therapy may involve exercises that strengthen swallowing muscles so that food and drink go into the stomach rather than the windpipe. Or, they might recommend that you slightly modify some of the foods that you eat. Or, it might be recommended that you make slight positional changes when you’re eating. And believe it or not – you might need lessons on swallowing slightly differently!

Whatever the outcome of the procedure and the treatment options prescribed, you’ll be able to resume a normal life without the worry of you “swallowing wrong.” At Excel ENT, we’ll do everything we can to walk you through every step of the way of this issue, and we’ll hang in there with you until the prescribed treatment gets rid of your swallowing issues.

Contact Excel ENT to diagnose your swallowing disorder

Swallowing should not be a constant struggle. If you are ready to address and treat your swallowing problems, contact Excel ENT today to schedule an appointment with ExcelENT’s Speech-Language pathologist (SLP), Amy Schiwitz.  

What Is a Voice Disorder?

six seated adults holding colored word bubbles in front of their faces

Voice Disorders


Did you know that as many as nine percent of Americans have a voice disorder, but that fewer than one percent seek professional treatment? One possible reason for people not seeking treatment is that voice disorders can take many forms, and they often accompany other illnesses. Sometimes, people may not realize that they have a treatable issue.

Read on to learn about some common causes and symptoms of voice disorders, plus how professional treatment can improve a person’s life.

What is a voice disorder?

The vocal cords are two tiny muscles that are covered in layers of tissue. They’re very delicate and need to be able to vibrate together smoothly. A voice disorder is anything that causes changes to a person’s vocal cords, which can then affect the pitch, loudness, tone, or the level of effort the person must exert to create sounds.

Generally, there are two classes of voice disorders:

  1. Physiological – changes in the body, including problems with the central nervous system
  2. Functional – using the vocal cords improperly or inefficiently

Speech is a very complex and dynamic muscle activity, so small changes in the body or in the way we use our voices can have a dramatic impact on a person’s vocal tone or ability to produce “normal” sounds. 

Causes and symptoms of voice disorders

 Some of the most common causes of vocal disorders are:


 The vocal cords can develop many different kinds of growths ranging from fluid-filled cysts to hard, benign papillomas. Surgeries and throat injuries can cause physical damage, which leaves behind scar tissue. It’s also possible to develop cancerous tumors on the vocal cords. Recall that two tiny muscles create your voice, so even a very small growth can have a dramatic impact on the sound of a person’s voice.


 One of the most common causes of vocal changes is inflammation, especially from illnesses such as colds or other upper respiratory viruses. Excessive stomach acid from GERD (gastroesophageal reflux disorder) can irritate the vocal cords, as can allergies. Other factors that can cause inflammation are smoking, overusing the voice, some medications, and surgery.

 Nervous system disorders

 Since the nervous system controls vocal cord movements, medical conditions that impact the nervous system can also affect the voice. People who suffer from MS, Parkinson’s disease, ALS, or strokes may struggle to use their voice normally.


 The vocal cords are muscles, so they can suffer from improper or excessive use. Talking or singing too much, screaming, shouting, or even excessive coughing and throat clearing can damage the muscles. Some people may develop polyps, which are like small blisters on the vocal cords. In extreme cases, the vocal cords can hemorrhage. 

 Some occupations put people at a greater risk for misuse-induced voice disorders. Teachers, those who work in loud manufacturing environments, salespeople, and singers use their voices more and louder than other people, so they need to be particularly careful to protect their vocal muscles.

 Lifestyle factors

 Things like smoking, excessive alcohol intake, and limited water consumption can affect the vocal cords. Also, a person’s age can cause changes in how well the vocal cords operate.


 Each voice disorder is unique, but some common symptoms are: 

  • Rough, breathy, strained voice
  • Abnormal pitch (too high/low, lots of variation in pitch)
  • Weak, hoarse, lost voice
  • Raspy or shaky voice
  • Needing to use more effort than normal to speak
  • Becoming easily fatigued
  • Running out of breath
  • Tension, pain, or tenderness in the throat
  • Persistent cough or throat clearing

If you exhibit any of these symptoms and they persist for two weeks or more, especially if they’re affecting your quality of life, then it’s time to schedule an appointment.

Diagnosing voice disorders

 To diagnose a throat disorder, a speech-language pathologist needs to be able to see the vocal cords. At ExcelENT, Amy Pittman uses video laryngoscopy to see a person’s throat, larynx, and vocal cords.

The short procedure involves putting a tiny camera through the lower nasal passage to reach the throat. The patient needs to be awake so that he or she can speak, which helps Amy see the vocal cords while they vibrate and move. The procedure isn’t painful and lasts less than one minute.

 The camera helps Amy see if there are any growths or signs of an infection. She also watches how a person uses his or her voice and whether there’s tension in the muscles. Then, she’s able to determine whether the patient would benefit from voice therapy or if they need medical or surgical treatment.

How do you treat a voice disorder?

 Each disorder and individual are unique, so Amy customizes treatment plans to the exact needs of each patient. Treatment may include one or more of the following:

Lifestyle changes

 Sometimes, simple lifestyle changes can have a significant impact on the vocal cords. Drinking more water, quitting smoking, and making diet changes that reduce acid reflux can prevent vocal irritation. Taking time to rest vocal cords and learning how to warm them up before prolonged use can also reduce inflammation and fatigue.

Voice therapy

 When you use your voice, your vocal cords vibrate 100 – 200 times each second. With every vibration, they hit each other, and the impacts can cause damage. People who use their voices a lot, like teachers and singers, sustain more damage than the average person.

It’s possible to learn to use your voice in a way that limits the damage. A speech-language pathologist can teach a patient the proper technique, vocal exercises to strengthen the muscles, relaxation techniques, and even breathing strategies that help him or her use the vocal cords more efficiently.


 Some patients may benefit from medications. Antacids, for example, can help control GERD symptoms. When the vocal cords are exposed to less stomach acid, they’ll be healthier.


 If there are growths on the vocal cords, sometimes a patient needs surgical intervention to remove them. If the growths are cancerous, a patient may also need radiation therapy.

Don’t struggle with a voice disorder alone

Speech is something that most people take for granted until they develop a voice disorder. If you or a loved one is experiencing vocal changes, come in and see our voice specialists for diagnosis and a custom treatment plan.

Meet Our New Speech-Language Pathologist, Amy Schiwitz

Throat Monitor OPT

New Speech-Language Pathologist Amy Schiwitz


We communicate every day. From a simple “hello” in the morning to a discussion about a project at work, speech is a part of our entire day. However, have you ever wondered what would happen if you were unable to communicate with your voice?

Excel ENT is very fortunate to welcome a new member to our team to assist you in any speech, voice, and swallowing issues that you may experience. We are excited to introduce Amy Schiwitz, Speech-Language Pathologist, to the Excel ENT of Alabama team!


Picture of Amy Schiwitz, speech-language pathologist

Meet Amy Schiwitz!

With more than eight years of experience in speech and language pathology, Schiwitz is excited to bring her knowledge and expertise to the community.

“I have always been fascinated with how we communicate with one another,” says Schiwitz. “You go from having an idea in your head, then the brain processes it and turns it into English. Then, it turns into movements in the vocal cords, tongue, and lips as the person speaks what they were thinking and the other person almost instantaneously understands your words. It is extremely interesting.”

It’s easy to take verbal communication for granted until you have voice and swallowing issues

“One aspect I enjoy about this position is that I am able to see a wide range of patients,” Schiwitz says. “From teenagers to even a 105-year-old patient, I am able to help a variety of patients with speech and swallowing issues, which keeps things interesting.”

What Can You Expect During a Consultation?

If you have been experiencing a voice problem for more than two weeks, it is best to seek the assistance of a speech-language pathologist. If you have swallowing issues, it is important to schedule an appointment as soon as you notice difficulty swallowing.

“When it comes to voice problems, I see a lot of issues due to reflux, sinus drainage, vocal overuse, and growths on vocal cords,” says Schiwitz. “When a patient first walks into my office, we discuss their medical history. We also discuss when the problem first started so I can better understand the issue at hand.”

Schiwitz uses an endoscope in the patient’s nose to help her diagnose the issue. Then she and the patient discuss her findings. Together, they develop a plan to alleviate the symptoms and help the patient improve his or her quality of life.


Treatment Options Are Available

Depending on the diagnosis, there are a variety of treatment options available to help patients with speech and swallowing disorders.

“I am able to provide voice and swallowing therapy, which is completely individualized to the patient,” explains Schiwitz. “However, if more medical intervention is needed, Dr. Davis is here to assist. Patients are able to get a two-for-one deal when it comes to treatment here at Excel ENT of Alabama.”

If Schiwitz determines that voice therapy is the best option, patients will usually see improvement within the first few sessions. If the patient needs medication or surgical intervention, Schiwitz and Dr. Davis work closely to provide the treatment.

“As a therapist, I love that patients are able to not only have therapy benefits, but also more involved medical treatment, if needed, by an experienced and knowledgeable physician. We really do treat the whole patient here, and not just the symptoms, which is something I enjoy most about being a part of the Excel ENT of Alabama team.”


Discover how the team at Excel ENT of Alabama in Birmingham, AL, can help you regain your voice and swallowing issues!

Are you suffering from voice and swallowing issues? Contact the team at Excel ENT of Alabama today to schedule an appointment for a medical evaluation to receive the proper diagnosis and treatment plan.