A Clear Voice BLA Connections

In the final episode of series 4 of BLA Connections: A Clear Voice, host Natalie Watson is joined by Professor Reza Nouraei, Consultant Laryngologist and Tracheal Surgeon at Queen’s Medical Centre, Nottingham, to discuss how to oxygenate our patients whilst operating on the larynx under general anaesthetic. Prof Nouraei walks us step-by-step through THRIVE and other tubeless ventilation methods. 


“You have all the time in the world to put a scope in, as long as it's less than three minutes.”


This quote from Prof David Howard, a global Laryngology pioneer and a friend and mentor to many UK Laryngologists including Prof Nouraei, was an inspiration to search for methods of increasing apnoea time.


THRIVE is essentially a method of ventilating patients who are under general anaesthesia and under conditions of muscle paralysis (i.e. apnoea), by filling the upper airways with oxygen and by activating a ventilatory exchange process which increases the time to desaturation. 


As well as explaining the functions and indications for THRIVE, Prof Nouraei shares his tips and insights for using the procedure successfully, including which patients and conditions might not be suitable for it. We also discuss other ventilation strategies and new airway management tools for further improving them.


To ensure that patients with acutely compromised airways are managed safely, it is vital to understand the anatomy of laryngoscopy and to appreciate how the sharp angle between the lips and the larynx is converted into a straight line. This enables the laryngologist to create safe access corridors for oxygenation and for shared-airway surgery after the patient has been anaesthetised and has been rendered apnoeic. 


Apnoeic ventilation has been a major game changer for our specialty, as well, more broadly, for the care of patients with complex and compromised airways whom, as laryngologists, we are regularly called upon to support. 


For more expert insight into all things laryngology, please do look back at other episodes in this series, including the management and patient journey of airway stenosis, persistent throat symptoms, and the ageing voice. And if you have a topic you think we should cover next series, do let us know!


*Please note a declaration of interest: Prof. Reza Nouraei declares that he has received research and consultancy support from Fisher and Paykel.

Contact Information
Visit www.britishlaryngological.org or download BLA Connect from your app store for further information and details on becoming a BLA member.
Email: enquiries@britishlaryngological.org for any questions or topic suggestions you may have for future episodes.
This show is brought to you by the BLA. You can follow us on  Twitter, Facebook, Linkedin and Instagram hosted by Natalie Watson @surgeonsinger produced and directed by Heather Pownall of Heather's Media Hub Ltd. 

In this episode of BLA Connections, A Clear Voice, we are joined by Professor Reza Nouraei, Consultant Laryngologist and Tracheal Surgeon at Queens Medical Center, Nottingham, UK, to discuss the exciting subject of artificial intelligence (AI) and its role in the future of laryngology and global healthcare.
AI gives us the ability to classify voice signals, develop imaging programs for stroboscopy and high-speed laryngoscopy and identify regions of interest for further scrutiny. This can all help with areas where we are trying to take activity out of the operating room and into the outpatient setting. It has the potential to impact survival rates and early diagnosis of diseases such as Parkinson’s.

What about ‘big data’? “Big data is the engine of artificial intelligence.” It’s most relevant to laryngology in terms of population science and feeds into personalised medicine. Big data sets can help increase access to healthcare, clear COVID-19 backlogs and, with multi-centre collaborations, it can help reduce health inequalities across the UK and around the world. 

So, what part will this kind of technology play in the future of laryngology? Prof Nouraei believes that technology can extend the reach of subspecialist laryngologists and be a means of supporting allied health colleagues. With AI and big data, we can bridge the healthcare gap and offer more specialised services with less need for supervision. This technology can make specialist knowledge that takes years to acquire more accessible and inclusive.

 “The big driving force in the NHS, and probably healthcare worldwide, is to get the right person in the right place to see the right [clinician] in the shortest possible time.” Artificial Intelligence can go a long way towards making this a reality.

Contact Information
Visit www.britishlaryngological.org or download BLA Connect from your app store for further information and details on becoming a BLA member.
Email: enquiries@britishlaryngological.org for any questions or topic suggestions you may have for future episodes.
This show is brought to you by the BLA, you can follow us on  Twitter, Facebook, Linkedin and Instagram hosted by Natalie Watson @surgeonsinger produced and directed by Heather Pownall of Heather's Media Hub Ltd. 

Cutting Edge Laryngology 2022 is coming on the 22-23 September 2022, showcasing the latest advances in our field. In this special episode of the podcast Natalie meets with Associate Honorary Treasurer of the BLA, Chadwan Al Yaghchi, to discuss the programme and the topics they are looking forward to hearing about: from dysphagia to airway management, speech and language therapy to COVID sequelae, paediatric services to airway management – Cutting Edge Laryngology has it covered! Chad and Natalie are particularly excited about the keynote lectures from President of the Union of the European Phoniatricians and the Finnish Laryngological Society, Ahmed Geneid, on office based laryngology, and President of Dysphagia Research Society, Jacqueline Allen, on negotiating laryngological uncertainty. 
This year the conference will be held virtually, meaning that the panel of experts can be truly global. Alongside Ahmed from Finland and Jacqui from New Zealand will be other international speakers, including Farzaneh Ahmadi from Western Sydney University, presenting her bionic voice prosthesis for the first time in the UK, Craig Derkay, possibly the father of RRP new therapeutics, from Eastern Virginia Medical School, and long-standing friend and supporter of the BLA, Marshall Smith from the University of Utah.
Attendees will be active participants with the chance to ask questions and participate in panel discussions and enjoy live poster sessions featuring slides and a presentation. An added benefit of the virtual format is the opportunity for those who can’t be there on the day to register and watch high quality recordings of the full programme in their own time. 
Cutting Edge Laryngology is a multidisciplinary and interdisciplinary meeting and will appeal to any health professionals with an interest in laryngology. To register go to https://www.laryngologyconference.com/

Contact Information
Visit www.britishlaryngological.org or download BLA Connect from your app store for further information and details on becoming a BLA member.
Email: enquiries@britishlaryngological.org for any questions or topic suggestions you may have for future episodes.
This show is brought to you by the BLA, you can follow us on  Twitter, Facebook, Linkedin and Instagram hosted by Natalie Watson @surgeonsinger produced and directed by Heather Pownall of Heather's Media Hub Ltd. 

In this episode of A Clear Voice, we speak with Dr Aaron Johnson about age-related changes to the larynx. Following a decade-long career as a professional classical singer and singing teacher, Dr Johnson trained to be a Speech and Language Pathologist. He now works at NYU Langone’s Voice Centre and researches the effects of vocal training, voice use and ageing on the muscles of the larynx.
We start by looking at the ageing process of the voice – how this differs for males and females related to hormonal changes and how other age-related changes to the body affect our voice. Dr Johnson then shares his experience as a singing teacher working with the ageing voice and how his own preconceptions were challenged as he saw first-hand the effect of vocal exercise on the ageing voice. This experience has made him passionate about sharing the message that getting older doesn't have to mean the inevitable decline of voice function and that there is something you can do about it. Likewise, he urges clinicians to not make assumptions about patients, as a lot can be done for the ageing voice to strengthen and improve function.
We discuss some of Dr Johnson’s recommended interventions and exercises based on his research into neuromuscular changes in the larynx as it ages. He shares his take on the most effective form of vocal exercise, focussing on endurance and intensity. He also emphasises the importance of ensuring that the voice remains active and in regular use as we age; “If you don't use it, you lose it.” 
Voice remains an important interdisciplinary, multidisciplinary field, and clear clinical and surgical interventions are also needed to improve muscle function and make this kind of exercise possible, and we touch on some of the established and emerging areas of treatment. 
In closing, Dr Johnson focuses on advocacy and the need to make people aware that voice doctors like him are out there and able to provide real support and improvement for those suffering from voice problems.

Further information:
Singing Through Change by Nancy Bos, Joanne Bozeman and Cate Frazier-Neely – looking at the singing voice in women going through menopause
https://singingthroughchange.com/ 
Lee Silverman Voice Treatment (LSVT) – an intensive voice therapy for individuals with Parkinson’s disease and other neurological conditions which affect voice.
https://www.slt.co.uk/speech-language-and-communication/one-to-one-therapy/lee-silverman-voice-treatment/ 
Phonation Resistance Training Exercises (PhoRTE) – a high-intensity voice therapy program designed specifically for pathologic age-related voice changes. https://phorte.org/ 
Encore Creativity for Older Adults – Choral organization for adults 55 years of age and older with ensembles around the United States. https://encorecreativity.org/ 
For more information about Dr. Aaron Johnson, please visit http://voicescientist.com/
Contact Information
Visit www.britishlaryngological.org 
Email: enquiries@britishlaryngological.org for any questions or topic suggestions you may have for future episodes.
This show is brought to you by the BLA,  hosted by Natalie Watson @surgeonsinger produced and directed by Heather Pownall of Heather's Media Hub Ltd. 
 

In this very special episode, Natalie Watson is joined by Charlie Harper to tell us his personal experience of airway stenosis. Charlie shares his advice to other patients going through similar experiences, as well as his incredibly valuable thoughts on how we as healthcare professionals can do better for our patients.
After experiencing severe symptoms including nosebleeds, deafness and breathing difficulties, Charlie was diagnosed with granulomatosis with polyangiitis (GPA) in 2019. As the benefits of successive dilation surgeries reduced, he required an emergency tracheostomy – an experience which Charlie describes as devastating in its impact on day-to-day life, and perhaps not sufficiently acknowledged as such by healthcare professionals. Charlie was eventually referred to a hospital in London, where, very unusually, he underwent two laryngeal tracheal resections, following a second stenosis after the first procedure, caused by his tracheostomy. Whilst all of this was happening, healthcare services and all our daily lives were changed beyond recognition by the start of the Covid-19 pandemic. And Charlie’s personal life was also changed forever by the birth of his daughter – an experience which was massively impacted by his health issues, which meant he was unable to be present at the birth in the way he would have wished, or even to hold his newborn daughter.
In his advice to other patients in similar circumstances, Charlie explains the importance of a positive outlook and surrendering oneself to the process. He emphasises the key role of psychological support in adapting to life changing diagnoses and treatments, and believes that professional help in this area should be available to all patients. He also has some excellent suggestions for improving care and support pathways for tracheostomy patients and shares his views on how essential it is for different specialties to work together. Lastly, Charlie gives us clinicians a striking reminder that what is routine to us is often life changing for patients, and we must try to remember this in our interactions.
Charlie leaves us with the lighter side of his story, sharing some funny anecdotes and a heartfelt thanks to his wife for her support and love. This episode is truly essential listening for both patients and clinicians. We hope you enjoy it.

Contact Information
Visit www.britishlaryngological.org or download BLA Connect from your app store for further information and details on becoming a BLA member.
Email: enquiries@britishlaryngological.org for any questions or topic suggestions you may have for future episodes.
This show is brought to you by the BLA, you can follow us on  Twitter, Facebook, Linkedin and Instagram hosted by Natalie Watson @surgeonsinger produced and directed by Heather Pownall of Heather's Media Hub Ltd. 

Welcome to the latest episode of BLA Connect, A Clear Voice, where we join host, Natalie Watson and Mr James O’Hara, Clinical Senior Lecturer at Newcastle University and Honorary Consultant Otolaryngologist at Newcastle-upon-Tyne Hospitals, to talk about a topic that is incredibly common in the laryngology clinic – persistent throat symptoms.
James and Natalie discuss the many and varied causes of an irritated larynx and persistent throat symptoms, and the historic low-level of evidence for standard treatments such as proton pump inhibitors. The results of the TOPPITS (Trial of Proton Pump Inhibitors) run by James O’Hara with Prof Janet Wilson showed that these were no more effective than placebo treatment. So where does that leave us? Treatment is moving towards the use of alginates, such as Gaviscon, and James is involved in a new pre-clinical trial, (TALGITS – Trial of Alginates and Throat Symptoms) to look at the effectiveness of these in treating persistent throat symptoms and hopefully improve the management of these symptoms in primary care.
Ultimately, we all want to provide the best care for patients and providing a diagnosis or label for their symptoms can seem a good way of doing this. However, the lack of clear treatment pathway for persistent throat symptoms can lead to unnecessary worry with patients often referred to Head and Neck Cancer clinics. When we do see patients in clinic, James and Natalie emphasise the importance of letting the patient talk, being honest about the lack of evidence-based treatment in this area, considering comorbidities such as fibromyalgia and chronic pain symptoms, and discussing behavioural modifications and strategies for how patients can take ownership of and manage their own symptoms.
The take home message from this episode must be to always question and improve what we do for the patient’s benefit. 
Listen to previous episodes of this podcast from the podcast provider of your choice and on our BLA Connect App. If you have any suggestions for topics you would like to hear about or guests you want to hear from please do get in touch at enquiries@britishlaryngological.org. You can also support us by hitting Like, Subscribe or leaving a review for this podcast with your provider. Thank you for listening. 
Contact Information
Visit www.britishlaryngological.org or download BLA Connect from your app store for further information and details on becoming a BLA member.
Email: enquiries@britishlaryngological.org for any questions or topic suggestions you may have for future episodes.
This show is brought to you by the BLA, you can follow us on  Twitter, Facebook, Linkedin and Instagram hosted by Natalie Watson @surgeonsinger produced and directed by Heather Pownall of Heather's Media Hub Ltd.