Voice Feminization for Transgender Women

There are an estimated 1.4 million adults across the country who identify as transgender, according to recent reports. That means that nearly 0.6 percent of the adult population share – to some capacity – the struggle to transition their voice to match the gender with which they identify.

But why is this such an important issue?

The sound of the human voice plays an incredibly important role in our identity, which is why vocal transition is so important in the lives of transgender men and women. However, many transgender men and women are not able to properly transition their voice from male to female or female to male due to underlying or undiagnosed medical conditions.

So where can you go to for help?  Where do you even start?

Here is one fabulous resource…

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Colorado Surgical Team Leads the Country in Innovative Tech for Transoral Robotic Surgery

Presbyterian/St. Luke’s Medrobotics Flex(R) System robot is the first system from Medrobotics West of the Mississippi and is the first training center for Medrobotics for laryngeal robotic surgery in the world.

Innovation in tech is always exciting. We line up for the latest releases in mobile technology and dedicate countless pages of internet content to invention, innovation and progress in tech – but nothing touches and changes lives more than advancements in medicine.

And innovation in medical technology means far more than better picture quality or speed. It means that people are building and evolving machines that help save and improve the quality of human lives – and one of the most exciting revolutions in medical technology is happening right in our own backyard. The surgical team at Presbyterian/St. Luke’s Medical Center in Denver, Colorado has already started to change lives with the acquisition of the Medrobotics Flex®Robotic System – the only system of its kind West of the Mississippi and the only system being used for transoral robotic surgery and laryngeal operations.

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Transoral Robotic Surgery in Denver Colorado

Transoral Robotic Surgery – The future of robotics is limitless

The surgical treatment of cancer is difficult even in the best of circumstances, but when you combine the additional obstacle of operating in small spaces such as the throat, tongue or tonsils – surgery can be extremely challenging.

What makes these particular procedures so challenging is the small, confined nature of the anatomy of our mouth and throat that are both difficult to see and get to. Due to the nature of this particularly tricky part of our anatomy, surgeries are typically invasive – requiring long recovery times and an increased risk of complications.

Throat Surgery

Luckily, there have been tremendous strides in surgical robotics technology that are making surgeries minimally invasive and highly effective – particularly the advancements in transoral robotic surgery.

Transoral Robotic Surgery (TORS)

Transoral robotic surgery (TORS) is a procedure to remove oral cancers in which a surgeon uses a sophisticated, computer-enhanced system to guide the surgical tools using an enhanced view of the cancer and surrounding tissue. Using a robotic system to guide the surgical tools allows for more-precise movements in tiny spaces and the capability to work around corners.3

New robotics systems are able to use sophisticated, guided endoscopes that can provide the surgeon with high resolution three-dimensional image of the back of the mouth and throat – the same areas previously very difficult area to both reach and visualize without these tools. The system then allows for two robotically-guided instruments to act as a surgeon’s arms, helping to make it much easier to operate in these difficult-to-reach areas.

The Benefits

Traditionally, these types of surgeries require large incisions through the neck and sometimes opening the bottom jaw, resulting in long hospital stays, painful rehabilitation and complications that can include difficulty swallowing, decrease or loss of speaking ability and sleep apnea.

Surgical centers like Presbyterian/St Luke’s in Denver, Colorado are a leading the way in robotic surgery techniques that help eliminate some of the challenges and complications from invasive surgeries, particularly in laryngeal surgery.

PSLs Robotics program, led in laryngeal surgery by Dr. David A Opperman, is home to the latest in transoral robotic surgery technology for ear, nose and throat head and neck surgery. The program’s Medrobotics Flex(R) System robot is the first system from Medrobotics West of the Mississippi and is the first training center for Medrobotics for laryngeal robotic surgery in the world.

“The Flex® Robotic System gives physicians the ability to access anatomical locations that were previously difficult or impossible to reach minimally invasively.  And because it is affordable and efficient, the Flex® Robotic System allows hospitals to expand the patient population that they serve and improve the productivity of their facilities.”2

Robotic surgery applied in the field of otolaryngology allows for surgeons to see better, which means they can be more precise and ultimately, produce better outcomes for patients in treatment for common head and neck pathology, including benign and malignant disease, treatment for sleep apnea, and common laryngeal procedures that include:

  • Tonsillectomy
  • Radical tonsillectomy
  • Uvulopalatopharyngoplasty (UPPP) for sleep apnea
  • Tongue-base resection for sleep apnea
  • Tongue-base tumor resections
  • Parapharyngeal space tumor resections
  • Supraglottic laryngectomy
  • Subglottic stenosis excision and repair
  • Treatment of laryngeal papillomas

Dr David A Opperman, the first fellowship-trained laryngeal surgeon trained in the Medrobotics system, says:

 We are able to visualize tumors and pathology more completely, plan dissections more precisely, and with the optics capability and 3D systems that are now available, we can make more precise cuts and spare more healthy tissue in the resection of malignant disease.

The advancements in transoral robotic surgery not only help with navigating the difficult surgical procedures, but also allow surgeons to correct or prevent scarring and offer treatment options for abnormalities that would otherwise be impossible to treat. 

The future of robotics is limitless. The machines are getting smaller and the instruments more precise. We are able to access tumors that we used to approach outside-in, in an inside-out approach, allowing us to solve issues with cosmetic deformities and lowering overall morbidity and mortality. This leads to better outcomes, shorter hospital stays, faster recoveries, and less pain. All because of robotic technology.

More procedures using transoral robotic technology are being discovered every day.


Flex® Robotic System: Expanding the reach of surgery®

The system being put to use by surgical teams around the country, including the team at PSL, is an incredible step forward in surgical tech.  The main advantages to the system are that it allows surgeons to visualize the anatomy using magnified HD views not possible with other minimally invasive procedures, reach more by navigating a nearly 180 degree path to reach challenging surgical targets and treat more patients by being able to overcome the limitations of straight surgical tools.2

The Future

The future looks incredibly bright in the field of robotics and we can’t wait to see what is next. Keep an eye on the blog for more on the ever-changing world of robotics in the healthcare industry.

If you have questions about these procedures or any questions involving ear, nose, or throat conditions please contact your local physician. If you live in Colorado, you can get in touch with Dr. David A Opperman by visiting ColoradoVoiceClinic.com.

Colorado_Voic_Clinic_ent_doctor_opperman_dave_dr_doctors in colorado_healthone_surgeon_porter_specialist_throat_vocal_health_condition_treatment_hearing_loss_acid reflux_lost voice_hoarse_denver_aeg_singer_reconstruction_botox_medical_recommended

1. Presbyterian/St. Luke’s Center for Robotic Surgery
2. Medrobotics.com
3. Mayo Clinic – Transoral Robotic Surgery for Oral Cancer
4. Dr. David A Opperman, Colorado Voice Clinic & Presbyterian/St.Luke’s
CU Football Announcer Larry Zimmer Rehab

University of Colorado Announcer’s Rehabilitation – (via The Denver Post)

CU Buffs announcer Larry Zimmer’s hospitalization and rehabilitation timeline

Updated:   09/13/2015 09:56:25 AM MDT

A timeline of Larry Zimmer’s hospitalization and rehabilitation:

Oct. 4: Zimmer collapses at his home on Lookout Mountain and is rushed by ambulance to St. Anthony Hospital in Lakewood. He remains in intensive care for five days.

Oct. 9: Showing improvement, Zimmer is moved to the general population of the hospital. He is able to talk and walk. Soon he will lose the ability to do both.

Oct. 14: Doctors determine he is aspirating, causing food and drink to enter his lungs. Blood clots are diagnosed in his right arm because of the “pick line” used to administer drugs. It is removed. Breathing has become difficult. A tube is inserted to help him breathe, and he has surgery to insert a feeding tube into his stomach. He will not eat again until January.

WATCH:VIDEO: Legendary CU Buffs announcer Larry Zimmer overcomes illness

Oct. 22: Zimmer is diagnosed with a lung infection and moved back to ICU, in critical condition. The infection will worsen, and he will soon be wearing an oxygen mask 24 hours a day. He also has a hematoma on his vocal cords.

Oct. 25: A tracheotomy is performed. Blood clots remain a concern, and Zimmer is losing blood, probably because of blood thinners.

Nov. 2: Zimmer is given a blood transfusion.

Nov. 7: Zimmer’s condition has improved and he is transferred to Select Specialty Hospital, a long-term acute care facility located at Porter Hospital. In his first days there, he is examined by a team of doctors, including David Opperman, who says the hematoma on Zimmer’s vocal cords has healed but the left cord is paralyzed. He is confident he can bring back Zimmer’s voice, but he can’t begin treatments until Zimmer is off the ventilator. That comes two weeks later.

Nov. 20: Opperman administers the first of three injections into the paralyzed left vocal cord designed to move it into a position where it can come in contact with the other vocal cord and create speech — a temporary fix until the cord regains function on its own. Therapy is begun to help with swallowing. Shortly after, Zimmer takes the first “swallow test” and does not pass. The vocal cords are not functioning in the swallowing process, and the epiglottis is not functioning correctly.

Nov. 26: Another setback as a staph infection is detected in the lungs. Antibiotic treatment is begun.

Dec. 5: Breathing has improved to the point where the tracheotomy tube can be removed.

Dec. 10: Zimmer is moved to PowerBack Rehabilitation in Lakewood, still unable to eat or drink. Therapy will include speech, physical therapy (to learn again to sit, stand and walk) and occupational therapy designed to help in skills such as using the toilet, taking a shower and getting dressed. That night Zimmer experiences severe pain in his right leg and is given pain medication.

Dec. 11: Dr. Christine Wildeman (then PowerBack’s medical director) is concerned about the leg pain but is more concerned about what appears to be a deterioration of Zimmer’s condition.

Dec. 12: Leg pain continues, and Wildeman determines Zimmer is “bleeding out.” He is taken by ambulance back to the St. Anthony emergency room for a blood transfusion and is admitted to ICU. A scan shows internal bleeding and a hematoma in the leg. Zimmer will receive four units of blood over two days.

Dec. 17: A neurological exam of the right leg shows pressure from the hematoma apparently injured a major nerve and the nerves in the leg went dormant. It shows the nerves are not dead, however, and feeling probably will return eventually. While at St. Anthony’s, speech therapy is continued, and a second swallow test is given. Zimmer fails.

Dec. 20: Zimmer returns to PowerBack.

Jan. 8: Opperman administers the second injection to the left vocal cord. Speech therapy continues to strengthen throat muscles so Zimmer can pass the swallow test and be allowed to eat and drink.

Jan. 9: Zimmer’s physical condition has advanced so he can sit up in bed, and he works with a device that allows him to stand for the first time. He takes his first steps since collapsing, walking a few feet with a walker.

Jan. 15: Zimmer finally passes the third swallow test, and is cleared to eat food and to drink for the first time since October. His first meal is what was available for lunch that day at PowerBack: a pulled pork sandwich and tater tots.

Jan. 27: Zimmer is able to walk from his room to the lobby with the walker and works on an anti-gravity treadmill.

Feb. 8: Zimmer is able to walk up and down stairs and get in and out of the car.

Feb. 19: Zimmer receives the third and final injection into the left vocal cord.

Feb. 20: Zimmer returns home for the first time in 139 days since he collapsed Oct. 4. Home physical therapy begins.

March 30: Outpatient physical therapy begins at Layne Physical Therapy in Golden with therapist Peggy Coit. Sessions are twice weekly, and Zimmer progresses from walking with the walker to walking with a cane, and finally to walking without aid.

April 8: An exam by Opperman indicates another injection is unnecessary because the left vocal cord has begun to function on its own (about 10 percent of normal). This is a major turning point.

May 7: Opperman determines the vocal cords are working normally, and surgery will not be necessary.

May 11: Weekly speech therapy sessions begin with Kathe Perez.

July 2: Zimmer and CU announce he will return to the broadcast booth in the fall.

Sept. 12: Zimmer returns to the broadcast booth as CU hosts Massachusetts.

John Meyer, The Denver Post

Original article from the Denver Post: http://www.denverpost.com/colleges/ci_28802555/timeline-larry-zimmers-hospitalization-and-rehabilitation

Contact the Colorado Voice Clinic at http://ColoradoVoiceClinic.com

Sam Smith To Undergo Vocal Surgery – “Dreading Next Month”

British vocalist and multiple Grammy-winner Sam Smith has been scheduled for surgery to repair a vocal hemorrhage. Smith’s camp announced that he will undergo microlaryngoscopy surgery in eight weeks, which also meant cancelling a handful of performance dates in Japan, France, and the Philippines.

Sam Smith Schedules Surgery for Damaged Vocals

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Via ImThera Medical:

November 10, 2014

ImThera Medical, Inc. Receives FDA Approval for Pivotal Study for Obstructive Sleep Apnea Device

THN3 Study Will Expand the Clinical Evidence for this Novel Neurostimulation Therapy for Moderate to Severe Obstructive Sleep Apnea


SAN DIEGO, CA November 10, 2014

ImThera Medical, Inc., a privately held global medical device company, today announced that the U.S. Food and Drug Administration (FDA) has approved an investigational device exemption (IDE) for its THN3 Clinical Study. The THN3 Study will evaluate the safety and effectiveness of the aura6000® System for moderate to severe obstructive sleep apnea (OSA) in individuals who are unable to comply or unwilling to try PAP therapy or other OSA treatments. Data from this pivotal clinical study will be used to support a Pre-Market Approval (PMA) application for the aura6000 System.

“This is the most exciting innovation for the treatment of sleep apnea since CPAP,” said Michael Friedman, M.D., Professor of Otolaryngology and director of Chicago Sleep Center at Rush University Medical Center, Chicago IL and a study investigator. “I have had experience implanting the device during the earlier THN2 study. It is an easy and safe procedure to perform.”

Sponsored by ImThera Medical, the THN3 Study (Targeted Hypoglossal Neurostimulation Study #3) is a randomized, controlled, prospective, multi-center clinical trial. It is being conducted at leading medical centers in the United States and Europe. For more information on the THN3 Study visit http://www.THNStudy.com.

“This is a substantial milestone in the development of this technology,” said Alan Schwartz, M.D. Professor of Medicine and Medical Director, Johns Hopkins Sleep Disorders Center, Baltimore MD, principal investigator of the THN3 study, “We have seen very encouraging results from the earlier studies showing that most patients treated with the aura6000 System experienced significant improvements in their sleep apnea.”

“Millions of Americans are waiting for a solution for their obstructive sleep apnea,” said Marcelo Lima, President and CEO at ImThera Medical, “The approval of this study brings us one critical step closer to being able to make this novel device available to those patients.”

About ImThera Medical and the aura6000 System

The aura6000 System is based on ImThera’s proprietary THN Sleep Therapy® technology. THN Sleep Therapy delivers neurostimulation to the hypoglossal nerve increasing muscle tone of multiple tongue muscles and preventing the tongue from collapsing into the upper airway during sleep. This innovative technology is designed to address nighttime upper airway blockage, permitting normal and restful sleep for OSA patients. “Essentially, the system keeps the tongue in an awake position while the patient sleeps,” explains Dr. Michael Friedman.

The system consists of two implantable components, a small rechargeable pulse generator placed under the skin near the collarbone, and a multi-electrode lead placed in the upper neck. The electrodes deliver mild pulses to the hypoglossal nerve, stimulating various muscles and thereby increasing upper airway flow during sleep.

In November 2012, the aura6000 System was awarded the Golden Electrode Award for Best New Product. The aura6000 System has received the CE Mark, and is commercially available in select markets outside the United States. Within the United States it is only available to participants in this study.

About ImThera Medical, Inc.

San Diego-based ImThera Medical is a privately held company and a global leader in neurostimulation for the treatment of Obstructive Sleep Apnea (OSA). For more information, visit http://www.ImTheraMedical.com.

About OSA

OSA is characterized by repetitive episodes of respiratory arrest despite continuing breathing efforts. More than one million Americans are diagnosed annually with OSA. As many as 28 million Americans may suffer from OSA and only approximately 25 percent of this population is receiving treatment today.

While OSA is readily treated with continuous positive airway pressure therapy (CPAP), studies show that CPAP is a cumbersome treatment, and between 30-60% percent of patients cannot or will not comply with CPAP.

For more information on the THN3 Study visit http://www.THNStudy.com.

CAUTION: Investigational device. Limited by United States law to investigational use.


ImThera, aura6000, and THN Sleep Therapy are registered trademarks, and THN is a trademark of ImThera Medical, Inc.

© ImThera Medical, Inc. 2014 All rights reserved.

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From the Hearing Journal – New hearing conservation initiatives: Small steps with great potential

professional-voice-blog-colorad-voice-clinic-hearing-study-decibel-effects-hearing loss-concert-sound-Dr. Dave Opperman-study-research-noice-ENT doctors in colorado-ENT doctors in Denver-specialist-ear-nose-throat-otolaryngology-health-hospitalSara Bloom of The Hearing Journal discusses new hearing conservation initiatives, including research on the effects of noise levels on children and concertgoers.

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