Research and Clinical Innovations in Laryngology at Johns Hopkins

Physician-researchers in the Division of Laryngology advance clinical research and practice — leading studies on retrograde cricopharyngeal dysfunction, gender-affirming voice care and more.

Published in HeadWay - HeadWay Winter 2023

Advancing Care for Retrograde Cricopharyngeal Dysfunction

Retrograde cricopharyngeal dysfunction — a condition that prevents easy belching or burping — leads to uncomfortable bloating, gurgling and chest pressure. Fortunately, dilation and botulinum toxin injection of the cricopharyngeus muscle can improve patients’ quality of life. However, research on this condition has only taken place in single-institution, retrospective case series, so questions about treatment approaches, botulinum toxin doses and side effects persist in the medical community. Lee Akst — laryngologist and director of the Johns Hopkins Voice Center — leads a national consortium of laryngologists at six academic medical centers that is studying retrograde cricopharyngeal dysfunction to advance patient care.

“I think we’re ready nationally for a multi-institutional, prospective study on this rare condition,” says Akst. “By combining our experiences, hopefully we’ll be able to answer questions about how best to treat retrograde cricopharyngeal dysfunction.”

Gender-Affirming Voice Care

The Department of Otolaryngology–Head and Neck Surgery partners with the Johns Hopkins Center for Transgender Health to offer gender-affirming voice care for patients who are gender diverse and transgender.

“Voice is an important aspect of gender expression,” says speech-language pathologist Ashley Davis. “Helping patients achieve a voice that aligns with their gender identity can be a critical part of their experience.”

Gender-affirming voice care may include speech-language therapy or behavioral modification, as well as surgical adjustments in vocal cord function, to help achieve a particular pitch range. Laryngologists Akst and Simon Best offer surgeries to help elevate fundamental frequency and procedures to help lower pitch, assisting patients with achieving voices they feel are more authentic to themselves.

Medical Therapy for Idiopathic Subglottic Stenosis

Idiopathic subglottic stenosis (iSGS) is a rare debilitating disease that exclusively affects women. Progressive scar tissue develops spontaneously and narrows the airway, severely limiting the ability to breathe and communicate. Treatment for iSGS is procedural, with the goal of increasing the airway diameter to improve breathing and the voice. Despite advances in understanding of laryngotracheal stenosis pathophysiology and outcomes, there is still an urgent need to improve approaches to treatment.

Johns Hopkins laryngologist Alexander Hillel, and clinical trials coordinator Sarah Collins and colleagues, are leading the first interventional trial for treatment of iSGS. The trial is designed to evaluate the safety of the drug everolimus for patients with iSGS, evidence of which may lead to a nationwide, phase II clinical trial to assess the drug’s effectiveness.

Developing New Treatment Paradigms for Obstructive Sleep Apnea

Johns Hopkins sleep and airway surgeon Kevin Motz and pulmonary sleep medicine colleague Luu Van Pham recently launched a one-of-a-kind, multidisciplinary clinic for patients with obstructive sleep apnea who are intolerant of continuous positive airway pressure therapy. The researchers are collaborating to pioneer treatment plans — surgical and nonsurgical — to provide relief for patients and mitigate risk.

For patients who meet criteria, part of the treatment approach includes use of hypoglossal nerve stimulation. Motz leads a research program and clinical trial aimed at improving outcomes for patients in therapy through advanced physiologic measurements of upper airway collapsibility.


To refer a patient, call 443-997-6467 or email [email protected]

A Direct Procedure for Eustachian Tube Dysfunction

Johns Hopkins head and neck surgeons perform new surgical technique offering viable alternative to tympanostomy tubes — Eustachian tuboplasty.

Image shows detail of internal ear canal, including connection to Eustachian tube.

Comprehensive Treatment of Laryngotracheal Stenosis

The Johns Hopkins Complex Airway Clinic comprehensively treats patients with laryngotracheal stenosis using a multidisciplinary approach—often necessary due to the severity and extent of scar tissue caused by the condition.

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Providing Comprehensive Gender-Affirming Care

Transgender individuals face a variety of disparities, with serious consequences. Few medical centers in the nation have the expertise to provide these patients with the surgical, endocrine and other care that many desperately need.

Melissa Noyes, Paula Neira, Devin O’Brien Coon, Jennifer Rice-Assenza