Throat and thyroid disorders encompass conditions affecting the throat, voice box, and thyroid gland, such as vocal cord nodules, thyroid nodules, or throat cancer. MOSA can diagnose and manage these disorders using various techniques, including vocal cord injections, thyroid ultrasound-guided biopsies, or surgical procedures like thyroidectomy or laryngectomy, with a focus on preserving voice function and overall health.

The thyroid conditions that we treat at MOSA are mainly surgical thyroid problems, such as nodules, masses and tumors. If your thyroid hormones are off you should see an endocrinologist. If you have a nodule on your thyroid gland we normally order an ultrasound to see how big it is and what it looks like. If it’s bigger than 10mm it should be fine needle biopsied under ultrasound guidance. If the result is showing a benign mass (most common nodule is called colloid), we typically do not recommend surgery.

These benign nodules should only be removed (hemithyreoidectomy) if they cause symptoms, like pressure or breathing/swallowing problems. A good way to monitor these benign nodules are with regular ultrasound examinations. If the needle biopsy is questionable or malignant you will need a total thyreoidectomy and sometimes additional radioactive iodine treatment. If the entire gland is removed you will need life long thyroid medication, such as Synthroid. After thyroid surgery our patients often have a drain and stay in the hospital overnight to make sure there is no bleeding or swelling. The risk for hoarseness afterwards is roughly 1%, and can always be handled to restore the voice.

The salivary glands include the parotid glands which are situated in front of the ear, the submandibular glands located under the jaw line, and the sublingual gland which are found along the floor of the mouth under the tongue. Scattered  throughout the cheeks, lips, and palate are minor salivary glands. Fortunately the majority of salivary gland tumors are benign. The most common location for salivary gland tumors is the parotid gland. Salivary gland tumors do not vary in size with meals; salivary gland or salivary duct stone will present with swelling during meal time due obstruction of salivary flow. Salivary gland tumors tend to enlarge slowly and painlessly. Rapidly enlarging, painful tumors may be an infection or may be a cancer.  Any salivary gland swelling should be evaluated by an otolaryngologist; this may involve imaging studies (CT or ultrasound) or a biopsy (fine needle aspiration). If a tumor is identified your surgeon will recommend removal of the salivary gland (ie, parotidectomy) and if in cases of malignancy removal of lymph nodes in the area. Salivary gland stones are treated differently (see below)

Salivary gland stones occur most commonly in the submandibular gland and duct. The stones are like small pearls that form over many years due to deposition of calcium and phosphate in the ducts that drain saliva from the gland. When the stones become large enough, they block the flow of saliva and cause painful swelling of the salivary gland during meals. In many cases the stones may pass on their own, however in some cases the duct may be too small to allow passage of the stone(s). There are three techniques to remove stones:

  • Dilation of the duct opening
    • This can often be performed in the office with local anesthesia.
  • Sialoendoscopy
    • With the patient under general anesthesia, a small scope is inserted in to the duct and the stone is removed using a small retrieval basket. If the stone is not too big (less than 3-5 mm), this technique works well.
    • For patients with a history of recurrent salivary gland swelling without stones, narrowing of the ducts due to scarring is the problem. These areas of narrowing (stenosis) can be dilated with balloons using a technique similar to angioplasty for patients with heart disease. Salivary duct stenosis is often found in patients who have undergone external radiation therapy or radioactive iodine therapy following treatment of thyroid cancer. In many cases there may be no known cause for the stenosis, though it seems to be more common in women after menopause.
  • Removal of the gland
    • For large stones unable to be removed using sialoendoscopy, removal of the salivary gland is the final option. Removal of the parotid gland or submandibular gland is performed under general anesthesia and requires an overnight stay in the hospital.

Recurrent salivary gland swelling, often due to conditions such as sialadenitis or salivary stones, can cause discomfort and recurrent infections. Treatment options by an ENT specialist may include conservative measures such as hydration, warm compresses, and gland massage to promote salivary flow and alleviate symptoms. In cases of persistent or severe swelling, minimally invasive procedures such as sialoendoscopy may be recommended to visualize and remove salivary stones or debris obstructing the ducts, thereby relieving symptoms and reducing the risk of recurrence.

Minimally invasive sialoendoscopy is a specialized procedure performed by an ENT specialist to diagnose and treat conditions affecting the salivary glands, such as sialolithiasis (salivary stones) or strictures. During the procedure, a small, flexible endoscope with a camera is inserted into the salivary duct to visualize the gland and identify any obstructions or abnormalities. Treatment options may include removing salivary stones using micro-instruments or laser lithotripsy, dilating strictures, or irrigating the ducts to clear blockages, ultimately restoring normal salivary gland function and alleviating symptoms such as pain, swelling, and infection.

Esophageal dilation is a therapeutic procedure performed by an ENT specialist to widen a narrowed or obstructed esophagus, often due to conditions such as esophageal strictures, Schatzki’s rings, or eosinophilic esophagitis. During the procedure, a specialized dilator or balloon catheter is inserted into the esophagus and gently inflated to stretch and widen the narrowed area. This helps improve swallowing function, alleviate symptoms such as dysphagia or food impaction, and reduce the risk of complications such as aspiration pneumonia. Esophageal dilation is typically performed under sedation or anesthesia in a controlled medical setting and may require multiple sessions for optimal results.

Zenker’s diverticulum is a pouch or outpouching that forms in the upper part of the esophagus, often causing symptoms such as dysphagia, regurgitation, or halitosis. Treatment options by an ENT specialist may include conservative measures such as dietary modifications, swallowing therapy, or lifestyle changes to manage symptoms. However, in cases of persistent or severe symptoms, surgical intervention such as endoscopic diverticulotomy or open surgical repair may be recommended to remove the diverticulum and restore normal esophageal anatomy and function, ultimately improving swallowing function and quality of life for the patient.

Multidisciplinary Approach to Throat Cancer

A multidisciplinary approach to throat cancer involves the coordinated efforts of a diverse team of healthcare professionals from different specialties, working collaboratively to provide comprehensive care and support to patients diagnosed with throat cancer. This team typically includes Ear, Nose, and Throat (ENT) specialists, medical oncologists, radiation oncologists, pathologists, radiologists, speech therapists, dietitians, and social workers, among others. Each member of the multidisciplinary team brings unique expertise and perspectives to the table, allowing for personalized treatment plans that address the complex needs of the patient. The multidisciplinary approach to throat cancer care may involve various treatment modalities such as surgery, chemotherapy, radiation therapy, immunotherapy, and supportive care interventions, with the goal of achieving optimal outcomes while minimizing side effects and maximizing quality of life for the patient. Regular multidisciplinary team meetings and discussions ensure ongoing communication and coordination of care, allowing for timely adjustments to treatment plans based on the patient’s response and evolving needs. Overall, the multidisciplinary approach to throat cancer emphasizes a patient-centered approach that prioritizes collaboration, expertise, and comprehensive care to achieve the best possible outcomes for patients.

The Head and Neck Cancer Program at MOSA and Ascension Health participates in CCOP, which is a national organization, in order to stream-line treatment and management of these cancers.

Transoral Laser Microsurgery (TLM) was first introduced in the 70s when the CO2 laser was developed for voice box cancer. Over the following decades TLM has grown into a subspecialty that offers tremendous advantages over traditional open surgery. TLM is performed by one thoroughly trained surgeon, with the laser  delivered via a high resolution microscope, down into the throat through metal tubes (endoscopes) that are designed to give the best possible visualization of the tumor. By using long, skinny precision instruments the surgeon can manipulate the tumor into positions where the laser can safely and extremely accurately cut it out. By removing the tumor from inside the patient¹s throat instead of cutting through the skin and the neck to get to it, as done in most cancer centers, TLM results in much less trauma to the tissue, less risk for swallowing and breathing difficulties afterwards and much better cosmetic outcome (no scars). TLM takes many years for a fellowship trained surgeon to master and it is therefore only offered in very few high quality centers. TLM of any size throat cancers is offered at St Joseph Mercy as the only hospital in the northern states, by Professor Jan Akervall, MD, PhD.

For people struggling with sleep apnea, sleep often seems like an insurmountable obstacle; instead of the refreshing and re-energizing interlude it is supposed to be, it leaves them fatigued and damages their overall health.

Dr. Paul T. Hoff, an ear, nose and throat surgeon with Michigan Otolaryngology Surgery Associates, is offering a high-tech solution to sleep apnea.

In fact, he is one of the first physicians to offer Trans-Oral Robotic Surgery (TORS) for the treatment of obstructive sleep apnea and has the largest experience in North America.

“TORS” expands the surgical options for the treatment of sleep apnea. TORS provides state-of-the-art 3-D imaging providing the surgeon with unparalleled visualization of the operative field and the ability to safely remove obstructive tissue from behind the tongue.

For patients who have attempted to utilize continuous positive airflow but cannot cope with wearing a mask at night, TORS could be a solution. Dr. Hoff is part of the St. Joseph Mercy Comprehensive Sleep Disorder Center offering a multidisciplinary approach to the treatment of sleep apnea.

Intensity-modulated radiation therapy (IMRT) is an advanced form of external beam radiation therapy used in the treatment of various cancers, including throat cancer. IMRT delivers highly targeted radiation beams to the tumor while minimizing exposure to surrounding healthy tissues and organs. This precision is achieved by modulating the intensity and shape of the radiation beams, allowing for customized dose distributions that conform closely to the shape of the tumor. By precisely targeting the cancerous cells while sparing nearby healthy tissues, IMRT can effectively destroy cancer cells while reducing the risk of side effects and complications. IMRT is often used as part of a multidisciplinary treatment approach for throat cancer, either as a primary treatment modality or in combination with surgery, chemotherapy, or other treatments, depending on the specific characteristics of the tumor and the patient’s individual needs.

The goal of modern Head and neck cancer treatment is not only to cure the disease but also to make sure normal functions and cosmesis are restored. If minimal invasive surgery can’t be done, major open head and neck cancer surgery has to be performed. In those rare cases there will be a need for comprehensive reconstructive surgery. The most common reconstructions are local or regional tissue flaps, where tissue is brought in from surrounding areas to cover the defect after the cancer surgery. If the defect is too large or in a difficult spot, a free flap might be needed. This consists of moving tissue that has been disconnected from one part of the body and moved to the surgical site. The most common free flap for head and neck reconstruction come from the left forearm. Skin, underlying tissue and vessels are moved in to the area where the tumor was removed and it’s sutured in to cover the defect and restore function (swallowing etc). The blood vessels will be connected to the vessels of the neck (micro-vascular surgery) to provide blood flow to the flap. These surgeries need a reconstructive team, lead by a plastic surgeon. Often the cancer surgeon and the plastic surgeon work at the same time to shorten

the operation, and still these procedures take a full day to complete.


Taking your first step towards better ENT health is easy. Contact us today to schedule an appointment. We look forward to providing you with exceptional care and helping you  achieve optimal ear, nose, and throat health