FAQs

Do you have any coordinators who can make arrangements for my medical trip to Manila? Or can you introduce one to me?

We are sorry but you will need to make your own arrangements for your travel and hotel accommodation outside the clinic prior to surgery.

Can you arrange my flight ticket?

We do not offer this service at this time.

If there is no flight available on the day before my scheduled operation, can it be rescheduled?

Last minute rescheduling of an operation is not possible. Please check everything to make sure you will be able to get to the clinic in time before finalizing your date of surgery.

I am worried because I do not speak Filipino.

All our staff and doctors can communicate with you in English.

How long am I going to stay in the clinic?

Basically it is going to be a two-night/three-day stay or a three-night/four-day stay. Please note that vocal communication remains restricted after the discharge from the clinic for as long as one week after the operation. 

Do I need to arrange/bring a bedside attendant for the clinic stay?

No, you don’t.

One of my friends/ family members is planning to join my medical travel. Can he/she stay with me in the clinic?

We can accommodate only one person to accompany you during your stay in our clinic.

Can I check in the clinic earlier than the scheduled time if I arrive at the clinic unexpectedly early?

You should be admitted before 8:00 am and on fasting. Blood samples will be taken early in the morning.

Is it possible to arrange everything in one day – in other words, from the preoperative examination through the operation itself?

No, the preoperative examination is necessarily done one day before the operation. 

What would be the cost of the preoperative examination?

Pre-operative Examination is already included in the cost of the Surgery.

For the earliest operation available, how soon in advance can I schedule an appointment?

It depends on the vacancy in the schedule, which is constantly being updated. Please check with us through the Consultation Form.

Is the anesthesia general anesthesia?

In thyroplasty we use Local anesthesia so that we can check and adjust your voice during the operation.

Are there age criteria for the operation?

We can give throat operations to patients between the ages of 13 and 75 in general.

Who will perform my operation?

Dr. Espina and Dra. Quinto are the operating doctors. 

What's ISSHIKI Method?

 [PDF] Surgical tips for type2 thyroplasty for adductor spasmodic dysphonia: Acta Oto-Laryngologica 2010 (898KB) 

How can I have follow-up checkups after the operation?

We will check with you at intervals of 1, 3, 6 and 12 months after the operation through email and Zoom/Google online consultations. You can come back for a direct examination if the condition requires.

What should I be careful about after the operation?

Since you cannot speak for a week after the operation (it is called ‘silence therapy’), the most critical thing is to schedule your operation for a time when you can afford such a week.

I would like to travel around Manila after the operation. Are there things that I should be careful about?

Nothing, other than refraining from speaking for seven days. That is the only major thing. Please see the Postoperative Patient Guide for details.

Can I have the follow-up checkups in a hospital/clinic in my country?

Taking out the stitches after a week can be done by your primary doctor. Or, if you like, we can provide a buried suture that does not need to be removed.

What is the normal length of complete recovery?

The recovery is around 3 months.

Are there limitations after the recovery period, such as no shouting, coughing, limited voice use due to fatigue, etc?

You should keep completely silent up to 7 days after the surgery. You should talk softly for the first month after surgery.

If you think the thyroplasty surgery are unsatisfactory, are there risks for any permanent damage from a consequent surgery that reverses the procedure?

If you are not satisfied with the result, we can reverse your larynx modification procedure by removing the titanium bridges. You might sense a slight difference even after the removal of the bridges.

How long do the titanium bridges last?

Permanently. There is very little possibility of their collapsing.

What is the chance of a titanium bridge dislocating and failing?

We have had no such experiences.

Are there any long term side effects from the surgery - hoarseness, high-pitched voice, swallowing difficulty, etc?

Some patients feel some hoarseness where they once spoke more easily. Few patients feel swallowing difficulties after surgery. All the patients' voices are slightly changed to a higher pitch.

How long does the scar last? Will it go away?

It depends on the patients. It tends to disappear more on those with darker skin.

Is there information regarding the cost and payment methods?

Please contact us for details of the cost.

Is the operation covered by my insurance? What are the conditions and terms that apply for insurance coverage?

Since it depends on your insurance provider’s policy, please ask your health insurance company to find out what is covered.

Does Type 2 thyroplasty surgery using a titanium bridge work well for patients who use their voice a lot?

Yes, most patients in vocally-intensive occupations improve enough to become comfortable in talking at work. However, some have experienced a feeling of fatigue after talking for a long time. This is observed more often in male patients, and some of them have had both ADSD and muscle tension dysphonia. Such patients need to modify their way of speaking.

So it is preferable for them, and all patients in general, to refrain from too much speaking at first, especially just after surgery. It seems that patients who slowly begin to use their voice after the operation are less likely to develop this fatigue. So again, we stress that you avoid sudden and extensive use of speech after the operation.

I have dietary restrictions for my religious practice/ for my allergies. Could you consider these restrictions to arrange my meals during the stay?

Yes, we can.

I have pre-existing conditions (such as diabetes, hypertension, etc)/ I have some medication I take regularly. Can I still have the operation?

Please bring all your routine medication and talk with your doctor at the initial examination. You can also consult with us before traveling to Manila through the online web inquiry system.

Is GID (gender identity disorder) covered by my insurance?

Again, this depends on your insurance company’s policy, so please consult with them.

Can you introduce me to a medical facility in which I can get a physical GID operation - the SRS (sex reassignment surgery)?

Sorry. We do not offer this service.

Is there any voice training that you recommend to practice after the operation?

We can offer you training sessions through Online consultations. Please ask us for details upon your admission.

Why does my voice cut out when I talk? 

This can also be caused by adductor spasmodic dysphonia, please refer to FAQ#2 for the possible causes.

Why is my voice hoarse? What causes a voice to become hoarse?

Voice hoarseness can be caused by the following:

• Secondary to a viral or bacterial infection causing the laryngeal mucosa to swell
• Acid reflux (laryngopharyngeal reflux)
• Secondary to mass lesion/s on the vocal cords
• Secondary to a complication after a neck surgery (e.g. thyroidectomy)
• Secondary to cardiac or pulmonary conditions that might impinge the recurrent laryngeal nerve as it courses through the aorta and pulmonary artery to the larynx. This impingement might cause left-sided vocal fold paralysis or paresis (weakness)

Why does my voice shake when I talk? I feel that my voice seems strangulated. 

You may be suffering from spasmodic dysphonia, specifically adductor spasmodic dysphonia (ADSD). ADSD is characterized by uncontrollable spasms of the vocal fold muscles. These sudden, involuntary movements interfere with the proper vibration of the vocal folds.

A shaky voice (sometimes described as a voice with tremors) can also be caused by muscle tension dystonia (MTD). This disorder causes themuscles around the larynx to tighten, causing it to work inefficiently. This results in a voice that sounds strangulated. Muscle tension dystonia is prevalent among 40-50-year old women

Why does my voice sound weak and breathy? 

A weak or breathy voice may be caused by spasmodic dysphonia, specifically abductor spasmodic dysphonia (ABSD).This form of spasmodic dysphonia is less common, the spasm causes your vocal folds to remain open, resulting in a weak and breathy voice. Some patients may describe this as a murmured or whispery voice. 

Why does my voice suddenly sound high/low-pitched?  

This can also be caused by adductor spasmodic dysphonia, please refer to FAQ#1 for the possible causes.

Why does my voice cut out when I talk? 

This can also be caused by adductor spasmodic dysphonia, please refer to FAQ#2 for the possible causes.

Why does my voice crack? Is it normal for a voice to crack even for females? 

A voice can crack due to the reasons enumerated in #1. This can also be caused by spasmodic dysphonia, please refer to #s 2 and 3.

Is having a sore throat serious? Is it a symptom of COVID? 

Yes, it is one of the common symptoms of COVID 19. But it doesn’t mean that if your throat is sore, you already have COVID.

What kind of doctor treats spasmodic dysphonia?  

If you feel that you may have spasmodic dysphonia, it is best to consult with an ENT-HNS doctor, specifically a laryngologist who is trained to assess/diagnose spasmodic dysphonia.

Not all ENT-HNS specialists are aware of spasmodic dysphonia or trained to identify this condition. As a result, SD patients can be misdiagnosed if not seen by an ENT or laryngologist who have hands-on experience in correcting this condition.

What should I expect when I visit a voice doctor for spasmodic dysphonia? 

You would expect a thorough history-taking and physical examination by the laryngologist. Additional procedures such as videostroboscopy will be performed for anatomical assessment. Videostroboscopy is a technique wherein the doctor gently inserts a thin flexible tube attached to a video camera through the nose and into the back of the patient’s mouth to visualize your vocal cords.

How is SD diagnosed? What are the possible treatments? 

 SD is diagnosed by a trained ear. It should be taken into consideration that not all ENT-HNS are exposed to this condition since cases are limited or at least overlooked, hence there is a large margin that is misdiagnosed.

There are some videostroboscopic findings which suggest SD that can lead to a high index of suspicion for the diagnosis.

What are the possible treatments of spasmodic dysphonia? 

Currently, these are the available treatments for spasmodic dysphonia in the Philippines:

• Temporary – Botox (ADSD)
• Permanent – Type 2 thyroplasty (ADSD) or lateralization
• For ABSD (difficult to treat, we might do further assessment)

How much does surgery for spasmodic dysphonia in the Philippines cost?

The cost of spasmodic dysphonia thyroplasty in the Philippines varies due to a number of factors. Please call  0917 637 5588 for further information. 

I am transgender, can a doctor make my voice sound more female/male?   

Technically yes, we just have to assess your voice first (voice analysis) to know if the said range that you are aiming for is feasible.

What is the procedure for a voice change? Is this available in the Philippines? 

Voice change procedure from female to male is known as Type 3 thyroplasty. Voice change procedure from male to female is Type 4 thyroplasty. Both voice change procedures can be performed at IMVC Manila.

How much does voice feminization/ voice masculinization cost in the Philippines? 

The cost of voice feminization or voice masculinization in the Philippines varies due to a number of factors. Please call 0917 637 5588 for further information.

My voice became permanently hoarse after my thyroidectomy. Can you fix it? 

Yes. There is a big possibility that your laryngeal nerve was severed during the procedure. This caused your true vocal cords to be paralyzed. This can be corrected with medialization or Thyroplasty Type 1.