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Jose L. Ruiz, M.D.
Voice Disorders range from a mild laryngitis to severe life-threatening diseases that may require extensive treatments. To learn more click the link below. 

Dr. Ruiz located in Central Florida serving Kissimmee and Orlando, Florida is dedicated to the evaluation and treatment of hoarseness and acid reflux and to further the understanding of these conditions through education. 

Dr. Ruiz offers in-office screening, in Kissimmee, Florida without the need to be put to sleep, for Acid Reflux Disease, Vocal Fold Cancer and Esophageal Cancer by using the latest technology. 




There are many types of hoarseness or voice quality changes that if left untreated will limit one's ability to communicate effectively, cause a loss of income or lead to serious medical conditions.  To learn more click the link below.

Acid Reflux occurs when the tube that you uses to intake the food from the throat to stomach is not strong enough to handle the acid.  To learn more click the link below.

For more information, please
Or call 407-518-1810

"Dr. Ruiz took the time to listen to my problems and helped to get me back on my feet.  I can't thank him enough."
Hoarseness and Acid Reflux                                                                 Jose L. Ruiz, M.D.

Voice Disorders range from a mild laryngitis to severe life-threatening diseases that may require extensive treatments.

Some common signs of a voice disorder include:

Vocal fatigue
Breathy voice quality
Change in pitch range of the voice
Excessive coughing
Excessive throat clearing
Change in voice after a cold or flu

Bowed Vocal Chords
Bowed Vocal Folds is a term used to describe vocal folds that have lost muscle bulk due to injury, aging or neuromuscular diseases. Bowed vocal folds fail to come together and then result is usually a breathy voice sound and effortful phonation.

Chronic Cough
Chronic Cough is a cough lasting more than 2 months that does not resolve with rest or medication. A chronic cough usually has multiple causes. Treatment requires pharmacological intervention and behavioral management.

A program of respiratory retraining is a specialized treatment that is used to resolve chronic cough when it is associated with abnormal movements of the vocal folds known as paradoxical vocal fold motion disease (PVFMD). 

Chronic Cough is a common problem seen in the Voice and Swallowing Center. It is often treated without success as a sinus, allergy or lung problem or as a functional problem that people are told to "live with it." Chronic cough can be extremely debilitating. One of the most often overlooked causes of chronic cough is Paradoxical Vocal Fold Motion Disorder (PVFMD). PVFMD is known by many different names such as vocal fold dysfunction, vocal stridor, irritable larynx syndrome and adult onset asthma.

Symptoms of PVFMD
Patients with PVFMD complain of severe long-term cough, occasional changes in voice quality, increased breathing difficulty around soap powders, perfumes and other odors, shortness of breath or air hunger and even wheezing or other breathing noises associated with breathing. Despite the use of steroids, inhalers or other pharmacological agents, the cough and breathing difficulties persist in people with PVFMD.

A standard series of tests are used to diagnose PVFMD. The first part of any examination is a thorough case history relating to the onset, severity and previous treatments of the problem. Next is a transnasal flexible laryngoscopic examination of the larynx and vocal folds. In this exam, the patient is given specific vocal and breathing tasks to perform while the larynx and vocal folds and the entire exam is recorded on DVD in order to study the motions during each of the tasks. An experienced voice pathologist does a perceptual assessment of the voice during the visit. The video exam of the larynx is followed by a breathing test to identify the breathing components related to the lungs and the upper airway.

Treatment for PVFMD is comprehensive and carried out by an ear, nose and throat specialist and a voice therapist. PVFMD is often accompanied by laryngopharyngeal reflux an inflammation of the larynx caused by stomach acid in the larynx. Proper medication is the first step in the treatment. This is followed by a series of breathing exercises known as respiratory retraining. Respiratory Retraining focuses on coordinating breathing with vocalization. This technique has been shown to be useful for patients with excessive cough, paradoxical vocal fold motion disorder, vocal spasm or laryngeal irritation. It is used in conjunction with the treatment of laryngopharyngeal reflux. The exercises consist of rhythmic breathing using minimal inhalation effort and working up to active exercises combining breathing and vocalization in specific rhythmic patterns. The origins of this program date back to studies of PVFMD at the National Jewish Hospital in Denver Colorado. (www.njh.org)

Treatment of PVFMD may take as little as 3 weeks or as much as 6 months. The treatment is highly successful and results in a vastly improved quality of life for those who have suffered with cough. A report of this treatment was selected for presentation at the Eastern Sectional Meeting of the 2004 American Academy of Otolaryngology in New York City.


What is Hoarseness?
Hoarseness is a common term used by most people to describe changes in the voice that make it sound abnormal. When a voice is not normal, it is said to be "hoarse". Actually, there are many types of hoarseness or voice quality changes that if left untreated will limit one's ability to communicate effectively, cause a loss of income or lead to serious medical conditions. Hoarseness (the technical term is dysphonia) has many causes and is only a sign that a problem exists with the vocal folds, the muscular structures that vibrate to produce sound for speech and singing.

How is the voice produced?
The vocal folds (vocal cords) are housed inside the larynx, the structure in the neck easily identified by the prominent "Adam's apple." The vocal folds lie right behind the Adam's apple. The vocal folds produce sound when they come together and are driven by the air supply from the lungs. In order for sound to be clear and not hoarse, the vocal folds must move together symmetrically, be capable of opening and closing regularly and then have sufficient air flow from the lungs to keep them vibrating. The vocal folds are capable of vibrating at speeds as low as 10 times a second all the way to 1200 times a second, as in a soprano singing a high note. However, when the voice is hoarse, the vocal folds may fail to close, fail to vibrate symmetrically or fail to maintain vibration at a steady rate.

How are voice problems diagnosed?
A comprehensive evaluation of hoarseness includes a detailed history or voice usage and an examination of the larynx and the vocal folds. The details surrounding the onset of the problem are particularly important. How, when, where and under what conditions did the problem begin? The evaluation of hoarseness includes a perceptual assessment of voice quality - pitch, loudness, pitch breaks or other changes from the normal voice. Instrumental assessment of the voice including measurement of pitch and loudness range, and clarity (called perturbation) is an important part of the evaluation.

How are the vocal folds examined?
Visual examination of the vocal folds is the key to a comprehensive evaluation of hoarseness. The examination of the vocal folds may be done with a flexible endoscope that passes through the nose or a rigid endoscope that shines a light onto the vocal folds from the mouth. Video strobolaryngoscopy is a special examination technique that uses a special light and microphone to synchronize the movements of the vocal folds so they may be viewed in slow motion. The details of vibration and vocal fold motion are recorded for review and permanent record. Examinations are routinely conducted in the office and take only a few minutes.

How is hoarseness treated?
Treatments of hoarseness may include medications, voice therapy, surgery or all of these. Voice therapy is a behavioral technique that consists of vocal hygiene, a daily plan for avoiding voice misuse, strain and over use, Voice therapy also consists of vocal exercises, respiratory support management and vocal relaxation. Voice therapy is used to return the voice to its highest and best use after injury or surgery. Voice therapy is the treatment of choice for many voice disorders. Voice therapy is conducted by a certified and licensed speech-language pathologist after vocal fold examination. Comprehensive care of hoarseness may also require surgery if changes are not responsive to voice therapy or medications.

When to get help?
Hoarseness which lasts for two weeks or more requires a comprehensive diagnosis and treatment to prevent further injury or damage to the voice and return the voice to normal use.

Laryngeal Papilloma
Laryngeal Papilloma are growths on the larynx thought to be caused by a viral infection.

Muscle Tension Dysphonia
Muscle Tension Dysphonia is a voice disorder characterized by strained, effortful phonation usually causing vocal fatigue if used extensively.

Two types are known:

Primary muscle tension dysphonia - a type of vocalizing or speaking in which the muscles in the neck are tense and when no other lesion or paralysis is seen.

Secondary muscle tension dysphonia - a compensatory method of vocalizing due either to a paralysis, paresis or muscular weakness causing the person to squeeze other parts of the larynx to help produce sound.

Paradoxical Vocal Fold Motion
Paradoxical Vocal Fold Motion (PVFM) is an abnormal motion of the vocal folds.
The vocal folds move toward each other during quiet breathing when they should remain completely abducted (open). The movement results in irritation and cough.

PVFM is often misdiagnosed as asthma. Asthma medications fail to resolve the cough and often make it worse.
Proper treatment is with a program of respiratory retraining to reduce the abnormal movements of the vocal folds when breathing.

Reflux refers to the backflow of stomach contents into the esophagus and/or throat.

Reflux Laryngitis
Reflux Laryngitis is hoarseness and voice change due to reflux material coming up to the level of the larynx.

Reinke’s Edema
Reinke's Edema is swelling of the vocal folds due to trauma or noxiousirritations (cigarette smoking) resulting in a deep husky voice. Women with Reinke's Edema are often mistaken for a male on the telephone.

Vocal Fold Atrophy
Vocal Fold Atrophy is loss of muscle bulk in one of the voice muscles.

Vocal Fold Cysts
Vocal Fold Cysts are benign lesions on the vocal folds that may either be filled with mucous (mucous retention cyst) or a fibrous mass on the vocal folds.

Occasionally, the cysts reside deep in the tissue of the vocal fold and causes the vibratory pattern to be restricted in motion. In children and some adults, cysts may have a contralateral mass lesion and it may be difficult to determine if these are cysts or vocal nodules.

Video laryngostroboscopy is necessary to properly diagnose these lesions.

Vocal Fold Granuloma
Vocal Fold Granuloma is an area of thickened, irregular tissue on the vocal fold caused by irritation.

Vocal Fold Paralysis
Vocal Fold Paralysis is damage to the recurrent laryngeal nerve or superior laryngeal nerve that can produce a vocal fold paralysis. These are branches of the X Cranial Nerve. When the vocal fold is paralyzed, it loses its mobility.

Voice Misuse
Excessive shouting, screaming or throat clearing are all behaviors that contribute to voice misuse and possibly to an injury to the voice.

Other things such as throat clearing, breathing noxious fumes (second hand smoke), cigarette smoking, excessive use of alcohol, use of street drugs and attempting to speak or sing while sick or under excess stress are all part of vocal misuse.

Vocal Nodules
Vocal Nodules are bilateral symmetric lesions on the vocal folds that develop from excessive and improper use of the voice. They occur mostly in young boys and in adult females. These lesions are similar to calluses on the hands or feet.

Vocal nodules are treated with voice therapy and vocal hygiene and usually go away when the vocal abuse or misuse is eliminated.

Vocal Papilloma
Papillomas are benign epithelial tumors that are caused by infection with the human papilloma virus (HPV). They are the most common benign neoplasms affecting the larynx and upper respiratory tract.

Although papillomas are benign, their rapid growth can cause obstruction of the airway that can lead to asphyxiation if not treated.The papilloma can affect the vocal folds and/or epiglottis, and can occasionally spread distally to involve the trachea or bronchi.

Vocal Polyps
Vocal Polyps are benign epithelial lesions of the vocal folds that are fluid filled and usually unilateral. The fluid filled area usually causes asymmetry in the vibration of the vocal folds.This often results in a wet hoarse quality of the voice.

Vocal polyps are treated with surgery after vocal hygiene and voice therapy


Acid Reflux occurs when the tube that you uses to intake the food from the throat to stomach is not strong enough to handle the acid. The food intaken by you is digested by the stomach with the help of an acid produced and stored by it. The stomach walls are built strong enough to store that acid without causing damage. 

For unknown reasons when acid flows back into the oesophagus from stomach it creates heartburn, which is widely considered the first symptom of acid reflux or GERD. It leaves a constant chest burning sensation. You may find these acid reflux symptoms occurring to everyone once in a while, but when it happens regularly over a period of 2 to 3 times in a week with no visible relief even after medication, then you have acid reflux or GERD. A change in diet intake can give you relief to an extent from acid reflux attack, but if it reoccurs then one needs medical attention.

The main cause of acid reflux attack is when the lower oeasophageal sphinter which is a divider between stomach and oeasophagus giving up at inappropriate times, thereby not blocking the entry of acid into easophagus. This stomach acid when flows back into the easophagus, it causes severe heartburn right in between the chest.

NOTE: The information provided on this web site is not intended to take the place of consultation with your physician. You should always consult a physician whenever you require diagnosis or treatment. All information on this site is subject to change without notice. Although the site is updated regularly, it may not yet include the most recent changes.



DESCRIPTION: ENT Doctor in Kissimmee and Orlando Area. Treating patients with Chronic Hoarseness, Acid Reflux, Chronic Cough, and other Vocal Disorders.

KEYWORDS: Chronic Hoarseness, Hoarseness, Acid Reflux, Acid Reflux Disease, Esophageal Cancer, Chronic Cough, Throat Clearing, Reflux, Laryngitis, laryngologist, voice disorders, reflux treatment, reflux doctor