Dr. Casado is a prestigious otolaryngologist from Marbella with a degree from the University of Cordoba. He is specialized in Voice Feminization, Dysphonia, Endoscopic Nasosinusal Surgery, Vertigo, Pharyngitis and Septorhinoplasty.
What is the most frequent reason for which patients come for consultation?
We distinguish patients by age, on the one hand there are children and on the other hand there are adults. The most frequent pathology for which children come is usually due to ear problems, sensation of ear plugging, nasal obstruction and recurrent tonsillitis, classically known as angina. That, on the one hand, would be the children’s pathology. On the other hand, the pathology of adults, which is more varied, the reasons for consultation are usually also due to a sensation of hearing loss, which is called hypoacusis; nasal obstruction, difficulty in breathing, with headaches mainly associated with sinusitis; voice pathologies, which is what would be dysphonia; and finally, balance disorders, in short, vertigo.
What are the medical and surgical treatments?
In principle, on average, it is considered that the pathology susceptible to surgery that comes to my office is approximately 10%. That is to say, out of 10 patients, 1 is susceptible to surgery. The rest are usually resolved with surgical treatment, or at least with a first intention, which is not surgical. I always say that I do not usually indicate surgery in a first visit. Within the surgical treatment there are different modalities. Here we would divide it by apparatus, by structures. Within the pathology of the ear, the most common surgical techniques would be, on the one hand, the placement of transtympanic drains, and on the other hand, tympanoplasty, which is usually the closure of a perforation. It is also very frequent in this area, due to the coastal area, the recalibration of the external duct, due to the famous osteomas or esostosis of the duct. In the case of nasal pathology, of the difficulty to breathe through the nose, there would be surgeries on the septum, such as sectoplasty, on the turbinates, turbinoplasty, or on sinusitis, which would be the endoscopic nasosinusal surgery. Finally, on the throat we have, on the one hand, surgical interventions that consist in the removal of the tonsils, which would be tonsillectomy, and on the other hand, everything related to voice pathology, which is called phonomicrosurgery, which consists in removing lesions that alter the voice and that are located on the vocal cords, such as polyps, nodules, edema, etc.
What are the most advanced techniques you apply in your practice?
With regard to the most advanced techniques, the most modern techniques we use, it is worth mentioning the use of radiofrequency or diode laser to reduce the size of the turbinates. On the other hand, the use of laser in the removal of benign lesions of the vocal cords, also the removal of small stones inside the salivary glands, which is called sialoendoscopy. And finally, minimally invasive ear surgery.
What is voice feminization? How do you increase vocal tone?
I prefer to talk about increasing vocal tone rather than voice feminization. Certain patients come to my office who want to increase their vocal tone, that is, to achieve a stereotypically feminine voice. I achieve this with a method that consists of a surgical technique called Wendler Glotoplasty, a technique that is performed through the mouth, through the mouth, without any external incision, which produces a shortening of the vocal cords. Subsequently, the mass is reduced by the use of laser on the vocal cords. With this method, which consists on the one hand of surgical treatment associated with postoperative speech therapy, we achieve voices with a fundamental frequency above 165Hz. Above this threshold of 165Hz it is considered a stereotypically feminine voice, a high vocal pitch, which is what we are aiming for, which is our objective.