About

Peter C. Belafsky, M.D., M.P.H., Ph.D., is a professor in the Department of Otolaryngology at UC Davis Health and serves as the Director of the Center for Voice & Swallowing. His primary clinical interests include the comprehensive diagnosis and management of voice, swallowing, and airway disorders. As the head of the Voice and Swallowing Center at UC Davis, he treats a wide array of laryngeal and esophageal disorders, including vocal fold paralysis, vocal fold dysfunction, laryngopharyngeal reflux, chronic cough, and dysphagia caused by various neurological and structural conditions. Dr. Belafsky has pioneered minimally invasive treatments for voice and swallowing disorders, performing in-office procedures such as treatment of laryngeal polyps, leukoplakia, papillomas, strictures, and vocal fold medialization. His research focuses on the innovative treatment of profound swallowing disorders. He has developed a medical device to manually control the upper esophageal sphincter, is working on an innovative dilator for upper esophageal sphincter stenosis, and is developing a comprehensive swallow propulsion system. Additionally, he is evaluating the use of muscle stem cells for dysphagia rehabilitation. Dr. Belafsky's academic background includes a B.A. from Vassar College, an M.D. and M.P.H. from Tulane University, and a Ph.D. from Tulane University Graduate School. His training includes an internship and residency in Otolaryngology at Tulane University, and a fellowship in Laryngology at Wake Forest University. He has received numerous awards for clinical excellence and research contributions, including the American Laryngological Presidential Citation Award and the Dean's Team Award for laryngeal transplant. His work has significantly contributed to the field of laryngology and swallowing disorder treatment, emphasizing minimally invasive procedures and innovative therapeutic devices.

Research topics

• Internal medicine
• Medicine
• Physical therapy
• Pediatrics
• Surgery

Selected publications

• Effects of Mesenchymal Stem Cell‐Derived Exosomes on Lung Inflammation in a Murine Aspiration Model

  The Laryngoscope · 2026-02-16

  articleSenior author

  ABSTRACT Objective Aspiration pneumonia is a major cause of morbidity and mortality in adults with swallowing impairment. Exosomes from mesenchymal stromal cells (MSCs) present a potential therapeutic for aspiration pneumonia. This study aimed to assess the potential of MSC exosomes to mitigate lung inflammation in a murine aspiration model. Methods Seventeen adult male rats were divided into three groups: Animals in the LPS‐EXO group ( n = 7) underwent intratracheal instillation of 2.5 mg/kg lipopolysaccharide (LPS) aspirate and 40 μL of MSC exosome therapeutic intravenously. The LPS‐only group ( n = 7) underwent LPS aspiration alone without exosome therapy. Three rats underwent instillation of air as sham controls. All animals were euthanized 6 h post instillation. Histopathologic lung injury severity was determined and gene expression of pro and anti‐inflammatory cytokines was evaluated using quantitative real‐time reverse transcription‐polymerase chain reaction (qRT‐PCR). Results The mean composite histologic lung injury score was 8.3 (±1.1) for the LPS‐only group, 7.13 (±3.2) for the LPS‐EXO treatment group, and 3.3 (±1.1) for the sham control group. One‐way ANOVA showed a significant group effect ( p = 0.02), and trend analysis revealed a significant linear improvement across groups ( p = 0.006; η 2 = 0.43). qRT‐PCR showed significantly lower Tnf expression in the LPS‐EXO group versus the LPS‐only group ( p < 0.05). No other significant differences were found between the LPS‐EXO and LPS‐only groups on qRT‐PCR. Conclusions Results of this preliminary investigation suggest that intravenous delivery of MSC exosomes reduces expression levels of proinflammatory cytokine Tnf and attenuates histopathological markers of lung injury in a murine model of aspiration‐induced lung damage. Level of Evidence NA.

  PublisherDOI

• 26-A-12757-ACC DYSPHAGIA: A NOVEL RISK FACTOR FOR POOR OUTCOMES FOLLOWING COMMON CARDIOVASCULAR SURGICAL PROCEDURES

  Journal of the American College of Cardiology · 2026-03-27

  article
  PublisherDOI

• Off‐Label Use of a Tracheoesophageal Prosthesis for Occlusion of an Oronasal Fistula

  Head & Neck · 2026-01-20

  article

  BACKGROUND: An oronasal fistula is an abnormal communication between the oral and nasal cavities, which can arise as a result of radiation therapy for head and neck cancer, resulting in significant speech and swallowing challenges. METHODS: We present a case in which a transesophageal prosthesis (TEP) was used as an alternative to existing treatment options for oronasal fistulas, which include surgical repair or a palatal obturator prosthesis. RESULTS: A 59-year-old female with a history of poorly differentiated squamous cell carcinoma of the nasopharynx with metastatic neck disease, treated with radiation therapy over 20 years ago, presented with an oronasal fistula resulting in significant weight loss and hypernasal speech. Due to the discomfort caused by a palatal obturator, a TEP device was offered as an alternative treatment option for the patient's oronasal fistula. Post-procedure videofluoroscopic swallow study and speech analysis demonstrated markedly improved nasal regurgitation and speech intelligibility. CONCLUSION: This case demonstrates the use of a TEP device as an effective, non-surgical treatment option for oronasal fistula.

  PublisherDOI

• DNA immunotherapy for recurrent respiratory papillomatosis (RRP): phase 1/2 study assessing efficacy, safety, and immunogenicity of INO-3107

  Nature Communications · 2025-02-12 · 13 citations

  articleOpen access

  Recurrent respiratory papillomatosis (RRP) is a chronic airway disease caused by Human Papillomavirus (HPV). INO-3107, DNA immunotherapy designed to elicit T-cells against HPV-6 and HPV-11, was evaluated in a 52-week Phase 1/2 study for efficacy, safety, and immunogenicity (NCT04398433). Thirty-two eligible adults with HPV-6 and/or HPV-11 RRP, requiring ≥2 surgical interventions in the year preceding dosing were enrolled between October 2020 and November 2021 and administered 4 INO-3107 doses by intramuscular injection followed by electroporation. The primary endpoint was safety and tolerability, as assessed by treatment-emergent adverse events (TEAEs). Secondary endpoints included surgical intervention frequency and change in RRP Severity Score (modified) post-INO-3107 and assessment of immune responses. 81% (26/32) of patients experienced surgery reduction following INO-3107 compared with the year prior to treatment. Blood assessments revealed HPV-6 and HPV-11 antigen-specific T-cell induction. RNA sequencing identified an inflammatory response in papillomas, inclusive of cytolytic CD8 + T-cell signatures. T-cell receptor sequencing revealed emergent T-cell clones in blood and confirmed trafficking to papillomas. Treatment-related adverse events (AEs) were reported in 13/32 (41%) patients, all low-grade. INO-3107 provides clinical benefit to HPV-6 and/or HPV-11-associated RRP adults and is well-tolerated. Importantly, treatment-induced peripheral T-cell responses traffic to airway tissue and are associated with clinical response.

  PublisherOA PDFDOI

• Cancer treatment-related head and neck fibrosis: a narrative perspective of epidemiology, pathophysiology, prevention, assessment and non-surgical treatment

  Physical Therapy Reviews · 2025-05-26 · 1 citations

  articleSenior author
  PublisherDOI

• Dysphagia Outcomes in Zenker Diverticulum: A Longitudinal <scp>POuCH</scp> Study

  The Laryngoscope · 2025-08-19 · 1 citations

  articleOpen access

  OBJECTIVE: Patients with cricopharyngeus muscle dysfunction (CPMD) with and without diverticula (e.g., Zenker Diverticulum) often struggle with dysphagia for years prior to diagnosis or intervention. Surgical treatment is successful; yet, there is limited long-term data on dysphagia outcomes after surgery. METHODS: Individuals prospectively enrolled in the Prospective Outcomes of Cricopharyngeal Hypertonicity (POuCH) collaborative with and without diverticula who underwent surgery from November 2014 to August 2024 and had at least 12 months of follow-up were included. Eating Assessment Tool 10 (EAT10) was used to characterize patient-reported outcomes. Descriptive statistics were performed using means, frequencies, and spaghetti plots. RESULTS: Of 164 patients initially identified, 2 withdrew and 2 were excluded for incomplete data; 160 were included. 31% were women, with a mean (SD) age of 70.1 (11.5). Endoscopic surgery (113, 71%) was more common than open technique (47, 29%). 19.4% of patients had undergone previous surgery. Postoperatively, patients were found to have improved EAT-10 scores, with smaller changes recorded after 36 months. Median change in EAT-10 compared to preoperative score was -12 points [IQR: -18, -5] at 12 months. 39 (24%) patients were followed for > 24 months (median change -11 [IQR: -14, -7]); 26 (16%) > 36 months (-9.5 [-17, -5]), and 12 (7.5%) > 48 months (-4 [IQR: -18, 4]). Six patients died during the study period. CONCLUSION: Improved dysphagia after surgery appears stable with minimal change over time. Most patients (96.3%) survive at least 1 year. Surgical intervention for patients with CPMD with or without diverticula is an effective and reliable treatment option.

  PublisherOA PDFDOI

• Histamine 2‐Receptor Antagonists Tachyphylaxis: A Scoping Review

  The Laryngoscope · 2025-12-29

  articleSenior author

  OBJECTIVE: Histamine 2-receptor antagonists (H2RAs) commonly treat gastroesophageal reflux disease (GERD). However, tachyphylaxis, defined as the rapid reduction of efficacy, is frequently reported and remains poorly understood. This investigation performed a scoping review on the decrease in H2RA efficacy with repeat dosing. DATA SOURCE: Following PRISMA-ScR guidelines, we systematically searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Database through August 27, 2025. REVIEW METHOD: Two reviewers independently screened studies and extracted data on mechanisms, impact, and management strategies. RESULTS: While H2RAs effectively reduce gastric acid secretion, continuous dosing leads to tachyphylaxis of unclear etiology. Initial H2RA treatment increases the percentage of time intragastric pH is > 4, from 8% to 38%. Tachyphylaxis begins by the second dose, 2, with an 11.2% reduction in efficacy by day 3. By day 15, tachyphylaxis results in a 13.0%-27.5% (mean: 20.3%) decrease in efficacy, after which no further reduction in effectiveness occurs. In comparison, once-daily proton pump inhibitors maintain a daily intragastric pH of 63% above 4, with no tachyphylaxis observed after 14 days. CONCLUSION: Tachyphylaxis is a well-documented, diminished treatment effect observed across the entire class of H2RAs. It typically begins by day 2 and plateaus quickly, resulting in up to a quarter decrease in absolute efficacy. The precise mechanisms underlying H2RA tachyphylaxis remain uncertain. H2RAs should not be prescribed as first-line agents for the management of frequent GERD or routinely added in cases of incomplete response to PPIs.

  PublisherDOI

• 1541P DNA immunotherapy (INO-3107) in HPV-6 &amp; 11 recurrent respiratory papillomatosis: Long-term efficacy

  Annals of Oncology · 2025-09-01

  article
  PublisherDOI

• Heart Rate as a Predictor of 6‐Month Pneumonia Risk in Patients With Dysphagia

  Laryngoscope Investigative Otolaryngology · 2025-12-01

  articleOpen accessSenior authorCorresponding

  ABSTRACT Objective To determine whether resting heart rate (HR) or heart rate variability (HRV) derived from finger photoplethysmography (PPG) predicts 6‐month pneumonia risk in patients with dysphagia. HRV reflects autonomic regulation of inflammation which may predispose to respiratory complications. Methods A total of 301 patients who underwent a videofluoroscopic swallow study (VFSS) in 2020–2021 were enrolled. Prior to VFSS, resting HR was measured using the CorSense HRV finger sensor (ELITE HRV). Additional HRV metrics, including the standard deviation of normal‐to‐normal intervals (SDNN) and the root mean square of successive differences (RMSSD) were collected from a subset of 153 participants. Pneumonia incidence was assessed at 3 and 6 months through phone interviews and medical record review. Results The mean age was 66.3 ± 12.5 years, and 38% were female. Twenty patients (7%) developed pneumonia, with 75% of cases occurring within 3 months. Patients who developed pneumonia had higher resting HR than those who did not (83.4 vs. 74.3 bpm, p &lt; 0.01). This association remained significant after adjusting for age ( p = 0.01). Pneumonia risk increased stepwise with higher HR thresholds, with a 2.4‐fold greater risk observed at HR ≥ 82 bpm and a 2.8‐fold risk at HR ≥ 90 bpm. HRV metrics were not significantly associated with pneumonia incidence. Conclusion Elevated resting HR, though within the normal range, was associated with increased pneumonia risk in patients with dysphagia. This may reflect underlying inflammation or autonomic dysfunction. Because comorbidities, medications, and VFSS severity were not accounted for, these findings should be interpreted as preliminary. Resting HR may represent a simple, non‐invasive tool for pneumonia risk stratification in this population, but larger studies are needed for validation. Level of Evidence 2.

  PublisherOA PDFDOI

• Esophageal Screening During the Videofluoroscopic Swallow Study: Roadblocks and Roadmaps

  Perspectives of the ASHA Special Interest Groups · 2025-11-06 · 1 citations

  article

  Purpose: There are reported barriers to implementation of esophageal screening during the videofluoroscopic swallow study (VFSS) completed by the speech-language pathologist (SLP). Often, patients referred to the SLP for a VFSS have an esophageal component that may explain their complaint. In this article, authors explore roadblocks to esophageal screening and potential roadmaps to improve patient care through standardization of esophageal screening procedures. Conclusions: A strong body of literature supports physiologic, anatomic, and disease state relationships of the oropharynx and esophagus. Despite this, the assessment of the oropharynx and esophagus is dichotomized. There remain billing limitations for same-day esophagram and VFSS, and the well-documented esophageal screen provides a view of bolus flow in an upright, typical eating position with consideration of oropharyngeal function to provide a comprehensive view of the continuous process of swallowing from mouth to stomach. The continued practice of evaluating the oropharynx without consideration of the esophagus poses a threat to patient safety and may delay care. A collaborative, multidisciplinary effort among healthcare professionals to create streamlined practice parameters, update position statements, and enhance education parameters will allow for cohesive practices among professionals. Assessment of the swallow mechanism is incomplete without consideration of the entire continuum.

  PublisherDOI

Recent grants

• Manual Control of the Upper Esophageal Sphincter

  NIH · $1.3M · 2011–2016

Frequent coauthors

• Gregory N. Postma

  Augusta University

  151 shared

• James A. Koufman

  89 shared

• Maggie A. Kuhn

  University of California, Davis

  48 shared

• Milan R. Amin

  New York University

  40 shared

• Catherine J. Rees

  36 shared

• Nogah Nativ‐Zeltzer

  Tel Aviv University

  29 shared

• Rebecca Leonard

  26 shared

• Daniel J. Cates

  University of California, Davis

  20 shared

Labs

• Center for Voice and SwallowingPI

Education

• M.D., Otolaryngology

  University of California, Davis

  1992

• Other, Public Health

  University of California, Berkeley

  1994

• Ph.D., Otolaryngology

  University of California, San Francisco

  1998

Awards & honors

• American Laryngological Presidential Citation Award, COSM, 2…
• Dean's Team Award, for laryngeal transplant, 2011
• Recipient, Dean's Team Award for Excellence in Clinical Care…
• The Honorable Mention Award for Clinical research, The Ameri…