Raising Voices: Helping Patients Recover From Voice Disorders

September 24, 2010

By: Nicholas D. Lukacs, DO

Category: Ear, Nose & Throat

Tags: Acid Reflux, chronic cough, chronic hoarseness, speech, vocal fatigue, voice

Each year millions of people are affected by voice disorders. For those who rely on their voice to make a living, such as teachers, doctors, actors, singers, and public speakers, problems like chronic hoarseness and vocal fatigue can be devastating. There are many causes of vocal disorders and the underlying etiology is often multifactorial. Vocal overuse, acid reflux, tobacco use, and chronic allergies are a few of the many potential causes of vocal dysfunction. In addition, any patient with persistent hoarseness should be evaluated to rule out laryngeal cancer. Proper diagnosis of the disorder is crucial for appropriate treatment.

Patient Profile: Curing Chronic Hoarseness

Doris Godwin suffered from constant hoarseness for over five years. The 80-year-old had been evaluated and treated in the past for laryngopharyngeal reflux, with no improvement in her symptoms.

Doris was evaluated using the Kay Pentax Rigid Videostroboscopy system. A submucosal cyst involving the medial surface of her right vocal cord was discovered. “The cyst was preventing complete closure of her vocal cords during phonation and impairing normal vocal cord vibration,” said Dr. Lukacs. “This was causing a raspy and breathy quality to her voice.”

“I thought it was a problem I would just have to live with, then a relative suggested CornerStone Ear, Nose & Throat.” – Doris Godwin

After failing conservative medical management, it was agreed that surgery was the best option and Doris underwent submucosal excision of the right vocal cord cyst. An operating microscope was used along with an injection of steroid into her right vocal cord to promote healing. After the surgery, Doris was placed on one week of strict voice rest. At her post-op visit, she had significant improvement in her vocal quality. With restricted voice use, her vocal quality continued to improve as her healing progressed over the next several weeks.

At CornerStone Ear, Nose & Throat, we offer state-of-the-art diagnostic capabilities including flexible fiberoptic laryngoscopy and rigid videostroboscopy (see cover article in this issue).

Our physicians can help patients who suffer from:

• Chronic hoarseness
• Vocal fatigue
• Chronic cough
• Restriction of dynamic range

Types of Voice Disorders

Voice disorders fall into a few main categories – structural, neurogenic, functional and psychogenic.

Often, a patient’s disorder may fit more than one category and the challenge lies in determining the primary cause.

Structural Disorders

With structural disorders there is a problem involving the tissue or fluids of the vocal cords. Examples include:

• Contact Ulcers
• Papilloma
• Cysts
• Nodules
• Hemorrhage
• Polyps
• Laryngitis
• Trauma
• Granuloma
• Leukopolakia

Neurogenic Disorders

Neurogenic disorders are related to problems with the nervous system, including:

• Paralysis/Paresis
• Tremor
• Spasmodic Dysphonia
• Symptom of a neurological disorder (ALS or Parkinson’s)

Functional Disorders

With functional disorders, the physical structure is normal but there is muscle tension due to improper use or strain. Examples include:

• Muscle tension dysphonia
• Anterior/posterior constriction
• Pharyngeal constriction

Psychogenic Disorders

It is rare for a psychological disorder to be the sole cause for a voice problem, but a psychogenic component is often present because of the emotional impact a voice disorder can have.

Throat Cancer

Cancer of the larynx or any part of the throat is not considered a voice disorder. However, unexplained hoarseness is one of the warning signs of cancer.

Treatment Protocols

“There are a variety of treatment options available depending on the patient’s specific condition,” said Nicholas Lukacs, D.O. of Cornerstone Ear, Nose & Throat. “In many cases, treatment of underlying causes of laryngeal inflammation such as acid reflux and postnasal drainage are initiated. In patients who do not respond to conservative management microscopic vocal cord surgery can be performed to address structural lesions of the vocal cords. Voice therapy with a speech pathologist is also an important part of the treatment protocol for both surgical and nonsurgical patients to improve vocal technique and prevent recurrence of their symptoms.”