Each year, millions of people experience voice disorders that, if left untreated, could severely impact their quality of life, especially those in professions that require them to rely heavily on their voice.
Voice disorders can be divided into three categories: structural, neurogenic, and functional. Structural voice disorders involve the tissues of the vocal cords and include vocal cord lesions, nodules, or polyps. Neurogenic voice disorders, such as vocal cord paralysis and spasmodic dysphonia, are related to a problem or breakdown of the nervous system that serves the vocal cords. Functional voice disorders are caused by muscle misuse and strain, similar to how squinting can cause vision problems.
The Most Common Voice Disorders Include:
Chronic hoarseness – Also known as chronic laryngitis, this condition can be caused by a multitude of external factors including acid reflux disease, breathing in irritating substances such as smoke and dust, and use of inhalers. Low-grade or chronic infection of the vocal cords can also cause this condition.
Vocal cord paralysis – When the nerve input to the voice box is eliminated, the outcome is vocal cord paralysis. This condition can be caused by injury, blunt trauma, or surgery to the neck or chest (such as thyroidectomy and anterior cervical spinal fusion), or by tumors in the skull base, neck, or chest. In addition, a large number of cases are idiopathic, which means no known cause is ever identified. The left vocal cord is more commonly paralyzed statistically, simply because the nerve on the left side (recurrent laryngeal nerve) is much longer for odd anatomic reasons. Treatment usually begins with voice therapy. If symptoms are still severe, phonosurgery, an operation that reshapes the vocal cords, may be considered.
Symptoms of vocal cord paralysis include:
- Hoarseness with a breathy voice
- Needing additional air pressure for normal conversation
- Shortness of breath
- Noisy breathing
- Choking or coughing when swallowing
Vocal Cord Hemorrhage
A vocal cord hemorrhage occurs when a blood vessel on the outside of the vocal cord ruptures and the surrounding soft tissue fills with blood. This can be caused after a person shouts or screams and a sudden loss of voice occurs. This condition should be considered a vocal emergency. Patients should immediately contact an ENT physician and refrain from any vocal use until the hemorrhage heals.
Nodules, Polyps & Cysts
Voice problems are often caused by vocal cord lesions such as nodules, polyps, and cysts. Nodules are like calluses that form on both sides of the vocal cord. Usually, these nodules gradually resolve once the vocal overuse has stopped. Unlike nodules, polyps typically occur on only one vocal cord and can come in different shapes and colors, causing a variety of voice problems. Cysts appear as fluid-filled masses on the surface of the vocal cord or further down near the ligament. The placement and size of these cysts can affect the severity of the vocal problem. Suggested treatment typically includes vocal rest, hydration, and voice therapy. Surgery may also be necessary to remove cysts or polyps, especially as they can be early indications of potential cancer.
Common symptoms associated with nodules, polyps and cysts include:
- Vocal fatigue
- Breathy voice
- Frequent throat clearing
- Cracking of voice when first talking
While an incredibly serious condition, laryngeal cancer, if caught in the early stages, is very treatable and usually curable. If you are experiencing hoarseness or vocal fatigue lasting more than a month with no improvement, especially if you have a history of reflux or tobacco use, it’s important to visit your ENT physician immediately for examination to rule out the possibility of laryngeal cancer.
Diagnosing Voice Disorders
A thorough evaluation, including the use of a fiber-optic endoscope, can detect and diagnose many vocal disorders, including nodules, cysts, and polyps. At CornerStone Ear, Nose & Throat, we also have the technology to perform videostroboscopy. This diagnostic test provides a magnified video of the vocal cords as they vibrate in slow motion. This test is essential in assessing the function of the vocal cords and detecting vocal cord swelling, lesions, scar tissue, and muscle tension disorders, which might be difficult to see otherwise. Suspicious lesions of the vocal cords that otherwise might require biopsy can also be closely watched with videostroboscopy, as their true nature is more easily seen through this method.