Raising Voices

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. She thought her problem was just something she had to live with until she met our doctor.

At CornerStone Ear, Nose & Throat, 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. This was causing a raspy and breathy quality to her voice.

After she did not respond to conservative medical management, we determined surgery was the best option. Doris underwent submucosal excision of the right vocal cord cyst. An operating microscope was used along with an injection of steroids 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.

CornerStone Ear, Nose & Throat offers 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
  • Leukoplakia

Neurogenic Disorders

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

  • Paralysis/Paresis
  • Tremor
  • Spasmodic Dysphonia
  • Symptoms 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 of 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. 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.

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