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Voice disorders and hoarseness are often used interchangeably to describe an abnormality of normal voice production.  This hoarseness can be caused by a number of different reasons, and can be described as breathiness, raspiness, pitch changes, and voice strain.  The vocal cords are primarily responsible for producing voice, and are located in the voicebox (larynx).  Any large or subtle change in the length, tension, texture, or movement of the vocal cords will affect the quality of an individual’s voice.

Causes:

  • Nodules (Singer’s nodules)
  • Smoking
  • Vocal cord polyps
  • Tumors (Papilloma, cancer)
  • Vocal cord paralysis
  • Trauma
  • Heartburn (Reflux, GERD)
  • Inflammation (laryngitis)
  • Airway narrowing (stenosis)
  • Congenital malformations (birth defects)

Diagnosis:

  1. Fiberoptic Laryngoscopy
    A laryngoscope is a small fiberoptic camera that is placed through the mouth or the nose in order to visualize the vocal cords.  Your physician can clearly see the movement of the vocal cords, the presence or absence of any abnormal growths, and identify if anything is blocking the vocal cords from normal function.  This is typically performed in the office with the use of a simple topical anesthetic spray.  The procedure takes a few minutes and is easily tolerated by most patients.
  2. Direct Laryngoscopy
    If an abnormality is detected during the fiberoptic laryngoscopy, a direct laryngoscopy is typically performed under general anesthesia.  This procedure involves placing a larger laryngoscope through the mouth in order to directly visualize the vocal cords.  A more detailed examination can be done using a microscope.  Biopsies and the removal of tumors or masses can be accomplished at this time.
  3. Video Stroboscopy
    Video stroboscopy is a technology that utilizes a special fiberoptic laryngoscope to capture a slow motion video of the vocal cords during movement.  The physician or speech therapist can carefully examine several parameters of the vocal cord movement such as:  symmetry, vibration, closure, amplitude, and mucosal wave pattern.  Although video stroboscopy is not routinely performed, it does help to establish a more definitive diagnosis and thus aid in a more focused treatment plan.
  4. Imaging/Radiology
    CT scans can be helpful in assessing the extent of a tumor or mass that has been identified on direct or fiberoptic laryngoscopy.  This usually requires IV contrast dye to help visualize different anatomic structures, the extent of disease, and the effects of treatment for patients that may be receiving radiation or chemotherapy to treat certain cancers of the vocal cords or neck.

Treatment:

  1. Surgery
    Surgical intervention is traditionally used to biopsy or remove tumors and masses such as polyps, papillomas, cancers, and sometimes vocal cord nodules (singer’s nodules).  This treatment usually requires the use of a specialized instrument (laryngoscope) that is used to directly visualize the vocal cords.  The identified mass can be directly examined, photographed, and removed.  For certain patients that suffer from vocal cord paralysis, a specialized procedure called a thyroplasty can be performed, which involves the placement of a special implant to help improve voice quality.   All of these procedures are typically performed while the patient is comfortably sleeping under general anesthesia.
  2. Voice Therapy
    For patients that are diagnosed with singer’s nodules and/or certain forms of vocal cord muscular motion problems caused by neurologic injury or vocal abuse, voice therapy with a trained speech pathologist can be very effective in improving overall voice quality.  Therapy typically involves many sessions, but is a reliable treatment method, especially for patients who are singers, and/or individuals who use their voice for public speaking.  In specific instances, vocal cord nodules may need to be surgically removed.
  3. Medication
    Patients that suffer from certain forms of laryngitis and vocal cord inflammatory processes, the use of anti-inflammatory steroids can reduce inflammation and improve voice quality.  Steroids are typically used for 5-14 days, depending on the cause and severity of the initial problem.  For the treatment of voice or swallowing problems caused by heartburn (reflux, GERD), specific medications such as Aciphex, Nexium, Prevacid, Protonix, Prilosec, Pepcid, Zantac, and many others, are used to treat heart burn, which can be the underlying cause of difficulty swallowing (dysphagia) and/or voice changes.
  4. Diet/Lifestyle
    Patients that overuse or misuse their voice can also benefit from not only voice therapy, but also changing their vocal use or habits with the help of a speech pathologist, or at home, after careful evaluation and instruction in the office.  Voice and swallowing problems caused by heartburn (reflux, GERD) are not only treated with medication, but with adjustments in lifestyle and diet by avoiding:
  • acidic foods (tomatoes, citrus foods)
  • acidic drinks (soda, citrus juices)
  • spicy food
  • chocolate
  • coffee
  • fatty/greasy food
  • eating just before bedtime
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