Vocal Cord Disorders
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The vocal cords (also called vocal folds) are 2 bands of smooth muscle tissue found in the larynx (voice box). The larynx is set in the neck at the top of the trachea (windpipe).
The vocal cords vibrate and air passes through the cords from the lungs to produce the sound of your voice. The sound is then sent through the throat, nose, and mouth, giving the sound “resonance.
” The sound of each person's voice is determined by the size and shape of the vocal cords and the size and shape of the throat, nose, and mouth. Vocal cord disorders affect the vocal cords.
Some of the more common vocal cord disorders include the following.
|Vocal Cord Disorder||Description|
|Laryngitis||Laryngitis causes a raspy or hoarse voice due to inflammation of the vocal cords. Laryngitis can be caused by excessive use of the voice, infections, inhaled irritants, or gastroesophageal reflux (GERD, or heartburn).|
|Vocal nodules||Vocal nodules are noncancerous growths on the vocal cords caused by vocal abuse. Vocal nodules are often a problem for professional singers. The nodules are small and callous-. They most often grow in pairs (one on each cord). The nodules most often form on parts of the vocal cords that get the most pressure when the cords come together and vibrate. Vocal nodules cause the voice to be hoarse, low, and breathy.|
|Vocal polyps||A vocal polyp is a soft, noncancerous growth, similar to a blister. Voice polyps cause the voice to be hoarse, low, and breathy.|
|Vocal cord paralysis||Paralysis of the vocal cords may happen when one or both vocal cords doesn’t open or close properly. A common disorder, this condition can range from relatively mild to life-threatening. When one or both vocal cords are paralyzed, food or liquids can slip into the trachea and lungs. A person may have trouble swallowing and coughing. Vocal cord paralysis may be caused by the following:
Treatment may include surgery and voice therapy. Sometimes, no treatment is necessary and a person recovers on his or her own.
What causes vocal cord disorders?
Vocal cord disorders are often caused by vocal abuse or misuse. This includes excessive use of the voice when singing, talking, coughing, or yelling. Smoking and inhaling irritants are also considered vocal abuse.
What are the symptoms of vocal cord disorders?
Symptoms vary, the type of vocal cord disorder. They include changes in your normal voice such as: a raspy or hoarse voice; or, a hoarse, low, and breathy voice. Vocal cord paralysis may also cause trouble swallowing and coughing.
How are vocal cord disorders diagnosed?
Any hoarseness or change in voice that lasts longer than 2 weeks should be brought to the attention of your healthcare provider. (Sometimes the hoarseness may be from laryngeal cancer.)
In addition to a complete medical history and physical exam, the healthcare provider may examine the vocal cords internally with a small scope called a laryngoscope. In the case of paralysis, your healthcare provider may also do a laryngeal electromyography that measures the electrical current in the vocal cords.
How are vocal cord disorders treated?
Vocal cord disorders caused by abuse or misuse are easily preventable. In addition, most disorders of the vocal cords can be reversed. Your healthcare provider will figure out the best treatment :
- How old you are
- Your overall health and medical history
- How sick you are
- How well you can handle specific medicines, procedures, or therapies
- How long the condition is expected to last
- Your opinion or preference
Treatment may include any of the following:
- Resting the voice
- Stopping the behavior that caused the vocal cord disorder
- A referral to a speech-language pathologist who specializes in treating voice, speech, language, or swallowing disorders
- Surgery to remove growths
Key points about vocal cord disorders
- Vocal cord disorders can affect your voice or ability to talk.
- Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord paralysis.
- Vocal cord disorders are often caused by vocal abuse or misuse.
- Symptoms may include a raspy, hoarse, low, or breathy voice, or trouble swallowing or coughing.
- Any hoarseness or change in voice that lasts longer than 2 weeks should be brought to the attention of your healthcare provider.
- Vocal cord disorders caused by abuse or misuse are easily preventable.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
There are numerous factors that can cause problems with the voice:
- Heavy voice use (teachers, singers, performers, etc.).
- Chronic cough or persistent throat clearing.
- A virus or illness.
- Acid reflux (LPR or GERD).
- Inadequate breath support.
Hoarseness may also result from swelling, chronic irritation, or a learned pattern of muscle tension with voicing. These common factors can create persistent hoarseness that does not simply go away with time.
In addition, certain benign or cancerous growths can occur on the vocal cords and cause alterations in the voice and sometimes swallowing.
If a patient experiences ongoing hoarseness that lasts for several weeks, the patient should see a doctor for a thorough evaluation.
An evaluation for a voice disorder usually begins with a visit to the Ear, Nose, and Throat physician. The physician may order a videostroboscopic examination to access the structure and function of the patient’s larynx (voice box).
Videostroboscopy uses modern video and digital imaging technology to examine the voice box during the production of voice.
The study gives high-resolution video images of the voice box in slow motion, so that the vocal cord may be carefully studied.
This also provides a nice opportunity for each patient to see his or her voice box and have a better understanding of his/her voice problem. This study is performed at Eastern Carolina ENT Head & Neck Surgery.
Once the videostroboscopic evaluation has been completed, the physician will confirm a diagnosis and implement a plan of care to best treat the voice disorder. Treatment of voice disorders ranges from speech therapy to medical therapy or even surgical therapy, depending on the particular diagnosis.
In many cases, speech therapy is the only form of treatment required. Speech therapy is appropriate for patients with vocal nodules, muscle tension dysphonia, vocal misuse or overuse, patients with weakness of their vocal folds, and patients who are post-op from surgery for their vocal cords, as well as numerous other problems with the voice.
Speech therapy is catered to the specific diagnosis for each patient.
Speech therapy may include any of the following:
- Providing the patient with specific information on the type of problem or vocal instrument abnormality present, and the most ly causal factors.
- Explaining how the above is/are interfering with normal voice production.
- Describing the necessary coordination of the breathing and speech systems to produce.
- normal voice.
- Assigning the patient out-of-clinic activities designed to make them aware of his/her daily vocal use.
- Identifying daily vocal abuse patterns and working on strategies to eliminate them.
- Implementing strategies to establish more appropriate daily vocal hygiene and vocal health.
- Specific work on elimination of vocal muscle tension.
- Specific work on establishing appropriate breath support and speech breathing patterns.
- Specific work on strengthening the vocal fold muscle for a stronger voice.
Speech therapy is often initiated with home exercises given the same day as the videostroboscopic examination. Follow-up with formal office visits may be indicated by each patient’s specific needs and diagnosis.
Medical therapy for voice disorders most commonly includes treatment for acid reflux. Patients are encouraged to follow some dietary restrictions which will reduce the symptoms associated with acid reflux in the throat. A medication may also be used to reduce the amount of acid production. Medical therapy may also include treating an underlying cause of the hoarseness.
Surgical therapy is sometimes necessary for certain structural abnormalities found during videostroboscopy.
Call Eastern Carolina ENT Head & Neck Surgery at 252-752-5227 for more information or to schedule an appointment.