| Most changes in the voice result from a
medical disorder. Failure to seek a physician’s care can lead to
hoarseness and more serious problems. They include:
Laryngitis
Laryngitis is a swelling of
the vocal cords usually due to an infection. A viral infection (a “cold”)
of the upper respiratory track is the most common cause for infection of
the voice box. When the vocal cords swell in size, they vibrate
differently, leading to hoarseness. The best treatment for this condition
is to rest or reduce your voice use and stay well hydrated. Since most of
these infections are caused by a virus, antibiotics are not effective. It
is important to be cautious with your voice during an episode of
laryngitis, because the swelling of the vocal cords increases the risk for
serious injury such as blood in the vocal cords or formation of vocal cord
nodules, polyp, or cysts. |
 |
This document is in PDF format; a free
version of Adobe Acrobat Reader® if it's not already on your
system.
Click
here for
a print version of "Laryngeal (Voice Box)
Cancer." |
|
|
Vocal cord
lesions
Benign noncancerous growths on the vocal cords are
caused by voice misuse or overuse and from trauma or injury to the vocal
cords. These lesions (“bumps”) on the vocal cord(s) alter vocal cord
vibration. This abnormal vibration results in hoarseness and a chronic
change in one’s voice quality, including roughness, raspiness, and an
increased effort to talk. The most common vocal cord lesions include vocal
nodules also known as “singer’s nodes” or “nodes” which are similar to
“calluses ” of the vocal cords. They typically occur on both vocal cords
opposite each other. These lesions are usually treated with voice rest and
speech therapy (to improve the speaking technique thus removing the trauma
on the vocal cords). Vocal cord polyp(s) or cyst(s) are other common vocal
cord lesions caused by misuse, overuse, or trauma to the vocal cords and
frequently require surgical removal after all nonsurgical treatment
options (i.e., speech therapy) have failed.
Gastroesophageal reflux disease and
laryngopharyngeal reflux disease
Reflux (backflow of
gastric contents) into the throat of stomach acid can cause a variety of
symptoms in the esophagus (swallowing tube) as well as in the throat.
Hoarseness (chronic or intermittent), swallowing problems, a foreign body
sensation, or throat pain are common symptoms of gastric acid irritation
of the throat, called laryngopharyngeal reflux disease (LPRD). LPRD is
difficult to diagnose because approximately half of the patients with this
disorder have no heartburn symptoms which traditionally accompany
gastroesophageal reflux disease (GERD).
Your gastric acid can flow
up to the throat at any time. The at-night aspect of LPRD is thought to be
the hardest to diagnose because there are usually no specific symptoms
while the reflux occurs. Consequently, patients will awake with throat
irritation, hoarseness, and throat discomfort without knowing the cause.
An examination of the throat by an otolaryngologist will determine if
stomach acid is causing irritation of the throat and voice box.
Poor speaking
technique
Improper or poor speaking technique is caused
from speaking at an abnormally or uncomfortable pitch, either too high or
too low, and leads to hoarseness and a variety of other voice problems.
Examples of this condition are when young adult females, in a work
environment, consciously or subconsciously choose to speak at a lower than
appropriate pitch and with a heavy voice. Percussive speaking, a voice too
loud or focusing on the first syllable of each word, is another improper
speaking technique that may result in injury or trauma to the vocal cords
and muscles causing “vocal fatigue”.
Other factors leading to
improper speaking technique include insufficient or improper breathing
while talking, specifically breathing from the shoulders or neck area
instead of from the lower chest or abdominal area. The consequence of this
practice is increased tension in the throat and neck muscles, which can
cause hoarseness and a variety of symptoms, especially pain and fatigue
associated with talking. Voice problems can also occur from using your
voice in an unnatural position, such as talking on the phone cradled to
your shoulder. This requires excessive tension in the neck and laryngeal
muscles, which changes the speaking technique and may result in a voice
problem.
Vocal cord
paralysis
Hoarseness and other problems can occur related
to problems between the nerves and muscles within the voice box or larynx.
The most common condition is a paralysis or weakness of one or both vocal
cords. Involvement of both vocal cords is rare and is usually manifested
by noisy breathing or difficulty getting enough air while breathing or
talking. However, one vocal cord can become paralyzed or severely weakened
(paresis) after a viral infection of the throat, after surgery in the neck
or cheek, or for unknown reasons.
The immobile or paralyzed vocal
cord typically causes a soft, breathy, weak voice due to poor vocal cord
closure. Most paralyzed vocal cords will recover on their own within
several months. There is a possibility that the paralysis may become
permanent, which may require surgical treatment. Surgery for unilateral
vocal cord paralysis involves positioning of the vocal cord to improve the
vibration of the paralyzed vocal cord with the non-paralyzed vocal cord.
There are a variety of surgical techniques used to reposition the vocal
cord. Sometimes speech therapy may be used before or after surgical
treatment of the paralyzed vocal cords or sometimes as the sole treatment.
Treatment choices depend on the nature of the vocal cord paralysis as well
as the patient’s voice demands.
Throat
cancer
Throat cancer is a very serious condition requiring
immediate medical attention. When cancer attacks the vocal cords, the
voice changes in quality, assuming the characteristics of chronic
hoarseness, roughness, or raspiness. These symptoms occur at an early
stage in the development of the cancer. It is important to remember that
prompt attention to changes in the voice facilitate early diagnosis thus
early and successful treatment of vocal cord cancer can be
obtained.
Persistent hoarseness
or change in the voice for longer than two to four weeks in a smoker
should prompt evaluation by an otolaryngologist to determine if there is
cancer of the larynx (voice box). Different treatment options for
this cancer of the voice box include surgery, radiation therapy, and/or
chemotherapy. When vocal cord cancer is found early, typically only
surgery or radiation therapy is required, and the cure rate is high
(greater than 90 percent).
Hoarseness
or roughness in your voice is often caused by a medical
problem. Contact
an otolaryngologist—head and neck surgeon if you have any sustained
changes to your voice.
|
