Disorders of the Voice

Most of us are familiar with occasional hoarseness or losing our voice from cheering on our favorite sports team or going through a case of laryngitis.  Allergies and other upper respiratory infections are also common causes of hoarseness or voice changes.  Most disorders of the voice are not worrisome or long lived but some need medical attention and may require further intervention for treatment.   When hoarseness or dysphonia (loss of voice) persists, other conditions should be considered.  These include polyps or nodules that may grow on the vocal cords, vocal paralysis, paradoxical vocal cord movement and spasmodic dysphonia.

  • Vocal Cord Nodules and Polyps– Polyps and nodules are noncancerous and are usually caused by overuse. With time, overuse of the vocal cords will cause areas to swell on the vocal cords.  If not given appropriate time to heal, they will harden and become calloused, developing into hard nodules that can cause hoarseness and other problems with the voice.  Polyps are typically larger than nodules but share many of the same characteristics and symptoms.  Common symptoms of both nodules and polyps include: hoarseness, a scratchy or breathy voice, lump in the throat sensation (also called a globus sensation), pain, decreased range of pitch, voice and body fatigue.  Polyps and nodules are usually diagnosed during a simple in-office procedure called a laryngoscopy which is performed by an otolaryngologist (ENT) like Dr. Bailey.  Depending on the size and effects of the nodule or polyp, surgery or monitoring may be recommended.  It is also important to stop smoking or to control stress as they too can cause significant irritation and strain on the vocal cords.
  • Vocal Cord Paralysis – If one or more of the vocal cords become paralyzed, an individual may experience changes in voice as well as breathing and/or swallowing problems. Injuries to the head and neck, tumors, disease, surgery, and strokes can all cause vocal paralysis by affecting the vagus nerve which serves and controls the movement of the vocal cords.  Depending on the degree of paralysis, treatment may involve speech therapy, muscle-nerve transplantation, medialization thyroplasty (moving the paralyzed vocal cord toward midline), injection of a substance to increase the size of the paralyzed vocal cord or even a tracheotomy to protect the airway and prevent difficulty in breathing.
  • Paradoxical Vocal Fold Movement (PVFM) – This voice disorder occurs when the folds of the vocal cords generally function properly but on occasion close when they should open, often leading both voice and breathing problems. PVFM may even be mistaken for asthma due to the wheezing it can cause.  Common causes of paradoxical vocal fold movement include excessive shouting or coughing, acid reflux, tobacco smoke, breathing cold air, neurological and psychological disorders.  Depending on its cause, PVFM can be treated with behavioral intervention such as vocal exercises, relaxation techniques, proper breathing for speech and of course, avoidance of triggers whenever possible.
  • Spasmodic Dysphonia – This chronic voice disorder results in a strained voice that is often tight, quivery, hoarse or even silent at times. Symptoms come and go, but are typically worse with stress and fatigue and surprisingly improved or even absent when singing or laughing.  Spasmodic dysphonia affects women more often than men and often first occurs between the ages of 30 and 50 years.  Causes of spasmodic dysphonia are usually multifactorial, but most have neurologic disorders that cause abnormal muscle contractions or tremors.  Currently, no cure exists for spasmodic dysphonia, however, Botox injections are often successful in reducing the severity and frequency of symptoms by relaxing the laryngeal muscles.  Speech therapy is also recommended in addition to the Botox injections in order to optimize voice production.