Voice Disorders

Dysphonia is the medical term for a voice disorder, typically presenting as hoarseness or changes in voice quality. Hoarseness that lasts longer than four weeks may signal a more serious vocal cord issue.

Symptoms of dysphonia may include:

• Dry, scratchy throat
• Hoarse or breathy voice
• Sore throat or vocal discomfort

Common causes include:

• Inflammation of the larynx (voice box)
• Vocal cord nodules (lumps) or other benign lesions
• Underactive thyroid (hypothyroidism)
• Vocal trauma that results in scarring
• Reinke’s edema
• Psychological stress or anxiety, which may lead to sudden voice changes, often after a cold

Depending on the underlying cause, your ENT may recommend further testing or a combination of medical management and speech therapy. If dysphonia is linked to a more serious condition, you’ll be referred to the appropriate vocal health specialist for advanced treatment.

Laryngopharyngeal reflux occurs when acid from the stomach flows backward into the throat and irritates the vocal cords. Unlike typical acid reflux, LPR may not cause heartburn.

Potential causes include:

• Malfunctioning upper or lower esophageal sphincter
• Hiatal hernia
• Abnormal esophageal contractions
• Slow emptying of the stomach

In addition, other factors may include:

• Diet choices (including chocolate, citrus, fatty foods, and spices)
• Overeating
• Alcohol and tobacco abuse
• Sometimes pregnancy

Symptoms of laryngopharyngeal reflux may include:

• Bitter taste in the throat (especially in the morning)
• Feeling that something is stuck in your throat
• Hoarseness
• Throat pain
• Burning sensation in the throat

• Difficulty swallowing

• Chronic cough

Treatment

Your doctor will most likely prescribe a medication to decrease acid production in the stomach, as well as suggest certain dietary and lifestyle changes that will help in reducing the reflux symptoms.

Reinke’s edema is a condition where fluid accumulates in the vocal cords due to long-term irritation or trauma, often from vocal overuse, gastric reflux, or cigarette smoking. It’s most commonly seen in middle-aged or postmenopausal women who smoke.

Symptoms include:

• Deep, husky voice
• Vocal fatigue
• Decreased vocal range

Treatment

Your doctor will try to address the underlying cause of Reinke's edema. If you are a smoker, you will be strongly encouraged to stop. If your condition is caused by gastric reflux, your doctor will prescribe treatment to treat that problem. Speech therapy is also prescribed for vocal rehabilitation that encourages proper use of your voice and vocal folds.

In some cases, surgery is recommended. The surgery performed to treat this condition is called vocal fold phonomicrosurgery. It involves the use of endoscopic tools, microlaryngeal instruments, and specialized techniques to repair the vocal folds.

The subglottis is the area just below the vocal cords. Subglottic stenosis refers to narrowing of this airway, which can cause breathing difficulties and is sometimes misdiagnosed as asthma.

Symptoms may include:

• Difficulty breathing (especially when inhaling)
• Noisy breathing
• Hoarseness

Treatments options

Depending on the severity of the narrowing, different treatments may be recommended. These may include:

• Laser resection: The surgeon will widen the narrowed part of the throat, making it easier for the patient to breathe. This may require multiple surgeries. Mitomycin, a chemical that decreases scar tissue formation, may be applied to decrease the chance of recurrent narrowing.
• Balloon dilation: The area of narrowing may be dilated with an inflatable balloon. This method is less invasive than the traditional method of placing rigid endoscopes through the area of narrowing. Multiple dilations may be required to ensure that the area of narrowing remains open.
• Tracheal resection: This procedure is usually performed with our colleagues in thoracic surgery. The area of narrowing is removed through an incision in the neck, and the two ends are brought back together. It usually requires hospitalization for approximately four to seven days after surgery.

Vocal cord nodules are benign, callus-like growths that form due to chronic vocal strain. Polyps, on the other hand, are often larger, blister-like lesions caused by vocal misuse or acute trauma.

Symptoms of nodules and polyps are similar and may include:

• Hoarseness
• Rough or scratchy voice
• Shooting ear pain or neck tension
• Vocal fatigue
• Sensation of a lump in the throat

Common causes include:

• Chronic vocal abuse (e.g., yelling, excessive talking)
• Long-term smoking
• Hypothyroidism
• Gastric reflux

Treatment

Nodules can be treated medically and with behavior modification, while polyps usually require surgery, followed by speech therapy. The underlying cause will be addressed first with medicine and speech therapy. Voice therapy includes learning proper vocal techniques, eliminating behaviors that harm the voice, and stress-reduction techniques.

The vocal cords are two elastic bands of muscle tissue located in the voice box (larynx) directly above the windpipe (trachea). These cords allow you to speak because when air held in the lungs is released and passed through the closed vocal cords, it causes them to vibrate. When you are not speaking, the vocal cords remain apart so you can breathe.

Vocal cord paralysis occurs when one or both vocal folds cannot move properly, leading to voice, breathing, or swallowing difficulties. When cords don’t close fully, the airway is left unprotected, leading to impaired voice production.

Symptoms include:

• Breathy or hoarse voice
• Difficulty speaking loudly or projecting
• Limited pitch control
• Coughing or choking while eating
• Difficulty breathing

Types of vocal cord paralysis and treatment:

• Unilateral paralysis: When only one vocal cord is affected, you may run out of air easily and be unable to speak clearly and with sufficient loudness to be understood. Unilateral vocal fold paralysis can be treated medically and/or with speech therapy. Surgical treatment may involve:
  • Vocal fold injections: Injections to bulk up the paralyzed cord and improve closure.
  • Thyroplasty: Surgery to move the paralyzed cord toward the center of the voice box through an incision in the neck.
  • Arytenoid adduction: A procedure to rotate part of the voice box for improved vocal closure, often performed with thyroplasty.
• Bilateral paralysis: Bilateral vocal fold paralysis affects both vocal folds, often resulting in airway obstruction. Bilateral vocal fold paralysis can be medically treated but frequently requires a tracheotomy to allow the person to eat and breathe safely. Other surgical procedures to open the airway may include a cordotomy (an incision in the vocal fold), and an arytenoidectomy (removal of part of the voice box).

In most cases, speech-language pathologists play a vital role in recovery. Speech therapy focuses on optimizing vocal technique, breath support, and reducing harmful vocal behaviors.

Laryngeal cancers are malignant (cancerous) growths found in the larynx (voice box). Because of their location, they are highly treatable if caught early, with a cure rate of around 90 percent.

You should see an ENT specialist if your voice is hoarse, weak, or different from normal for more than two to four weeks, especially if it's not caused by a cold. You should also get checked if you’re having trouble speaking, breathing, or using your voice without strain. Early treatment can prevent long-term damage and help you feel better faster.

Voice disorders can happen for many reasons. Common causes include vocal strain or overuse, infections, acid reflux, nerve problems, injuries, or growths like nodules or polyps. Sometimes, a medical condition like thyroid disease or stress can affect your voice too. A specialist can help figure out what’s going on and how to treat it.

Treatment depends on the cause of your voice problem. Many people improve with voice therapy, medication, or lifestyle changes like avoiding irritants or managing reflux. In some cases, surgery may be needed to fix a growth or correct how the vocal cords move. Your care team will create a personalized plan that fits your needs.