Voice Disorders

There are numerous different disorders which can cause problems with the voice. Some patients have problems with only their voice. Other patients have difficulty with swallowing as well. Common causes for a hoarse voice include swelling of the vocal cords. This can be caused by various factors. Heavy use of the voice or misuse of the voice are common factors in creating this swelling. Another very common cause is acid reflux from the stomach. This acid causes irritation to the throat and voice box and can cause intermittent or constant hoarseness. Other potential causes for hoarseness include abnormalities of the muscles that move the vocal cords. In some patients, the muscles controlling the vocal cords contract too vigorously and can cause disorders known as spastic dysphonia. Chronic muscle tension can also be a cause of hoarseness. In addition, certain benign or cancerous growths can occur on the vocal cords and cause alterations in the voice and sometimes swallowing.

The evaluation of a patient with a voice disorder usually begins with a visit to the Ear, Nose, and Throat physician. A careful history of the patient’s problem will usually narrow the range of potential causes. A physical examination, including the voice box, will often reveal the diagnosis. In some cases, the abnormalities of function of the voice box are not obvious on routine examination. In these cases, the physician may request that video stroboscopy be performed.

Video stroboscopy uses the most up-to-date video and digital imaging technology Photo of video stroboscopyto examine the voice box during the production of voice. This study is performed at Eastern Carolina ENT - Head and Neck Surgery, Inc. Basically, this study gives high resolution video images of the voice box in slow motion so that the vocal cords may each 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 what the problem is. To learn more about video stroboscopy, click here. These examinations are performed by Kathy Cox, PhD, assistant professor at ECU.

The treatment of voice disorders ranges from speech therapy to medical therapy to surgical therapy, depending on the particular diagnosis.

Surgical therapy may consist of removal of an abnormal growth on the voice box. This is most often performed under anesthesia in the Operating Room. Many other types of procedures are available as well, including a procedure done through a small neck incision, called thyroplasty. This operation is offered to patients who have a paralyzed vocal cord on one side. The purpose of this procedure is to move the paralyzed vocal cord closer to the functioning vocal cord so that the patient can produce a stronger and more normal voice again.

Medical therapy for voice disorders most commonly includes treatment for acid reflux. Patients are encouraged to follow some dietary restrictions which will reduce the amount of problems with acid reflux from the stomach into the throat area. Frequently, a medication is used to reduce the production of acid as well. We also recommend elevating the head at night to further reduce the tendency of acid to make its way into the throat while sleeping. Medical therapy may also include treating an underlying cause of the hoarseness. For example, some patients have chronic cough due to some other problem like bronchitis or a medication. Addressing this basic underlying problem will then reduce the strain on the voice box (chronic coughing can cause a lot of inflammation in the voice box).

Speech therapy is used very commonly with many of the voice disorders. Often, speech therapy is the only therapy that is required. Speech therapy may be appropriate for patients with vocal nodules, vocal polyps, vocal cord paralysis, spastic dysphonia, and vocal misuse or overuse, as well as numerous other problems with the voice. A speech therapy assessment consists of:

    • Family, medical, and vocal history
    • Informal assessment of speech articulation/phonology, language, and fluency
    • Oral-facial structure and function
    • Muscular tension sites
    • Maximum sustained phonation
    • Pitch (average, functional range, inflectional contour)
    • Intensity (during interactive conversation and range of flexibility)
    • Quality (oral-nasal resonance balance, hoarseness/roughness, tension, breathy, etc.)

 

Speech therapy is then 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 likely causal factors.
    • Providing the patient with specific information on how the above is/are interfering with normal voice production.
    • Describing the interactive function of the breathing and speech systems to produce normal voice.
    • Assigning the patient out-of-clinic activities designed to make them aware of their 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.

Kathleen Cox, Ph.D., CCC-SLP
Speech-Language Pathologist and Assistant Professor in the Department of Communication Sciences and Disorders at East Carolina University.

Dr. Cox performs advanced voice diagnostic examination at Eastern Carolina ENT-Head and Neck Surgery, Inc. on a part-time basis. Her bachelor's degree in speech-language pathology is from Ithaca College. She received her M.A., and PhD in speech-language pathology at The Ohio State University where her specialty was care of the voice and treatment of voice disorders, the role of the larynx in respiratory disorders, and understanding a specific respiratory disorder called "paradoxical vocal fold dysfunction". At East Carolina University she teaches graduate level courses in Laryngectomy Rehabilitation, Cleft Lip & Palate Speech Disorders, Voice Disorders, and Swallowing Disorders. She has been performing stroboscopic examinations for over 5 years and has extensive training in voice therapy, vocal assessment and stroboscopy.

 

 

 




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