There are numerous different disorders that 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 misuses 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
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 E-N-T - 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.
learn more about Video
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
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
- 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
- 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:
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
- Describing the interactive function of the
breathing and speech systems to produce
- Assigning the patient out-of-clinic activities
designed to make them aware of their daily vocal
- 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
- Specific work on establishing appropriate breath
support and speech breathing patterns.