Voice Disorders

There are numerous factors that can cause problems with the voice:

  • Heavy voice users (teachers, singers, performers, etc.)
  • Chronic cough or persistent throat clearing
  • Smoking
  • A virus or illness
  • Acid reflux (LPR or GERD)
  • Allergies
  • Sinus
  • Inadequate breath support

These common factors can create persistent hoarseness that does not go away with time. Hoarseness can mean any number of things could be going on with the vocal folds, including swelling, chronic irritation, or a learned pattern of muscle tension with voicing. 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. In addition, certain benign or cancerous growths can occur on the vocal cords and cause alterations in the voice and sometimes swallowing.  It is recommended to see a doctor for evaluation of any hoarseness that lasts for several weeks without resolving.

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. The physician may order a videostroboscopy examination be performed by a speech-language pathologist to assess function and structures of the voice box.

Videostroboscopy uses modern video and digital imaging technology to examine the voice box during the production of voice. The 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. This study is performed at Eastern Carolina ENT Head & Neck Surgery

To learn more about Videostroboscopy, click here.

Once videostroboscopy has been completed and a diagnosis made, a plan of action will be enacted to best treat the voice disorder. The treatment of voice disorders ranges from speech therapy to medical therapy to surgical therapy, depending on the particular diagnosis.
Speech therapy is used very commonly with many of the voice disorders. Often, speech therapy is the only therapy that is required. Speech therapy is appropriate for patients with vocal nodules, muscle tension dysphonia, vocal misuse or overuse, patients with weakness of their vocal folds, and patients who are post-op from surgery to their vocal folds, as well as numerous other problems with the voice. Speech therapy is 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.
  • Explaining how the above is/are interfering with normal voice production.
  • Describing the necessary coordination 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.
  • Specific work on strengthening the vocal fold muscle for a stronger voice

Speech therapy is often initiated with home exercises given the same day as videostroboscopy and diagnosis of the issue are completed. Follow-up with formal office visits are indicated by each patient’s specific needs and diagnosis.
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).
Surgical therapy is sometimes necessary to for certain issues found during videostroboscopy.

For example, the following is not an exhaustive list of issues requiring surgery, but names some of the most common:

  • Removal of an abnormal growth on the voice box
  • Radiesse Injection, a procedure involving a reabosrbable material being injected into the vocal folds to temporarily improved the voice of someone with a paralyzed vocal fold on one side
  • Thyroplasty, a procedure involving a small implant placed through a small neck incision to permanently improve the voice of someone with a paralyzed vocal fold on one side
  • Botox injections in the voice box, a procedure used to paralyze uncontrollable spasms of the vocal folds
To learn more about Videostroboscopy, click here.
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