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Most changes in the voice result from a
medical disorder. Failure to seek a physician’s care can lead to
hoarseness and more serious problems.
Laryngitis
Laryngitis is a swelling of the vocal cords usually due to an
infection. A viral infection (a “cold”) of the upper respiratory
track is the most common cause for infection of the voice box. When
the vocal cords swell in size, they vibrate differently, leading to
hoarseness. The best treatment for this condition is to rest or
reduce your voice use and stay well hydrated. Since most of these
infections are caused by a virus, antibiotics are not effective. It
is important to be cautious with your voice during an episode of
laryngitis, because the swelling of the vocal cords increases the
risk for serious injury such as blood in the vocal cords or
formation of vocal cord nodules, polyp, or cysts.
Vocal Cord
Lesions
Benign noncancerous growths
on the vocal cords are caused by voice misuse or overuse and
from trauma or injury to the vocal cords. These lesions
(“bumps”) on the vocal cord(s) alter vocal cord vibration.
This abnormal vibration results in hoarseness and a chronic
change in one’s voice quality, including roughness,
raspiness, and an increased effort to talk. The most common
vocal cord lesions include vocal nodules also known as
“singer’s nodes” or “nodes” which are similar to “calluses ”
of the vocal cords. They typically occur on both vocal cords
opposite each other. These lesions are usually treated with
voice rest and speech therapy (to improve the speaking
technique thus removing the trauma on the vocal cords).
Vocal cord polyp(s) or cyst(s) are other common vocal cord
lesions caused by misuse, overuse, or trauma to the vocal
cords and frequently require surgical removal after all
nonsurgical treatment options (i.e., speech therapy) have
failed.
Gastroesophageal Reflux
Disease And Laryngopharyngeal Reflux Disease
Reflux (backflow
of gastric contents) into the throat of stomach acid can
cause a variety of symptoms in the esophagus (swallowing
tube) as well as in the throat. Hoarseness (chronic or
intermittent), swallowing problems, a foreign body
sensation, or throat pain are common symptoms of gastric
acid irritation of the throat, called laryngopharyngeal
reflux disease (LPRD). LPRD is difficult to diagnose because
approximately half of the patients with this disorder have
no heartburn symptoms which traditionally accompany
gastroesophageal reflux disease (GERD).
Your gastric
acid can flow up to the throat at any time. The at-night
aspect of LPRD is thought to be the hardest to diagnose
because there are usually no specific symptoms while the
reflux occurs. Consequently, patients will awake with throat
irritation, hoarseness, and throat discomfort without
knowing the cause. An examination of the throat by an
otolaryngologist will determine if stomach acid is causing
irritation of the throat and voice box.
Poor Speaking Technique
Improper or poor
speaking technique is caused from speaking at an abnormally
or uncomfortable pitch, either too high or too low, and
leads to hoarseness and a variety of other voice problems.
Examples of this condition are when young adult females, in
a work environment, consciously or subconsciously choose to
speak at a lower than appropriate pitch and with a heavy
voice. Percussive speaking, a voice too loud or focusing on
the first syllable of each word, is another improper
speaking technique that may result in injury or trauma to
the vocal cords and muscles causing “vocal fatigue”.
Other factors leading to improper speaking technique include
insufficient or improper breathing while talking,
specifically breathing from the shoulders or neck area
instead of from the lower chest or abdominal area. The
consequence of this practice is increased tension in the
throat and neck muscles, which can cause hoarseness and a
variety of symptoms, especially pain and fatigue associated
with talking. Voice problems can also occur from using your
voice in an unnatural position, such as talking on the phone
cradled to your shoulder. This requires excessive tension in
the neck and laryngeal muscles, which changes the speaking
technique and may result in a voice problem.
Vocal Cord Paralysis
Hoarseness and
other problems can occur related to problems between the
nerves and muscles within the voice box or larynx. The most
common condition is a paralysis or weakness of one or both
vocal cords. Involvement of both vocal cords is rare and is
usually manifested by noisy breathing or difficulty getting
enough air while breathing or talking. However, one vocal
cord can become paralyzed or severely weakened (paresis)
after a viral infection of the throat, after surgery in the
neck or cheek, or for unknown reasons.
The immobile
or paralyzed vocal cord typically causes a soft, breathy,
weak voice due to poor vocal cord closure. Most paralyzed
vocal cords will recover on their own within several months.
There is a possibility that the paralysis may become
permanent, which may require surgical treatment. Surgery for
unilateral vocal cord paralysis involves positioning of the
vocal cord to improve the vibration of the paralyzed vocal
cord with the non-paralyzed vocal cord. There are a variety
of surgical techniques used to reposition the vocal cord.
Sometimes speech therapy may be used before or after
surgical treatment of the paralyzed vocal cords or sometimes
as the sole treatment. Treatment choices depend on the
nature of the vocal cord paralysis as well as the patient’s
voice demands.
Throat Cancer
Throat cancer is a
very serious condition requiring immediate medical
attention. When cancer attacks the vocal cords, the voice
changes in quality, assuming the characteristics of chronic
hoarseness, roughness, or raspiness. These symptoms occur at
an early stage in the development of the cancer. It is
important to remember that prompt attention to changes in
the voice facilitate early diagnosis thus early and
successful treatment of vocal cord cancer can be obtained.
Persistent hoarseness or change in the voice for longer
than two to four weeks in a smoker should prompt evaluation
by an otolaryngologist to determine if there is cancer of
the larynx (voice box). Different treatment options for this
cancer of the voice box include surgery, radiation therapy,
and/or chemotherapy. When vocal cord cancer is found early,
typically only surgery or radiation therapy is required, and
the cure rate is high (greater than 90 percent).
Hoarseness or roughness in your voice is often caused by
a medical problem. Contact an
otolaryngologist—head and neck surgeon if you have any
sustained changes to your voice.
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