VOICE DISORDERS

Most changes in the voice result from a medical disorderFailure to seek a physician’s care can lead to hoarseness and more serious problems.

What is Laryngitis?

Laryngitis is a swelling of the vocal cords usually due to an infectionA viral infection (a “cold”) of the upper respiratory track is the most common cause for infection of the voice boxWhen the vocal cords swell in sizethey vibrate differentlyleading to hoarsenessThe best treatment for this condition is to rest or reduce your voice use and stay well hydratedSince most of these infections are caused by a virusantibiotics are not effectiveIt is important to be cautious with your voice during an episode of laryngitisbecause the swelling of the vocal cords increases the risk for serious injury such as blood in the vocal cords or formation of vocal cord nodulespolypor 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 cordsThese lesions (“bumps”) on the vocal cord(s) alter vocal cord vibrationThis abnormal vibration results in hoarseness and a chronic change in one’s voice qualityincluding roughnessraspinessand 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 cordsThey typically occur on both vocal cords opposite each otherThese 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 misuseoveruseor trauma to the vocal cords and frequently require surgical removal after all nonsurgical treatment options (i.e., speech therapy) have failed.

Gastroesophageal & 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 throatHoarseness (chronic or intermittent)swallowing problemsa foreign body sensationor throat pain are common symptoms of gastric acid irritation of the throatcalled 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 timeThe at-night aspect of LPRD is thought to be the hardest to diagnose because there are usually no specific symptoms while the reflux occursConsequentlypatients will awake with throat irritationhoarsenessand throat discomfort without knowing the causeAn examination of the throat by one of our ENT physicians 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 pitcheither too high or too lowand leads to hoarseness and a variety of other voice problemsExamples of this condition are when young adult femalesin a work environmentconsciously or subconsciously choose to speak at a lower than appropriate pitch and with a heavy voicePercussive speakinga voice too loud or focusing on the first syllable of each wordis 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 talkingspecifically breathing from the shoulders or neck area instead of from the lower chest or abdominal areaThe consequence of this practice is increased tension in the throat and neck muscleswhich can cause hoarseness and a variety of symptomsespecially pain and fatigue associated with talkingVoice problems can also occur from using your voice in an unnatural positionsuch as talking on the phone cradled to your shoulderThis requires excessive tension in the neck and laryngeal muscleswhich 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 larynxThe most common condition is a paralysis or weakness of one or both vocal cordsInvolvement of both vocal cords is rare and is usually manifested by noisy breathing or difficulty getting enough air while breathing or talkingHoweverone vocal cord can become paralyzed or severely weakened (paresis) after a viral infection of the throatafter surgery in the neck or cheekor for unknown reasons.

The immobile or paralyzed vocal cord typically causes a softbreathyweak voice due to poor vocal cord closureMost paralyzed vocal cords will recover on their own within several monthsThere is a possibility that the paralysis may become permanentwhich may require surgical treatmentSurgery 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 cordThere are a variety of surgical techniques used to reposition the vocal cordSometimes speech therapy may be used before or after surgical treatment of the paralyzed vocal cords or sometimes as the sole treatmentTreatment 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 attentionWhen cancer attacks the vocal cordsthe voice changes in qualityassuming the characteristics of chronic hoarsenessroughnessor raspinessThese symptoms occur at an early stage in the development of the cancerIt is important to remember that prompt attention to changes in the voice facilitate early diagnosisthus 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 one of our ENT physicians to determine if there is cancer of the larynx (voice box)Different treatment options for this cancer of the voice box include surgeryradiation therapyand/or chemotherapyWhen vocal cord cancer is found earlytypically only surgery or radiation therapy is requiredand the cure rate is high (greater than 90 percent).

Hoarseness or roughness in your voice is often caused by a medical problemContact one of our ENT physicians if you have any sustained changes to your voice.

SWALLOWING DISORDERS

Difficulty in swallowing (dysphagia) is common among all age groupsespecially the elderlyThe term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomachThis may be caused by many factorsmost of which are temporary and not threateningDifficulties in swallowing rarely represent a more serious diseasesuch as a tumor or a progressive neurological disorderWhen the difficulty does not clear up by itself in a short period of timeyou should see one of our ENT physicians.

How do we swallow?

People normally swallow hundreds of times a day to eat solidsdrink liquidsand swallow the normal saliva and mucus that the body produces.

The process of swallowing has four related stages:

  • The first stage is the oral preparation stagewhere food or liquid is manipulated and chewed in preparation for swallowing.
  • The second stage is the oral stagewhere the tongue propels the food or liquid to the back of the mouthstarting the swallowing response.
  • The third stage is the pharyngeal stage which begins as food or liquid is quickly passed through the pharynxthe region of the throat which connects the mouth with the esophagusthen into the esophagus or swallowing tube.
  • In the finalesophageal stagethe food or liquid passes through the esophagus into the stomach.

Although the first and second stages have some voluntary controlstages three and four occur involuntarilywithout conscious input.

Swallowing disorder symptoms

Symptoms of swallowing disorders may include:

  • Drooling.
  • A feeling that food or liquid is sticking in the throat.
  • Discomfort in the throat or chest (when gastro esophageal reflux is present).
  • A sensation of a foreign body or “lump” in the throat.
  • Weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing.
  • Coughing or choking caused by bits of foodliquidor saliva not passing easily during swallowing and being sucked into the lungs.
  • Voice change.

How are swallowing disorders diagnosed?

When dysphagia is persistent and the cause is not apparentour ENT physician will discuss the history of your problem and examine your mouth and throatThis may be done with the aid of mirrorsSometimes a small tube (flexible laryngoscope) is placed through the nose and the patient is then given food to eat while the scope is in place in the throatThese procedures provide visualization of the back of the tonguethroatand larynx (voice box)These procedures are called FEES (Fiber optic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing)If necessaryan examination of the esophagusnamed TransNasal Esophagoscopy (TNE)may be carried out by one of our ENT doctorsIf you experience difficulty swallowingit is important to seek treatment to avoid malnutrition and dehydration.

Swallowing disorder treatment

Many of these disorders can be treated with medicationDrugs that slow stomach acid productionmuscle relaxantsand antacids are a few of the many medicines availableTreatment is tailored to the particular cause of the swallowing disorder.

Gastro esophageal reflux can often be treated by changing eating and living habits in these ways:

  • Eat a bland diet with smallermore frequent meals.
  • Eliminate tobaccoalcoholand caffeine.
  • Reduce weight and stress.
  • Avoid food within two hours of bedtime.
  • Elevate the head of the bed at night.

If these don’t helpantacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapyA speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflexPatients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.

Some patients with swallowing disorders have difficulty feeding themselvesAn occupational therapist or a speech language pathologist can aid the patient and family in feeding techniquesThese techniques make the patient as independent as possibleA dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

Once the cause is determinedswallowing disorders may be treated with:

  • Medication
  • Swallowing therapy
  • Surgery

Surgery is used to treat certain problemsIf a narrowing exists in the throat or esophagusthe area may need to be stretched or dilatedIf a muscle is too tightit may need to be dilated or released surgicallyThis procedure is called a myotomy and can be performed by one of our ENT physicians.

Many diseases contribute to swallowing disordersIf you have a persistent problem swallowingplease make an appointment with one of our ENT doctors.

Swallowing disorder causes

Any interruption in the swallowing process can cause difficultiesEating slowly and chewing thoroughly can help reduce problems with swallowingHoweverdifficulties may be due to a range of other causesincluding something as simple as poor teethill fitting denturesor a common coldOne of the most common causes of dysphagia is gastro esophageal refluxThis occurs when stomach acid moves up the esophagus to the pharynxcausing discomfortOther causes may include: hypertensiondiabetesthyroid diseasestrokeprogressive neurologic disorderthe presence of a tracheotomy tubea paralyzed or unmoving vocal corda tumor in the mouththroator esophagusor surgery in the headneckor esophageal areas.

Swallowing difficulty can also be connected to some medications including:

  • Nitrates.
  • Anticholinergic agents found in certain anti-depressants and allergy medications.
  • Calcium tablets.
  • Calcium channel blockers.
  • Aspirin.
  • Iron tablets.
  • Vitamin C.
  • Antipsychotic.
  • Tetracycline (used to treat acne).