People develop voice problems for many reasons. Doctors who specialize in ear, nose and throat disorders and speech pathology specialists are involved in diagnosing and treating voice disorders.
Treatment depends on what's causing your voice disorder, but may include voice therapy, medication, injections or surgery.
Causes
Your voice box (larynx) is made of cartilage, muscle and mucous membranes located at the top of your windpipe (trachea) and the base of your tongue. Your vocal cords are two flexible bands of muscle tissue that sit at the entrance of the windpipe. Sound is created when your vocal cords vibrate.
This vibration comes from air moving through the larynx, bringing your vocal cords closer together. Your vocal cords also help close your voice box when you swallow, preventing you from inhaling food or liquid.
If your vocal cords become inflamed, develop growths or become paralyzed, they can't work properly, and you may develop a voice disorder.
Some common voice disorders include:
- Laryngitis
- Muscle tension dysphonia
- Neurological voice disorders, such as spasmodic dysphonia
- Polyps, nodules or cysts on the vocal cords (noncancerous lesions)
- Precancerous and cancerous lesions
- Vocal cord paralysis or weakness
- White patches called leukoplakia
Risk factors
Many risk factors can contribute to a voice disorder, including:
- Aging
- Alcohol use
- Allergies
- Gastroesophageal reflux disease (GERD)
- Illnesses, such as colds or upper respiratory infections
- Improper throat clearing over a long time
- Neurological disorders
- Psychological stress
- Scarring from neck surgery or from trauma to the front of the neck
- Screaming
- Smoking
- Throat cancer
- Throat dehydration
- Thyroid problems
- Voice misuse or overuse
Diagnosis
Your doctor will ask you detailed questions about your voice problems and examine you thoroughly. A topical anesthetic may be applied to numb your vocal cord tissues before your doctor examines them using one of the following tools:
- Mirror. Your doctor inserts a long, rigid instrument with an angled mirror, similar to a dental mirror, into your mouth.
- Flexible laryngoscope. Your doctor inserts a flexible tube containing a light and camera through your nose.
- Rigid laryngoscope. Your doctor inserts a rigid viewing tube through your mouth.
- Videostroboscope. Your doctor inserts a camera that is combined with a flashing light into your mouth to provide a slow-motion view of your vocal cords as they move.
Additional tests are sometimes used:
- Sound (acoustic) analysis. Using computer analysis, your doctor can measure irregularities in the sound produced by the vocal cords.
- Laryngeal electromyography. Small needles are inserted through the skin to measure the electric currents in your voice box muscles.
Treatment
Depending on your diagnosis, your doctor will recommend one or more treatments:
- Rest, liquids and voice therapy. Like any other part of the body, the vocal cords need regular rest and fluids. Speech pathology specialists can teach you how to use your voice more efficiently through voice therapy, how to properly clear your throat and how much liquid to drink.
- Allergy treatments. If an allergy is creating too much mucus in your throat, your doctor or an allergy specialist can identify the allergy's cause and provide treatment.
- Smoking cessation. If your voice problem is the result of smoking, quitting smoking can help improve your voice along with many other areas of your health, such as boosting your heart health and lowering your cancer risk.
- Medications. Several medications are available for treating voice disorders. Depending on the cause of your voice disorder, you may need medication to reduce inflammation, treat gastroesophageal reflux or prevent blood vessel regrowth. Medications can be taken orally, injected into the vocal cords or applied topically during surgery.
Procedures
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Removal of lesions. Noncancerous lesions (polyps, nodules and cysts) on the vocal cords may need to be surgically removed. Your doctor can remove noncancerous, precancerous and cancerous lesions — including recurrent respiratory papillomatosis and white patches (leukoplakia) — using microsurgery, carbon dioxide laser surgery and, when appropriate, the newest laser treatments, including potassium titanyl phosphate (KTP) laser treatment.
KTP laser treatment is a state-of-the-art therapy that treats lesions on the vocal cords. It treats a lesion by cutting off the blood supply to the lesion, allowing the lesion to be removed while preserving the maximum amount of underlying tissue.
- Botox injections. Injections of tiny amounts of onabotulinumtoxinA (Botox) into the skin on your neck may be done in some cases. These injections can decrease muscle spasms or abnormal movements if you have a neurological movement disorder that affects the vocal muscles of the larynx (spasmodic dysphonia).
Sometimes one vocal cord may stop moving (become paralyzed). If you have one paralyzed vocal cord, you might often complain of hoarseness. You might also complain of choking when you drink liquids, but rarely have trouble swallowing solid foods. Sometimes the problem goes away with time.
If the problem persists, your doctor may conduct one of several procedures. These procedures can push the paralyzed vocal cord closer to the middle of the windpipe so that the vocal cords can meet and vibrate closer together. This improves the voice and allows the larynx to close when you swallow.
Treatments include:
- Bulk injection. Body fat, collagen, hyaluronic gel or another approved filler substance is injected, either through your mouth or the skin on your neck, to add bulk to the paralyzed vocal cord or to treat vocal cord weakness. The material fills the space next to your vocal cord and pushes it closer to your other vocal cord, allowing them to vibrate more closely together.
- Thyroplasty. A small opening is created in the cartilage from the outside of your voice box. The doctor inserts an implant through the opening and pushes it against the paralyzed vocal cord, moving it closer to your other vocal cord.
- Replacing the damaged nerve (reinnervation). In this procedure, a healthy nerve is moved from a different area of your neck to replace the damaged vocal cord. Your voice may improve in six to nine months. Some doctors combine this procedure with a bulk injection.
Read more about vocal cord paralysis treatment and allergies at Mayo Clinic.
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