VOICE DISORDERS

Listening to the healthy voice of a professional singer can be a dramatic and beautiful experience.  There are many conditions that can cause difficulties with the voice.  These can range from conditions as simple as a routine head cold up to something as complicated as a life-threatening cancer of the voice box.

The most common reason for acute hoarseness is related to an upper respiratory viral infection (a simple head cold).  This can cause direct swelling of the vocal cords or can cause mucous to drain down the back of the throat which can cause irritation and swelling of the vocal cords.  In either case, treatment is aimed at relieving symptoms such as pain and fever, and these conditions are usually self-limited.

Another very common reason for chronic or intermittent hoarseness is from acid reflux disease.  Stomach acid, which is very corrosive, trickles out of the stomach and up the esophagus (swallowing tube) irritating the voice box directly.  This can cause swelling and sometimes even a small growth of tissue called a granuloma on the vocal cord.  Treating the acid reflux, with dietary and lifestyle modifications, and sometimes with medication normally takes care of his condition.

Some people develop hoarseness because of an abnormal use of the throat muscles.  This sometimes happens after a bad case of laryngitis (such as from a head cold or bronchitis).  A person suffering with an acute laryngitis will sometimes force their voice and start using accessory muscles of the throat that they would not normally use.  This habit can out last the actual laryngitis and cause the persistent hoarseness.  This can usually be remedied with speech pathology services.

Another common cause of hoarseness is vocal nodules. These are tiny callus-like growths that occur on both vocal cords, usually from over use or abuse of the voice. They commonly occur in children who scream a lot and professional voice users such as singers or public speakers. Because of their causes, they are sometimes referred to as “screamer’s” or “singer’s” nodules. Vocal therapy is the usual treatment – aimed at changing bad habits and educating toward healthy vocal technique.

A relatively uncommon cause of hoarseness is from a disease called respiratory papillomatosis. Papillomas of the vocal cords are “warty” growths that can occur anywhere on the body, and are believed to be caused by a viral infection from one of the many Human Papilloma Viruses (HPV). If allowed to grow large, they can also cause breathing difficulties. They may show up at any age (including infants!) and are commonly treated with a surgical laser.

Paralysis of a vocal cord can cause voice problems and can occur for various reasons. The most common cause of this is following surgery to the neck or thyroid gland. The voice box is controlled by a pair of nerves, one on each side, which leaves the skull, runs down the neck into the upper chest, loops around and runs back up the neck to the voice box. Bruising or stretching of the nerve can cause temporary hoarseness that can last a few days up to a few months. Permanent injury to the nerve can cause a permanent problem that can be treated with an operation to “move” the abnormal vocal cord into a better position.

Several different types of growths can occur on the vocal cords which can lead to hoarseness. Benign growths, such as polyps and cysts can be caused by vocal abuse, or smoking and can usually be removed surgically. Of course, if the causative factors are not eliminated (such as smoking) they frequently come back. More dangerous cancerous growths can also occur in the voice box. These are almost always associated with tobacco smoking and often with alcohol abuse. Anybody who suffers with hoarseness for more than 2-3 weeks should be examined to make sure they do not have throat cancer. Like most cancers, the earlier it is identified, the more likely it is to be curable. Treatment can range from radiation therapy with or without chemotherapy to surgery. The surgery is sometimes easy and involves endoscopic removal of a very small tumor up to a total removal of the voice box (laryngectomy).

Since there are many different causes of voice problems, only a qualified Otolaryngologist (Ear, Nose and Throat Physician) can properly evaluate and treat these conditions. Most can be diagnosed with a simple office visit, but occasionally surgical endoscopy is necessary. The most important thing is to never ignore hoarseness that lasts more than 2 weeks.