A thorough evaluation is conducted when one of the following disorders is suspected.
CYSTS – Cysts are fluid filled lesions or growths that may be found anywhere on the vocal folds. They often occur as a result of trauma to the vocal folds and typically require surgical removal. Cysts can interfere with the vibration of the vocal folds and may result in a breathy or hoarse vocal quality.
GRANULOMAS – Granulomas of the larynx are benign growths on the vocal folds. They are usually caused by irritation to the tissues or cartilage of the larynx, such as reflux exposure or airway intubation (insertion of a breathing tube). Quality of the voice can be hoarse or husky. Treatment options include medical/surgical and non-surgical management, often in conjunction with speech therapy.
HEMORRHAGE – Vocal fold hemorrhages occur rarely and are typically caused by aggressive or improper use of the vocal folds. A hemorrhage results from a rupture of one of the blood vessels on the vocal fold with bleeding into the surrounding tissue.
LARYNGEAL CANCER - each year approximately 10,000 new cases of laryngeal cancer are diagnosed in the United States. Cancer of the larynx is typically associated with tobacco use. Studies suggest that tobacco in combination with heavy alcohol use significantly multiplies the risk of developing cancers of the larynx or pharynx (throat). Initial symptoms of cancer include persistent hoarseness (lasting for several weeks) or sore throat. Early identification of laryngeal cancer through examination and biopsy is usually associated with a positive outcome. Options for treatment of laryngeal cancer depend on the size, location, and progression of the disease. For those undergoing laryngectomy, or surgical removal of the larynx, options for voice restoration include training in alaryngeal speech production through use of an electrolarynx, esophageal speech, or tracheoesophageal speech. (See Laryngectomy Rehabilitation )
LARYNGEAL PAPILLOMA – Laryngeal papilloma appears as wart like lesions throughout the larynx, including on the vocal folds. Papillomas are caused by the human papilloma virus (HPV).Removal of the papilloma is usually required as it can interfere both with voice production and with breathing.
MUSCLE TENSION DYSPHONIA – Muscle tension dysphonia is a common condition in which there is excessive or inappropriate use of the muscles of the larynx. Vocal symptoms range from a tight, strained voice, breathiness or hoarseness. Speech or voice therapy is usually recommended for muscle tension dysphonia with an emphasis on proper voice placement, breathing, relaxation and muscle control.
PARADOXICAL VOCAL CORD DYSFUNCTION (PVCD) This condition may also be known as laryngospasm or vocal cord dysfunction,, in which the vocal folds close or adduct during inhalation (which is opposite to the usual motion of opening during inhalation). This condition may be exacerbated by reflux disease. Therapy for PVCD includes medical management of the condition causing the laryngospasm (ie. if reflux if suspected) in combination with speech/voice therapy that includes exercises of relaxation and breathing.
POLYPS – Vocal polyps are growths typically occurring on only one vocal fold. They can be small or large and may be found on any location of the vocal fold. Polyps typically result from voice misuse or trauma and are sometimes seen after a hemorrhage of the vocal fold. Surgery is often required to remove the polyp, in addition to speech.
REFLUX RELATED LARYNGEAL IRRITATION – Reflux is a condition in which acid or stomach contents backflow to the esophagus (gastroesophageal reflux). In certain cases, the reflux can backflow up to the level of the larynx or pharynx (throat), also known as laryngopharyngeal reflux (LPR). The erosive nature of the reflux can cause irritation and inflammation of the tissues of the throat, causing hoarseness and sore throats. Medical management of the reflux, if indicated, is the first line of treatment. In certain cases, speech or voice therapy is recommended to improve optimal laryngeal function and use of the voice during and after healing has occurred.
SPASMODIC DYSPHONIA (SD) – Spasmodic dysphonia is a voice disorder that results in involuntary spasms at the level of the larynx. In spasmodic dysphonia, the voice can sound tight, breathy or strained. The origin of the disorder is believed to be neurological (related to the brain and nervous system). Although there is no “cure” for spasmodic dysphonia, one of the most effective treatments to date has been small injections of botulinum toxin (Botox) into the muscles of the larynx. The injection weakens the muscles through blocking the nerve impulse to that specific muscle. Repeated injections may be needed every few months and the patient with spasmodic dysphonia may also work with speech therapy to optimize vocal quality.
TRAUMA – Trauma to the larynx can result from falls, sports injuries or motor vehicle accidents. The resultant damage to the larynx can vary, depending on the type of injury. Surgery or medical management may be required.
VOCAL FOLD ATROPHY OR BOWING – Bowing of the vocal folds results in a small gap in the middle of the folds causing incomplete closure. Although there are several reasons for why a vocal fold can become bowed, one of the more common reasons is aging. Vocal quality can be weak, breathy, or hoarse due to the weakened muscles of the vocal folds. Therapy is sometimes recommended to improve strength and flexibility of the vocal fold musculature.
VOCAL FOLD PARALYSIS - Vocal fold paralysis results from injury to the nerve that supplies movement to the vocal fold. Paralysis can occur as a result of a neurological condition or disease (i.e. stroke), trauma, or viral infection. In some cases, the cause of the paralysis is unknown, or idiopathic. Paralysis of the vocal fold can be temporary or permanent and may affect either one or both vocal folds. The voice may sound breathy or hoarse, and in extreme cases, a paralysis may result in no voice. A vocal fold paralysis sometimes causes difficulty breathing. In certain circumstances, surgery or medical procedures are performed to improve the opening or closure of the airway which can aid both voice production and/or provide better airway protection during swallowing. Options for surgical management include augmentation of the vocal fold through injection or moving the weak vocal fold closer to the other one through a procedure called medialization. Therapy is sometimes recommended before or after surgery to assist the patient in optimal use of their voice through exercise and compensation.
VOCAL NODULES – Vocal nodules appear as small, callous-like bumps where the anterior 1/3 and posterior 2/3 of the vocal folds meet. Nodules often occur bilaterally, or on both vocal folds, and are typically caused by vocal misuse or overuse. The voice may sound breathy or hoarse, may fatigue easily, or may have loss of range due to incomplete closure during movement of the vocal folds,. Nodules can be reduced or eliminated through proper care. Speech or voice therapy is typically recommended to identify patterns of voice misuse and improve vocal habits or use.
Contact the Voice and Swallowing Center at 678-843-7586.
Multimedia