General ENT

Swallowing and Voice Disorders


Though we often take our ability to eat and speak for granted, many people have difficulty with these tasks and may experience pain, discomfort and lack of control when trying to speak. Voice and swallowing problems can develop as a result of aging, overuse, surgery, smoking, or throat cancer, and may include laryngitis, spasmodic dysphonia, vocal cord paralysis, cancer of the vocal cord, benign growths and more.

Our doctors provide comprehensive diagnostic and treatment services for a wide range of voice and swallowing disorders and are specially trained to help you restore function to your voice.

While many of these problems accompany a cold or other minor condition, some are chronic and may require special management to control or cure the condition. Patients may benefit from voice therapy, medicine or surgery, depending on their individual condition. It is also important for patients to protect their voice by practicing breathing techniques, avoiding smoking, alcohol and caffeine and by drinking plenty of water.

Hoarseness

Hoarseness affects 30% of people at some point in their life, and it can affect all age groups.  Children aged 8-14 years, and adults greater than 70 years old, are particularly susceptible to hoarseness.  It can affect people professionally and lead to missed days of work, and socially in interactions with others either in person or over the telephone.  Otolaryngologists are uniquely equipped with the training, experience, and tools to evaluate, diagnose, and treat this problem.

As otolaryngologists we can perform a procedure in the office called laryngoscopy.  This diagnostic procedure only requires some topical (numbing) medication in the nose, and can be completed quickly without pain.  It allows visualization of the entire upper airway, all the way down to the vocal cords (aka vocal folds).  The vibration of the 2 vocal folds within the larynx is what produces the sound we know as the human voice.

Common causes of hoarseness

Acute and chronic laryngitis

The most common cause of hoarseness is inflammation of the vocal folds.  This can be more acute in the setting of upper respiratory infections, or chronic related to irritation from other medical conditions.  Common conditions that can cause inflammation of the vocal folds include rhinosinusitis, laryngo-pharyngeal reflux, smoking, and high voice demands / vocal abuse.

Trauma

Recent intubation, neck surgery, and radiation treatment to the neck can all cause hoarseness.  Patients can be intubated for respiratory support during severe illness, or during procedures that require general anesthesia.  Common neck surgeries that can cause hoarseness include cervical spine surgery, thyroidectomy, and surgery on the carotid artery.

Medications

Certain medications like blood thinners can cause bleeding into the vocal folds and create a hematoma.  Blood pressure medications called ACE-inhibitors can increase risk of cough, which commonly can lead to hoarseness.  Other blood pressure medications can contribute to dehydration of the vocal folds.  Inhaled corticosteroids, commonly used to treat asthma and other respiratory problems, can irritate the vocal folds or lead to fungal infection.

Neurologic disease

The motion and vibration of the vocal folds are essential to producing human speech.  Diseases that affect the neurological system can affect the vocal folds as well and cause hoarseness or a weak voice.  Common neurologic conditions that can present as hoarseness include Parkinson’s disease, stroke, and multiple sclerosis.  There are also diseases that specifically affect the nerves to the vocal folds (spasmodic dysphonia, vocal fold paralysis, and laryngeal tremor).

Benign laryngeal growths

Lesions within the vocal folds can develop and affect the voice.  These include laryngeal nodules, polyps, and cysts.  The most common of these are vocal fold nodules (aka singers’ nodules).  Nodules are like calluses of the vocal folds, and usually are present on both sides as they contact each other.  Oftentimes, these benign lesions will resolve without the patient requiring surgery.  Vocal fold polyps and cysts are more likely to require surgical excision, followed by speech therapy.

Laryngeal cancer

This type of cancer is newly diagnosed in approximately 12,500 Americans each year.  90% of this type of cancer is due to exposure to smoking and alcohol.  Smoking causes mutations in genes which impairs clearance of other toxins from the respiratory tract, and decreases the body’s immune response.  Alcohol seems to potentiate the effects of tobacco.

 

Treatment of hoarseness

Treatment of voice abnormalities varies depending on the diagnosis.  Medications like steroids, anti-reflux medications, and nasal sprays can reduce inflammation that causes laryngitis.  Speech therapy is a very effective intervention for hoarseness once the underlying diagnosis is made.  Surgery can be necessary when a mass or lesion is present on the vocal folds, or when the vocal folds need augmentation to help them vibrate with each other. 

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