Voice Disorders
The premier doctors on UVSC’s staff treat a wide range of voice and swallowing disorders. Patients at UVSC are given treatment and therapeutic measures that improve both the respective condition and overall quality of life.
Hoarseness
Hoarseness refers to any abnormal voice (also known as dysphonia), but all hoarse voices do not sound alike. Characteristics that can be seen in some hoarse voices include: breathiness (as in the classic Marilyn Monroe voice), roughness, decreased loudness, inability to project voice, strain, or the complete lack of a voice (aphonia). Many of these terms are subjective, and can be caused by many different conditions, including the ones described below.
Laryngitis
Laryngitis refers to inflammation of the vocal cords and the area around them. Laryngitis can produce a rough voice, decreased loudness, and even aphonia (see above). The inflammation can have many different causes, including the allergies, environmental irritants, a cold, the flu, bronchitis, sinusitis, and other respiratory infection.
Laryngopharyngeal Acid Reflux (LPR)
LPR is caused by stomach acid coming up from the esophagous and irritating the larynx and pharynx. This condition is different than gastroesophageal reflux disease (GERD). In GERD, the acid causes inflammation of the esophageal lining and the main symptom is heartburn. In LPR, the acid produces inflammation of the lining of the larynx and pharynx. Common symptoms in LPR include a dry cough, frequent throat clearing, a feeling that something is stuck in the throat. However, heartburn is often not seen in LPR; this is due to the fact that the esophageal lining is much tougher than the laryngeal or pharyngeal lining; therefore it is easier for the acid to inflame the larynx and pharynx without irritating the esophagous. Heartburn is usually not seen unless the lining of the esophagous or stomach is inflamed. This condition is usually treated by lifestyle and dietary modifications and by medication.
Muscle Tension Pattern (MTP)
MTP refers to an abnormal speaking pattern resulting in the improper use of the muscles of the voice box. MTP may be the primary problem causing the voice disorder (often called muscle tension dysphonia or MTD) or it may be present as a result of another problem. The symptoms of MTP include soreness of the muscles around the larynx and a voice that fatigues easily.
Recurrent Respiratory Papillomatosis (RRP)
(RRP) is a disease in which tumors grow inside the larynx, vocal cords and trachea. It affects both children and adult and is caused by the Human Papilloma Virus (HPV). Depending on the location and extent of the disease, RRP will present with hoarseness and/or shortness of breath.
Spasmodic Dysphonia
Spasmodic dysphonia is a voice disorder caused by involuntary movements of one or more muscles of the larynx or voice box. Individuals who have spasmodic dysphonia may have occasional difficulty saying a word or two, or they may experience significant difficulty in communication. Although stress does not cause this disease, it can make the voice worse. In the early stages of the disease, many patients find that singing is easier than talking. There are two types of spasmodic dysphonia (SD). The more common is adductor SD; here the vocal cords squeeze together too much, making it difficult for a person to “get words out” and causing a strained voice. In the other type, abductor spasmodic dysphonia, the voice becomes very breathy when a patient attempts to pronounce certain consonants such as “k”.
Teflon Granulomas
After its introduction in 1962, Teflon became popular for injection augmentation of the paralyzed vocal cord. Unfortunately, such injections have many drawbacks, including (a) “Teflon granuloma” formation (sometimes with airway obstruction); (b) Scarring of the vocal cord; and (c) when removal is attempted, complete removal is often not possible.
Vocal Cord Cancer
A disease in which cancer (malignant) cells are found in the tissues of the larynx, most often associated with a sore throat that does not go way, pain when swallowing, pain in the ear, a lump in the neck or a change or hoarseness in the voice.
Vocal Cord Granuloma
A granuloma is a particular type of laryngeal lesion that represents the body’s response to chronic irriation or trauma. This is usually seen after prolonged intubation and is made worse by stomach acid.
Vocal Cord Nodule
Vocal cord nodules are a nodule or mass of tissue that grows on both vocal folds (vocal cords). They are similar to calluses and are usually due to talking loudly or in a noisy environment. These are usually treated by voice therapy.
Vocal Cord Paralysis
Vocal cord paralysis is a voice disorder that occurs when one (unilateral) or both (bilateral) of the vocal cords do not move. Normally our vocal cords move apart when we breathe and together when we talk. In unilateral paralysis, the paralyzed cord is usually in a position such that the normal cord cannot meet it during talking. This produces a gap between the cords and can cause symptoms such as a breathy voice, decreased loudness, and vocal fatigue. Treatment includes temporarily or permanently moving the paralyzed vocal cord to midline. Reinnervation, when another nerve is attached to the paralyzed nerve, can also give good results under certain conditions. In bilateral paralysis, both vocal cords are at the midline position and they cannot move apart during breathing. This usually produces airway obstruction, and the voice is much less affected. There are a variety of surgical procedures designed to treat bilateral vocal cord paralysis.
Vocal Cord Polyp
Vocal cord polyps represent benign lesions that may have a variety of appearances. Polyps may be single or multiple, involve one cord or both, and may be big or small. These cause a hoarse voice and are usually treated by a combination of voice therapy and surgery.
Services and Treatments
As the definitive voice and swallowing care center in the Southwestern Ohio-Northern Kentucky region, UVSC offers customized approaches to treating patients’ voice, swallowing, and airway conditions.
Our Doctors use one of several methods to both view the larynx and evaluate vocal condition, and examine and evaluate swallowing conditions. These methods are customized to the needs of each patient.
Flexible Fiberoptic Laryngoscopy
Flexible fiberoptic laryngoscopy is the most common type of examination used to visualize the areas of the throat and voice box. The exam utilizes a thin flexible endoscope containing fiberoptic cable that can be manipulated to examine areas not normally seen by traditional examination techniques. The endoscope is inserted through the nose and passed into the throat under direct visualization. Most patients tolerate this examination without much difficulty.
Laryngeal Electromyography (LEMG)
Laryngeal electromyography (LEMG) is a test that gives information about the motor activity within the tiny muscles that control the vocal cords. This information is not available by any other test. This activity is important because it has implications for diagnosis and for predicting recovery of function. Diagnostically, LEMG is essential in determining the neuromuscular status of the vocal cords. Subtle weakness in the vocal cords may not be seen on endoscopic examination, and may only be evident after LEMG is performed. In cases of vocal cord motion impairment, LEMG can effectively distinguish vocal cord paralysis from impairment due to scarring.
Rigid Transoral Laryngoscopy
Rigid transoral laryngoscopy is one type of examination used to visualize the voice box. The examination utilizes a rigid endoscope (device used to examine internal structures) to visualize the vocal cords. The endoscope is inserted into the back of the mouth, and has an angled lens, which allows it to look down at the vocal cords. This examination results in a magnified view of the vocal cords with high image quality. It is best for studying abnormal growths on the vocal cords. Without stroboscopy, this technique cannot evaluate the vocal cord vibrations.
Laryngeal Sensory Testing
Sensory testing involves administration of a discrete pulse of air via a port, or opening, in a transnasally placed, thin, flexible endoscope, in order to elicit an airway protective reflex. Decreased or absent sensation can cause aspiration (food to go into the trachea instead of the esophagous).
Stroboscopy
This is similar to rigid transoral laryngoscopy, except that a strobe light is used instead of a constant light. This allows evaluation of the vibrations of the vocal cords during phonation. Stroboscopy should be done in most patients with hoarseness.
Professional and Occupational Voice Users
We also provide voice coaching and lessons for the professional and occupational voice users. Our certified vocologist will work one-on-one for maxuim results for your voice quality.
Who is an Occupational or Professional Voise User?
Anyone who's voice is essential their job is an occupational or professional voice user. We are all accustomed to thinking of singers, actors, actresses, and broadcast personalities as professional voice users. Indeed, special or unique qualities of the voice are often the essential feature of their careers.
But what about other occupational voice users? Teachers, clergy, salespeople, courtroom attorneys, telemarketers, and receptionists, are just some of the people for whom spoken communication is an essential part of what they do. Even in the era of e-mail and the internet, we can’t really imagine an effective classroom, pulpit, or courtroom without voice.
Physicians conveying important information to a college or patient and business executive conducitng a meeting all are occupational voice users.
What are some signs of a Voice Disorder?
Symptoms of a voice disorder may include any of the following:
• Feeling short of breath
• Chronic hoarseness or raspiness
• Urge to cough often or clearing of the throat
• Loss of vocal range
• Heartburn
• Vocal fatigue
• Loss of control or projection
• Acidic taste in the mouth
• Voice cuts out for no reason
For additional information:
University Voice & Swallowing Center
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