VOICE DISORDERS

Surprisingly, when we lose our voice it can affect more than routine everyday speaking. Many people rely on their voice in order to perform the essential functions of their job. This includes performers, teachers, salespeople, and numerous others. Ironically, people in such professions are more likely to experience vocal problems due to the strain of frequent use. Preventative care and prompt evaluation of problems can help patients avoid the development of more serious conditions.

When our voices are healthy, the three main parts to speech, the vocal cords, the larynx and the mouth, work in harmony to provide effortless voice during speech and singing. Abnormal changes in the voice are called "hoarseness." When hoarse, the voice may sound breathy, raspy, strained, or show changes in volume or pitch (depending on how high or low the voice is). Voice changes are related to disorders in the sound-producing parts (vocal cords or folds) of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together and, as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords hinder vibration, altering voice quality, volume, and pitch.

Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists who have learned how to examine the larynx. When hoarseness lasts longer than two weeks or has no obvious cause, it should be evaluated by an otolaryngologist. Problems with the voice are often best managed by a team of professionals who know and understand how the voice functions. These professionals are otolaryngologists, speech/language pathologists, and teachers of singing, acting, and public speaking. Vocal nodules, polyps, and cysts are typically treated with a combination of microsurgery and voice therapy.

Evaluation and treatment of voice disorders is performed by highly trained Otolaryngologists in conjunction with voice therapists. Doctors usually look at the vocal cords either with a mirror placed in the back of the throat, or with a very small, lighted flexible tube (fiberoptic scope) that is passed through the nose to view the vocal cords. Today’s advanced technology allows us to see the vocal cords and their function in greater depth.
We employ laryngeal videostroboscopy (magnified “slow motion” imaging of the larynx) for pinpoint accuracy of diagnosis of vocal cord disorders. stroboscopy is well tolerated by most patients. In some cases, special tests designed to evaluate the voice may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in diagnosing and guiding treatment.

Treatment may include, medication, voice rest and voice therapy with a trained voice therapist which is designed to improve vocal function and quality. These will include exercises strength and flexibility, needed for a constant healthy voice. The goal of any voice therapy program is to return the voice to normal or as near normal sounding as possible. Dietary control, weight control and vocal retraining are all mainstays of voice therapy. Recently the use of Botox has been shown to be helpful in specific cases of quivering voice, raspiness, and spasms of the voice.