Each year millions of people are affected by voice disorders. For those who rely on their voice to make a living, such as teachers, doctors, actors, singers, and public speakers, problems like chronic hoarseness and vocal fatigue can be devastating. There are many causes of vocal disorders and the underlying problem with many patients is often multifactorial. Vocal overuse, acid reflux, tobacco use, and chronic allergies are a few of the many potential causes of vocal dysfunction. In addition, any patient with persistent hoarseness should be evaluated to rule out laryngeal cancer, a condition where hoarseness is often the first symptom. Proper diagnosis of the disorder is crucial for appropriate treatment.
What are the different types of voice disorders?
Voice disorders fall into a few main categories: Structural, neurogenic, functional, and psychogenic. Often, a patient’s disorder may fit more than one category and the challenge lies in determining the primary cause.
With structural disorders there is a problem involving the tissues or structures of the vocal cords. Examples can include nodules, polyps, ulcers, or other lesions on the vocal cords. These lesions can impair the normal vibration and function of the vocal cords which causes hoarseness.
Neurogenic disorders are related to problems with the nervous system, including paralysis or weakness of the vocal cords, tremor, or other neurologic conditions. Patients with these conditions can also have difficulty swallowing and may be at risk for developing pneumonia due to aspiration which is when food that is swallowed goes down the wrong way and ends up in the lungs.
With functional disorders, the physical structure is normal but there is muscle tension due to improper use or strain causing muscle tension when vocalizing and preventing normal voice production. These disorders are often due to unconscious behaviors that can be corrected through speech therapy
It is rare for a psychological disorder to be the sole cause for a voice problem, but a psychogenic component is often present because of the emotional impact a voice disorder can have. In such cases, correct identification can be challenging, but recognition is important to ensure that mental health professionals can be involved in any treatment approach
What About Cancer Of The Larynx?
Cancer of the larynx or any part of the throat is not considered a voice disorder. However, unexplained hoarseness is one of the warning signs of cancer, and anyone with persistent hoarseness that does not resolve after 2 weeks should be evaluated by an ENT physician. A flexible laryngoscopy can promptly identify any issues, and endoscopy under anesthesia with a small biopsy can confirm the diagnosis. Our physicians can work quickly to accomplish this and initiate treatment, understanding that time is critical. Treatment options may only involve the use of minimally invasive laser excision or local radiation therapy to preserve the patient’s voice, although in more serious cases surgery to remove the larynx (laryngectomy) may be required.
What treatment options are available for voice disorders?
There are a variety of treatment options available depending on the patient’s specific condition. In many cases, treatment of underlying causes of laryngeal inflammation such as acid reflux and postnasal drainage are initiated. In patients who do not respond to conservative management, microscopic vocal cord surgery can be performed to address structural lesions of the vocal cords. Voice therapy with a speech pathologist is also an important part of the treatment protocol for both surgical and nonsurgical patients to improve vocal technique and prevent recurrence of their symptoms.