Voice change can be a frustrating issue with great impact on one’s lifestyle. Hoarseness can make the voice sound breathy, raspy, strained, or show changes in volume or pitch. Voice change is associated with variations of tissue health and technique of the voice box which includes vibration of the vocal cords housed within the larynx.
Here are some of the Common Voice Disorders listed below
The most common cause of hoarseness is acute laryngitis. The vocal cords become swollen due to effects of the common cold, upper respiratory tract viral infection, or from voice strain. Serious injury to the vocal folds can result from strenuous voice use during an episode of acute laryngitis, including frequent coughing. If hoarseness persists for two weeks or more, one should contact ENT Physicians Inc. for a comprehensive medical and voice behavior evaluation.
Benign Vocal Cord Lesions
Prolonged hoarseness can occur when you use your voice too much, or too loudly for extended periods of time. These habits can lead to nodules, polyps, and cysts. Vocal nodules (singers’ nodes) are callus-like growths of the vocal folds. Vocal fold polyps and cysts also occur in those who misuse their voice, but can also occur in those who do not.
If you experience a sudden loss of voice following a yell or other strenuous vocal use, you may have developed a vocal fold hemorrhage. A vocal fold hemorrhage occurs when one of the blood vessels on the surface of the vocal folds ruptures and the soft tissues fill with blood. It is considered a vocal emergency and should be treated with absolute voice rest and examination by an otolaryngologist (ear, nose, and throat doctor).
Gastroesophageal Reflux (GERD) or Laryngopharyngeal Reflux (LPR)
A possible cause of hoarseness is reflux disease. Voice change occurs when digestive acids from the stomach and/or esophagus enter the larynx. The increased acidity of mucous around the vocal cords causes tissue change and sometimes scarring of the vocal cords. Other typical symptoms of GERD include heartburn, sensation of something being stuck in the throat, difficulty swallowing, increased mucous in the throat, coughing/throat clearing and regurgitation. Usually, the voice is worse in the morning and improves during the day. The structures of the throat are much more sensitive to stomach acid and digestive enzymes so even small amounts of reflux can result in damage. Therefore, it is common to have voice change associated with reflux disease without any other reflux symptoms.
Smoking is another cause of hoarseness. Because smoking is the major cause of throat cancer, if smokers become hoarse, they should see an otolaryngologist. Smoking results in swelling of the vocal cords and can be referred to as Reinke’s edema or polyposis. With this type of tissue change, the voice generally deepens and becomes rough. Vocal cord swelling from smoking can be so severe that the airway is partially blocked resulting in shortness of breath or difficulty breathing.
Neurological Diseases or Disorders
Hoarseness can also appear in those who have neurological diseases such as Parkinson’s or a stroke, or may be a symptom of spasmodic dysphonia, a rare neurological disorder that usually affects only the voice, but sometimes affects breathing. A paralyzed vocal fold may be the cause of a weak, breathy voice. If the hoarseness persists for more than three months and other causes have been ruled out, a neurologist may be helpful for diagnosis.
Laryngeal cancer is a change of normal tissue into tumors or lesions that change over time. Laryngeal cancer starts on the surface of laryngeal tissue in the cells of the mucosa. When untreated, cancer can spread into deeper layers of tissue or other parts of the body.
Smoking is the most common cause of laryngeal cancers. The tissue changes and irritation from smoking can be worsened by alcohol and reflux disease.
Laryngeal cancers are generally patches or growths on the surface of the larynx. These may be white or red and vary in size and location. Cancers usually have a rough, irregular surface and may bleed from time to time. They may appear anywhere along the length of the vocal folds, as well as on other parts of the larynx, mouth or airway.
Allergies, thyroid problems, trauma to the voice box, aging, and hormone changes can also be factors in hoarseness.
How do I know what is causing my voice change?
Otolaryngologists at ENT Physicians, Inc. will obtain a thorough history of a patient’s hoarseness and general health. They will evaluate the voice and do a complete ear, nose, and throat exam. Visualization of the vocal cords is very important to understanding the cause of hoarseness. An ENT will often perform visualization on the initial visit using a laryngeal mirror or a flexible scope inserted through the nose, called a laryngoscopy. Videostroboscopy may also be completed by a speech-language pathologist in conjunction with the ENT. These procedures are well tolerated by most patients. A complete evaluation of the voice often includes a speech therapy assessment to measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in diagnosing and guiding treatment.