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Ear, Nose, and Throat Disorders

Damage to vocal cords from intubation

09/03/2008

Question:

I contracted pneumonia and had respiratory failure. I was intubated for 10 days. When I came out of it I couldn`t speak. They told me it was common and my voice would come back in time. It did but very little. The second month after this occured I was seen by an ENT doctor in the rehab facility I was in and he told me I had a dime size white spot over the vocal chord on the left side of my throat and advised me to see someone if the symptoms persisted. It is now over a year later and I still cannot sing, talk loud or yell. The pitch of my voice has changed and it is flat and very hoarse. I have lost all expressiveness in my voice. I also experience a small amount of pain in that area when I burp. Sometimes feels like a tickle and makes me cough if I talk too much. Could you please shed some light on this condition and should I be overly concerned? Is this something that may require surgery to correct or can it be corrected in another manner? I am terrified to have surgery and be put out.

Answer:

The nerve that controls most of the movement of the vocal cords is the recurrent laryngeal nerve, but decreased pitch (and a flat voice) may be due to injury of another nerve, the superior laryngeal nerve. Acid reflux can also cause some laryngeal damage and could explain the tickle or cough, and it can also delay healing from the original event - this may explain the pain.

Once the problem is identified, it can usually be treated by meds and/or voice therapy. In order to determine the problem, I would recommend getting a videostroboscopy - an exam where the speech pathologist or physician uses a rigid scope and a strobe to visualize the vibrations of our vocal cords. After the strobe, I would review it with an otolaryngologist that has expertise in the voice. Please let me know if you have any further questions.

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Response by:

Siddarth M Khosla, MD Siddarth M Khosla, MD
Assistant Professor
College of Medicine
University of Cincinnati