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Voice Disorders

Vocal Cords

Voice disorders can have both serious psychological and physical complications. The ability to exercise, enjoy a family outing or participate in any physical activity is restricted. Impairment may result from trauma, polyps/nodules, benign and cancerous tumors, vocal cord paralysis, multiple sclerosis, thyroid problems and vocal cord swelling.

Common in the elderly, voice disorders are being seen in increasing numbers as people live well into their 80’s.

Patients usually have a variety of complaints including breathlessness, fatigue and dizziness. In some cases, life-threatening situations can occur due to the inability of the affected vocal cord to open and close properly, allowing food to become lodged in the trachea, the main airway to the lungs.

Voice disorders from overuse and misuse are common in a variety of professions including professional singers, actors, radio/television personalities, politicians, salespeople, teachers and public speakers. A voice disorder may directly impact on an individual’s ability to hold steady employment and /or limit everyday physical activities seriously.

Voice Care

From opera singers to politicians to teachers, people rate ‘voice health’ a top priority.

When an opera singer cannot talk or when a politician cannot speak, the problem is very serious. Sometimes, it is a relatively simple matter. For example, if you do not drink enough water, you may wind up with dry vocal cords. When dry cords vibrate during singing or speaking, there is a risk of developing vocal nodules (small knot-like growths) or damaged vocal cords.

The more scientific the study of voice becomes, the more doctors can help patients steer clear of problems. This makes the study of the voice more mysterious. In the old days, a voice teacher could get away with saying, “Do this the way I say to do it because this is the way I do it.” Today, in contrast, a singer understands that you need breath support and a certain posture to sing correctly.

In recent years, the vocal aspect of otolaryngology has moved from a semi-art to a science, thanks to advances by ear, nose and throat physicians and improved technology. Also, the concept of vocal hygiene has been fully developed.

To improve vocal hygiene, try the following:

  • Drink lots of fluids – Drink 7-9 glasses of water per day; also good are herbal tea and chicken soup.
  • Try your best to maintain good general health – Exercise regularly.
  • Avoid smoking cigarettes – They are bad for the heart, lungs and vocal tract.
  • Eat a balanced diet – Include vegetables, fruits and whole grain foods.
  • Avoid dry, artificial interior climates.
  • Do not eat late at night – You may have problems when stomach acid backs up on the vocal cords.
  • Use a humidifier to assist with hydration.

Think about the medications you use, and how they can affect your voice:

  • Avoid taking antihistamines, decongestants and antidepressants – They dry out the membranes in your throat.
  • Take antacid for acid reflux – If you eat a late meal and you have trouble with acid reflux, raise the head of your bed, and take an antacid at bedtime.
  • Reduce your caffeine and alcohol intake – Caffeinated and alcoholic drinks pull water out of your system and deplete vocal cord hydration.
  • Avoid use of local anesthetic over-the-counter medications for throats. Chloraseptic? is one example.
  • Medications that help liquefy thick mucous and increase the output of thin respiratory tract secretions are helpful. Examples are Robitussin? and Guaifenesin?.
  • Question the use of progesterone dominant birth control pills. They may make the female voice deeper.

Think about how you use your voice:

  • Learn to use your voice with as little effort and tension as is necessary.
  • Less is more if we think of vocal longevity. Avoid speaking too much. Try taking vocal naps, avoid lengthy telephone conversations and wisely use natural pausing in conversation (avoid vocalized pauses).
  • Before singing or using the voice in unusual ways, always do vocal warm-ups.
  • Avoid shouting, screaming, loud laughter and heavy throat clearing.
  • Use non-vocal sounds such as clapping, bells or other things to gain the listener’s attention.
  • Move close to those with whom you are speaking. Face the person(s) with whom you are speaking.
  • Take advantage of amplification devices, such as microphones, as needed.
  • Be aware of noise in the environment and do not compete with it (parties, cars, airplanes).
  • Avoid making strange vocal noises and sounds. Do not whisper – it is worse than speaking because whispering strains your throat muscles.

Special Assessment Procedures

Based on state of the art technology, assessment of voice disorders can now be performed in a non-intrusive way, and many treatment plans are successful.

Videostroboscopy – Videostroboscopy is one of the most practical techniques for clinical examination of the larynx and vocal folds. “Stroboscopy” refers to using flashes of light to observe movement. Stroboscopy allows the examiner to observe the movement of the vocal folds in a type of “slow motion.” Stroboscopy can reveal laryngeal diseases (diseases of the larynx) early in their development. In many cases, stroboscopy is necessary for correct diagnosis. Capturing the examination on videotape allows the examiner and physician to review the film following completion of the examination (videostroboscopy).

Computerized Voice/Speech Analysis – State of the art equipment is used to study disorders of the human voice. Here, various elements of the voice are studied using digital methods.

Acoustic Analysis – Acoustic analysis uses a computer to analyze the patient’s voice, to determine variation from established norms. More than 33 different aspects of voice are analyzed from a single vocalization. Acoustic analysis of the voice is one part of the complete examination of voice.

Phonatory Function Analysis – Measurement of aerodynamic function consists of measurements of airflow, volume, airflow rate, peak airflow, subglottic (back of the tongue) pressure and phonation (speech sounds) time.

Sound Spectrograph – “Voice printing” examines the interaction between the vibratory source (vocal folds) and the resonance system (oral, nasal, pharyngeal cavities) during voice and speech production.

Voice Training – Professional voice users learn techniques to help avoid problems. Baseline measurements taken when the voice is healthy can pinpoint voice problems should they develop later.

Special Treatments and Therapies

Botoxin injections – Botoxin, or botox, is a toxin (poison) that is injected into specific muscles of the larynx (voice box) for dysphonia. Spasmodic dysphonia is a movement disorder that affects the larynx and is characterized by a tight, strained, strangled voice. The botoxin weakens the muscles of the larynx so that voice can be produced with much less effort. The results last for 3-5 months on average. Repeat injections are usually needed.

Post-laryngectomy rehabilitation – When the larynx is removed, usually for extensive cancer, rehabilitation of the voice is a main concern. A speech/language pathologist determines the most appropriate method of voice rehabilitation through an evaluation.

Phonosurgery – Phonosurgery is designed to alter voice quality and the ability to produce voice. A paralyzed vocal cord often will prevent closure of the vocal cords. Thyroplasty is a surgical technique that moves the paralyzed vocal cord closer to the normal, more robust vocal cord. Phonosurgery can raise or lower the pitch of a voice to a more desirable range.

For more information:

Go to the Ear, Nose, and Throat Disorders health topic.