Ironically, the voice box (larynx) is not actually designed for speech. Humans have learned to use it for speech, but that really isn’t its primary function; rather, it is there to separate the food tube from the breathing tube. However, for anyone with a voice or speech disorder, that primary function is of secondary importance.
The voice box consists of cartilage, muscle, the epiglottis (which helps protect the voice box during swallowing) and the vocal folds (vocal cords). Muscles control the movement of the vocal folds, which open to allow breathing and close to allow speech. Problems can occur anywhere within this area, leading to a variety of symptoms, diagnoses and treatments.
Types of Voice Disorders
There is a wide array of voice disorders that can be classified into various groups (e.g., inflammatory disorders, problems caused by overuse or misuse, vocal cord growths and neuromuscular disorders). At Lahey Hospital & Medical Center, we have the expertise and technology to diagnose and treat all of them, including rare and often misdiagnosed conditions. These are some of the more commonly seen types of voice problems:
- Laryngitis is an inflammation or swelling of the vocal folds caused by excessive use of the voice, bacterial or viral infections, or irritants such as inhaled chemicals or stomach acid that has backed up into the throat.
- Vocal cord paralysis (or paresis) is a voice disorder that occurs when one or both of the vocal cords do not open or close properly. Vocal cord paralysis is a common disorder, and symptoms range from mild to life threatening. Someone who has vocal cord paralysis often also has difficulty swallowing and coughing because food or liquids can slip into the trachea and lungs.
- Spasmodic dysphonia is a voice disorder caused by involuntary movements of one or more muscles of the voice box, causing the voice to break or to have a strained or strangled quality.
- Vocal nodules are small, benign (noncancerous) growths on the vocal cords, usually related to vocal abuse. Frequently seen among teachers and professional singers, vocal nodules are callus-like growths that form by repeated pressure at the juncture where the folds come together to vibrate. Vocal cord scarring can occur as a result of vocal nodules.
- Vocal polyps are benign growths similar to vocal nodules but are softer and more like blisters than calluses. They most often form on only one vocal cord. A vocal polyp is often associated with long-term cigarette smoking but may also be linked to hypothyroidism (decreased activity of the thyroid gland), gastroesophageal reflux or chronic vocal misuse.
We also treat throat, laryngeal and thyroid cancers.
Symptoms of Voice Disorders
Common symptoms of a voice disorder include:
- Breathy vocal quality
- Chronic cough or excessive throat clearing
- Vocal strain or fatigue
- Inability to speak loudly
- Loss of voice
- Reduced pitch range or sudden change in overall pitch
- Sudden or gradual change in overall vocal quality
- Tremulous quality in the voice
- Diplophonic (double-toned) quality
- Decreased breath support during speech
Hoarseness is the most common symptom of a voice disorder. Anyone who has had hoarseness for more than a week should see a doctor. In most cases, hoarseness and other voice problems are a result of vocal abuse and overuse. In some cases, however, hoarseness may be a symptom of vocal cord paralysis, neurologic disease, acid reflux, thyroid disorders or cancer. Other voice symptoms may be the result of infectious diseases, such as Lyme disease, syphilis or a fungal infection, or a symptom of previously undiagnosed asthma or lung disease.