Diagnosing Voice Disorders

At the Department of Speech Pathology, we provide a wide range of traditional and innovative diagnostic methods and technologies. Patients are often examined with a flexible telescope called a laryngoscope, which gives the physician a close look at the voice box. This tool enables the doctor to diagnose subtle disorders in the way the vocal folds move and to determine whether the patient is using his or her voice in a proper or improper manner.

Newer technology includes stroboscopy, a diagnostic exam that uses a tiny camera attached to a probe. The camera provides a magnified, high-resolution image to help physicians diagnose small vocal fold scars, for example. The physician can attach a microphone to the patient’s neck to pick up the frequency of the vocal cords’ vibration, which is far faster than the human eye can see. A computer interprets the vibration and flashes a strobe light to show a representation of the vocal fold vibration.

Utilization of acoustic analysis via computerized technology can also provide relevant information for diagnosis and treatment of voice disorders. The computer analyzes a recording of the patient’s voice in order to provide objective measures of how the voice is being used. The computer system can also be quite useful in treating voice disorders in adults and children, including trials of delayed auditory feedback for dysfluent patients and computerized voice games for children.

These technologies, combined with dynamic assessment (seeing and hearing the voice in action) and clinical observation help us to reach an accurate diagnosis and devise an appropriate treatment plan.

Treating Voice Disorders

At Lahey Hospital & Medical Center, we devise a treatment plan appropriate to each patient’s special needs. In some cases, a team approach may include–in addition to the otolaryngologist (ear, nose and throat specialist)–a speech pathologist, neurologist, psychologist, pulmonologist, primary care physician or pediatrician.

The type of treatment depends on the specific vocal condition and the patient’s other medical requirements. In all cases, however, we offer the latest proven therapies and technologies.

Most patients will be asked to go for a speech therapy evaluation and follow a treatment program before undergoing a surgical procedure, because properly directed vocal exercises can help or heal many patients’ voice problems. Depending on the underlying cause of the voice problem, therapy may be used to strengthen the muscles used to produce the voice, or to relax the structures and muscles that interfere with proper voicing.

Voice therapy can help patients learn to use their voices in a more efficient way. Computerized imaging and acoustic analysis of the patient’s vocal intensity, pitch and quality are used both as diagnostic measures and as biofeedback during treatment. The instrumentation actually allows patients to visualize the components of the voice, which often facilitates success.

Although many patients will improve or be cured by speech therapy and other non-surgical interventions, surgery is occasionally required to correct voice problems. For example, newer surgical treatments for vocal fold paralysis include hydroxyapatite injections and permanent implants to help the vocal folds return to a normal position. Many patients can receive vocal fold injections in our outpatient clinic, with only minimal discomfort. These injections are used to treat conditions such as glottic insufficiency, vocal fold paralysis and presbyphonia simply and easily.

Patients with vocal fold masses generally need to go to the operating room for their surgeries. During surgery, the vocal folds are magnified using a microscope, and a variety of equipment–including specialized knives, scissors, lasers and microdebriders–is used to remove the lesion.