Common Voice Disorders

We often take our voices for granted, but a voice problem can prove devastating in our ability of communicate. Symptoms of a voice disorder can range from hoarseness, to limitations in the singing range, to complete loss of voice. Some commonly encountered disorders include:

1. Vocal Nodules
2. Polyps
3. Cysts
4. Vocal Fold Paralysis
5. Muscle Tension Dysphonia
6. Laryngeal Cancer
7. Spasmodic Dysphonia
8. Vocal Fold Bowing
9. Paradoxical Vocal Fold Movement
10. Hoarseness due to Reflux Disease
11. Laryngeal Papillomas

Video of vocal folds with common voice disorders coming soon!

Vocal Nodules

Vocal nodules are small callous-like bumps located at the junction of the anterior and middle thirds of the vocal folds. They are typically bilateral and are the result of abusive phonation. When nodules become mature and enlarge, they interfere with vocal fold vibration and closure, thereby causing air leakage during phonation. The voice will sound hoarse and breathy as a result of decreased vocal fold closure. Treatment for vocal nodules involves working with a speech language pathologist to change voice behaviors and modify one’s environment accordingly. Typically, nodules can be reduced or eliminated with proper voice care.

Polyps

Polyps are small lesions that can occur at any location on the vocal folds. They are often the result of abusive phonation and can occur following a vocal fold hemorrhage. Polyps will many times require surgical removal in addition to direct voice treatment with a speech pathologist. Depending on the location of the polyp, the sound of one’s voice may vary.

Cysts

Cysts are small fluid filled lesions that can also occur at any location on the vocal folds. They are the result of trauma to the vocal folds and usually require surgical removal. As with nodules and polyps, a cyst may interfere with vocal fold vibration and will many times result in inadequate vocal fold closure.

Vocal Fold Paralysis

Vocal fold paralysis is the result of nerve damage and includes the causes of cerebrovascular accident (stroke), trauma, or virus. A person can exhibit a bilateral or unilateral paralysis. The paralysis may be temporary or permanent depending on the site and extent of the lesion. A paralysis in a more adducted (closed) position may spare the voice or only result in mild hoarseness. A paralysis in an abducted (open) position will result in a significantly breathy/hoarse voice due to an inability to close the vocal folds. A person may be at risk for aspiration of liquids and/or solids with this type of impairment. A surgery called medialization thyroplasty is available to improve vocal fold closure to protect the airway and improve the voice.

Muscle Tension Dysphonia

Muscle tension dysphonia is a common problem that can cause symptoms ranging from an extremely breathy voice to one that is tight/strangled and high pitched. A person can have mild to severe problems with this disorder that is caused by excessive or inappropriate muscle use. Several muscles surround the voice box and assist with vocal fold movement. A person can learn to use these muscles in an incorrect way, thereby causing a significant voice disturbance. To regain normal muscle functions, patients work directly with a speech pathologist. Treatment is focused on proper breathing, relaxation, muscle control, and voice placement.

Laryngeal Cancer

Cancer of the larynx is usually diagnosed with exam and biopsy, the most common cause being tobacco use. Laryngeal cancer is usually of the squamous cell type with varying locations. Treatment and surgical options are dependent on the site and size of the tumor. Initial symptoms of this type of cancer are many times a hoarse/gravely voice. If a person is hoarse for more than one month, medical attention is recommended. This is especially true for smokers.

Spasmodic Dysphonia

Spasmodic dysphonia is a focal disorder that causes tiny spasms at the level of the vocal folds. The most common perceptual symptom is a tight/strained voice, although occasionally a person may exhibit spasms with an excessive breathy vocal quality. The disorder is believed to be neurologic in nature with stress and other environmental factors exacerbating symptoms. This disorder is most common in females with an average onset between the ages of 20 and 50. Although there is no cure for spasmodic dysphonia, injections of botulism toxin (botox) have been very effective in reducing or eliminating the spasms temporarily. Patients usually return for repeat injections every 3 to 6 months. In addition to botox, treatment by a speech pathologist has been shown to lengthen times between injections and further improve vocal quality.

Vocal Fold Bowing

Vocal fold bowing results in a small gap in the middle of the vocal folds, causing incomplete vocal fold closure. Several diagnosis may be the cause of vocal fold bowing, although the most common cause is due to age and atrophy of the larynx. Inactivity of the vocal folds can lead to weaker muscles in the larynx, therefore, resulting in a less than optimal voice. Voice symptoms can include weakness, breathiness, hoarseness, or a strained voice if a person is using too much effort with speaking. Patient’s are instructed with specific exercises that strengthen the vocal folds and improve flexibility.

Paradoxical Vocal Fold Movement

Also known as vocal cord dysfunction and laryngospasm, this distressing disorder is most common in females and is characterized by adduction (closing) of the vocal folds during inhalation. This is many times accompanied with wheezing and/or stridor. Paradoxical vocal fold movement is often initially diagnosed as asthma, as in many females, episodes will only occur upon exertion. The disorder can be exacerbated by laryngo-pharyngeal reflux disease. Treatment for PVFM includes instruction of specific breathing patterns, laryngeal relaxation, and medical treatment of reflux disease when appropriate.

Hoarseness due to Reflux Disease

Reflux is the back flow of stomach contents through the esophagus. There are two types of reflux:

1. Gastro-Esophageal Reflux Disease (GERD) occurs when contents from the stomach return to the esophagus. This causes swelling and irritation to the tissue of the esophagus.
Symptoms include "heartburn" or indigestion.
2. Laryngo-Pharyngeal Reflux Disease (LPRD) occurs when stomach contents travel all the way up through the top sphincter of the esophagus to the tissues in the throat.

Laryngeal Papillomas

Wart-like lesions that are viral in nature. This is caused by human papilloma virus (HPV). This is an aggressive virus that usually requires surgical removal. Post-surgery recurrence of the virus is common resulting in the need for numerous surgeries. The lesions can greatly effect the sound of oneÍs voice due to the interference with vocal fold vibration. Spreading of the papillomas can occur both above and below the vocal folds, at times interfering with the airway. (For more detailed information, visit rrpf.org.)