A thorough evaluation
is conducted when one of the following disorders
is suspected.
CYSTS – Cysts are fluid
filled lesions or growths that may be found anywhere
on the vocal folds. They often occur as
a result of trauma to the vocal folds and typically
require surgical removal. Cysts can interfere
with the vibration of the vocal folds and may
result in a breathy or hoarse vocal quality.
GRANULOMAS – Granulomas
of the larynx are benign growths on the vocal
folds. They are usually caused by irritation
to the tissues or cartilage of the larynx, such
as reflux exposure or airway intubation (insertion
of a breathing tube). Quality of the voice
can be hoarse or husky. Treatment options
include medical/surgical and non-surgical management,
often in conjunction with speech therapy.
HEMORRHAGE – Vocal fold
hemorrhages occur rarely and are typically caused
by aggressive or improper use of the vocal folds.
A hemorrhage results from a rupture of one of
the blood vessels on the vocal fold with bleeding
into the surrounding tissue.
LARYNGEAL CANCER - each year
approximately 10,000 new cases of laryngeal cancer
are diagnosed in the United States. Cancer
of the larynx is typically associated with tobacco
use. Studies suggest that tobacco in combination
with heavy alcohol use significantly multiplies
the risk of developing cancers of the larynx or
pharynx (throat). Initial symptoms of cancer
include persistent hoarseness (lasting for several
weeks) or sore throat. Early identification
of laryngeal cancer through examination and biopsy
is usually associated with a positive outcome.
Options for treatment of laryngeal cancer depend
on the size, location, and progression of the
disease. For those undergoing laryngectomy,
or surgical removal of the larynx, options for
voice restoration include training in alaryngeal
speech production through use of an electrolarynx,
esophageal speech, or tracheoesophageal speech.
(See Laryngectomy Rehabilitation )
LARYNGEAL PAPILLOMA –
Laryngeal papilloma appears as wart like lesions
throughout the larynx, including on the vocal
folds. Papillomas are caused by the human
papilloma virus (HPV).Removal of the papilloma
is usually required as it can interfere both with
voice production and with breathing.
MUSCLE TENSION DYSPHONIA –
Muscle tension dysphonia is a common condition
in which there is excessive or inappropriate use
of the muscles of the larynx. Vocal symptoms
range from a tight, strained voice, breathiness
or hoarseness. Speech or voice therapy is
usually recommended for muscle tension dysphonia
with an emphasis on proper voice placement, breathing,
relaxation and muscle control.
PARADOXICAL VOCAL CORD DYSFUNCTION (PVCD)
This condition may also be known as laryngospasm
or vocal cord dysfunction,, in which the vocal
folds close or adduct during inhalation (which
is opposite to the usual motion of opening during
inhalation). This condition may be exacerbated
by reflux disease. Therapy for PVCD includes
medical management of the condition causing the
laryngospasm (ie. if reflux if suspected) in combination
with speech/voice therapy that includes exercises
of relaxation and breathing.
POLYPS – Vocal polyps
are growths typically occurring on only one vocal
fold. They can be small or large and may
be found on any location of the vocal fold.
Polyps typically result from voice misuse or trauma
and are sometimes seen after a hemorrhage of the
vocal fold. Surgery is often required to
remove the polyp, in addition to speech.
REFLUX RELATED LARYNGEAL IRRITATION
– Reflux is a condition in which acid or
stomach contents backflow to the esophagus (gastroesophageal
reflux). In certain cases, the reflux can
backflow up to the level of the larynx or pharynx
(throat), also known as laryngopharyngeal reflux
(LPR). The erosive nature of the reflux
can cause irritation and inflammation of the tissues
of the throat, causing hoarseness and sore throats.
Medical management of the reflux, if indicated,
is the first line of treatment. In certain
cases, speech or voice therapy is recommended
to improve optimal laryngeal function and use
of the voice during and after healing has occurred.
SPASMODIC DYSPHONIA (SD) –
Spasmodic dysphonia is a voice disorder that results
in involuntary spasms at the level of the larynx.
In spasmodic dysphonia, the voice can sound tight,
breathy or strained. The origin of the disorder
is believed to be neurological (related to the
brain and nervous system). Although there
is no “cure” for spasmodic dysphonia,
one of the most effective treatments to date has
been small injections of botulinum toxin (Botox)
into the muscles of the larynx. The injection
weakens the muscles through blocking the nerve
impulse to that specific muscle. Repeated
injections may be needed every few months and
the patient with spasmodic dysphonia may also
work with speech therapy to optimize vocal quality.
TRAUMA – Trauma to the
larynx can result from falls, sports injuries
or motor vehicle accidents. The resultant
damage to the larynx can vary, depending on the
type of injury. Surgery or medical management
may be required.
VOCAL FOLD ATROPHY OR BOWING
– Bowing of the vocal folds results in a
small gap in the middle of the folds causing incomplete
closure. Although there are several reasons
for why a vocal fold can become bowed, one of
the more common reasons is aging. Vocal
quality can be weak, breathy, or hoarse due to
the weakened muscles of the vocal folds.
Therapy is sometimes recommended to improve strength
and flexibility of the vocal fold musculature.
VOCAL FOLD PARALYSIS - Vocal
fold paralysis results from injury to the nerve
that supplies movement to the vocal fold.
Paralysis can occur as a result of a neurological
condition or disease (i.e. stroke), trauma, or
viral infection. In some cases, the cause of the
paralysis is unknown, or idiopathic.
Paralysis of the vocal fold can be temporary or
permanent and may affect either one or both vocal
folds. The voice may sound breathy or hoarse,
and in extreme cases, a paralysis may result in
no voice. A vocal fold paralysis sometimes causes
difficulty breathing. In certain circumstances,
surgery or medical procedures are performed to
improve the opening or closure of the airway which
can aid both voice production and/or provide better
airway protection during swallowing. Options
for surgical management include augmentation of
the vocal fold through injection or moving the
weak vocal fold closer to the other one through
a procedure called medialization. Therapy
is sometimes recommended before or after surgery
to assist the patient in optimal use of their
voice through exercise and compensation.
VOCAL NODULES –
Vocal nodules appear as small, callous-like bumps
where the anterior 1/3 and posterior 2/3 of the
vocal folds meet. Nodules often occur bilaterally,
or on both vocal folds, and are typically caused
by vocal misuse or overuse. The voice may
sound breathy or hoarse, may fatigue easily, or
may have loss of range due to incomplete closure
during movement of the vocal folds,. Nodules
can be reduced or eliminated through proper care.
Speech or voice therapy is typically recommended
to identify patterns of voice misuse and improve
vocal habits or use.
