Voice Disorders

When your vocal quality, pitch, or volume differs from what is considered normal for speakers of your age, gender, or culture, you may have a voice disorder. The possible causes could be structural, medical, or neurological changes, or inappropriate voice use over time. Additionally, some voice disorders have a psychological component that needs to be addressed.

At The Center for Voice and Swallowing, we have extensive expertise in the diagnosis and treatment of these disorders. As a patient, you will be cared for by our highly specialized team, which includes Michael Pitman, MD, Chief of the Division of Laryngology, Hayley Born, MD, and three voice specialized speech language pathologists/singing voice specialists.

Voice Disorders We Treat

Our specialists are skilled in treating the full range of voice disorders, including:

Structural Changes in the Vocal Fold

• Bowing/Presbylarynges 
• Congenital and acquired cysts
• Congenital and acquired webs
• Granuloma/Contact ulcer
• Laryngeal papillomatosis
• Laryngitis: acute and chronic
• Leukoplakia and hyperkeratosis
• Polyps
• Reinke’s edema
• Scarring and sulcus vocalis
• Vascular Lesions: vocal hemorrhage and varix
• Vocal fold cancer
• Vocal nodules

Neurogenic Voice Disorders

• Organic (essential) vocal tremor
• Spasmodic dysphonia: adductor and abductor
• Vocal fold paralysis: unilateral and bilateral
• Other neurogenic disorders

Other Voice Disorders

• Muscle tension dysphonia
• Puberphonia
• Ventricular phonation (plica ventricularis)

Symptoms of a Voice Disorder

An individual experiencing a voice disorder may have a voice quality that sounds:

• Unstable or quivering
• Rough, harsh, or hoarse
• Strained or choppy
• Weak, whispery, or breathy
• Too high or too low
• Significantly changed in pitch

Other symptoms include:

• Tension or pain in your throat when you speak
• Feeling that your larynx (voice box) is tired
• Feeling of a "lump" in your throat when swallowing
• Pain when you touch the outside of your throat

If you have been experiencing one or more of the above symptoms for more than two weeks, you should make an appointment with a specialist for an evaluation.

Diagnosing a Voice Disorder

Your primary care provider may send you to see an otolaryngologist (throat specialist) or a laryngologist (an otolaryngologist with training in voice disorders). The specialist will ask about your symptoms and may examine your vocal folds and larynx using certain tests, including:

• Videostroboscopy: This test uses a camera called an endoscope to visualize your larynx. There are two types of endoscopes: flexible and rigid. A flexible endoscope is a small camera that looks up through your nose and hangs over the back of your throat to view your larynx. It does not hurt and only takes one or two minutes to perform the test. A rigid endoscope is a slightly larger, but still small, firm camera that enters your mouth, just to the back of your tongue, and looks at your larynx via the mouth. It does not go down your throat and does not hurt. Both endoscopes use strobe lights that allow the physicians to view the vocal folds vibrating in slow motion.

• Imaging tests: X-rays, CT scans, and MRI can show growths or other tissue problems in the throat. These tests may be used in addition to the videostroboscopic examination.

Treatments for Voice Disorders

Treatment for a voice disorder depends on what's causing it. Your care may include:

• Lifestyle changes:  Changes such as voice rest and avoiding yelling can help reduce or stop symptoms. Exercises to relax the vocal cords and muscles around them can help in some cases.
• Speech therapy: Working with a speech-language pathologist can help with certain voice disorders. Therapy may include exercises and changes in speaking behaviors.
• Medications: Some voice disorders are caused by a problem that can be treated with medication. For example, antacid medication may be used for gastric reflux; hormone therapy may be used for problems with the thyroid or female hormones; and nasal sprays may be used for allergies affecting your voice.
• Injections: Muscle spasms in the throat can be treated with an injection of botulinum toxin. In some cases, fat or other fillers can be injected into the vocal cords to help them close better.
• Surgery: Often surgery is used to restore laryngeal function, as in the case of vocal fold paralysis, a vocal fold polyp, or vocal fold scar. For many procedures, a patient can remain comfortably awake in the office. Vocal fold lesions can be removed if necessary. If growths are caused by cancer, other treatment, such as radiation therapy, may be needed.