Voice Disorders

Voice production requires the coordination of three systems:

• Larynx (the voice box); this is where the crude buzzy sound is produced when the two vocal cords vibrate
• Resonating System; this transforms the buzzy sound into the person’s recognisable voice and is composed of the mouth, nose and sinuses
• Articulation; this is the mechanism by which recognisable words are produced and requires coordinated movement involving the soft palate, tongue and lips

There are a number of different conditions and disease that can lead to voice problems, such as hoarseness. If  you become hoarse frequently or over an extended period of time, or if you have noticed any changes to your voice then it is important to see a ENT consultant such as Mr Fayad so he can determine the underlying cause.

Benign Laryngeal Conditions

Click here for more information.

Infections

Acute Laryngitis
This is the most common cause of hoarseness and/or voice loss and it is caused by a viral infection that makes the vocal cords swell. The best treatment is to rest your vocal cords because you can cause serious trauma to your vocal cords if you overuse them while suffering from acute laryngitis. A viral infection won’t respond to antibiotics.

Chronic Laryngitis
This can be a result of Laryngopharyngeal Reflux (LPR) or an infection such as a yeast infection of the vocal cords.

LPR

Laryngopharyngeal Reflux (LPR) is the result of when the muscle at the top of your stomach is weakened or does not work properly and stomach acid backs up into your throat, causing inflammation of your throat and voice box. Click here for more information.

Benign Lesions

This includes nodules, polyps and papillomas on the vocal cords. Click here for more information.

Malignancy

Chronic or prolonged hoarseness can sometimes be the result of throat cancer and Mr Fayad’s first step will be to rule this out. Click here for more information.

Voice Misuse and Overuse

Using the voice is a physical act that utilises several muscles so just like straining a muscle after overusing it in the gym, it is possible to misuse or overuse the voice. This leads to fatigue of the voice and hoarseness and can lead to benign vocal cord lesions (see above) or a vocal cord haemorrhage. This is when one of the blood vessels on the surface of the vocal cord bursts and the soft tissues of the cord fill with blood. Absolute rest is the only cure.

Neurological

Hoarseness or voice difficulties can also be caused by paralysis or weakness of one or both vocal cords. This can be caused by a viral infection of the throat, as a result of surgery or trauma, or from a tumour or growth.

Although many cases recover within several months, some cases of paralysis are permanent and need treatment. Mr Fayad will determine what is the cause of the paralysis and the degree of impairment before deciding whether voice therapy will be effective or whether you’ll need surgical treatment.

Voice Hygiene

Your voice, very much like your teeth, for example, requires you to look after it. Stopping smoking should be top of the list. Here are the Ten Commandments for maintaining a healthy voice:

1. DON’T SMOKE: smoking damages the voice, accelerates ‘wear and tear’ and causes cancer.
2. ELIMINATE HABITUAL CHRONIC THROAT CLEARING-COUGHING: try taking sips of water when you feel the urge to clear your throat or if you have chronic dry cough.
3. DRINK LOTS OF WATER: the voice production mechanism needs humidification to work effectively. Like a machine that needs oiling!
4. CONTROL AND LIMIT VOCAL LOUDNESS – DO NOT COMPETE VOCALLY: avoid yelling, screaming, shouting, particularly in a noisy environment.
5. BALANCE EXTRA VOCAL DEMAND WITH VOICE REST: rest your voice before and after periods of excessive voice use. Listen more, talk less.
6. HUMIDIFY THE ENVIRONMENT: particularly the bedroom! At night we tend to breath more through the mouth and we swallow less saliva, hence, the upper aero-digestive tract tends to dry-up.
7. USE MEDICATIONS WITH CAUTION: particularly OTC lozenges that contain local anaesthetics.
8. AVOID ALCOHOL AND CAFFEINE: alcohol, caffeine as well as diuretics can cause fluid depletion from the body including the vocal cords.
9. REDUCE OR ELIMINATE LARYNGO-PHARYNGEAL REFLUX (LPR): this is a very common, yet ignored problem, and is caused by gastric acid flowing backwards toward the upper airway. Click here for more information. [LIVE LINK]
10. USE VOICE AND SPEECH THERAPY: do not wait until your voice problems become severe – voice and speech therapists are very well trained to deal with your voice problems/hygiene and their contribution in our speciality is invaluable.