Patients experiencing symptoms such as hoarseness, coughing, breathing difficulties, and throat and/or ear pain may have a Voice Disorder. These problems are generally centered on the larynx or voice box, an organ in the neck that houses the vocal cords and whose primary function is to protect the airway from aspiration of food and liquid into the trachea or windpipe. The larynx produces voice by using the lungs as a power source, the vocal cords as a vibrator, and the mouth, throat, nose and sinuses as a resonator. Together these structures, known as the vocal tract, generate voice with variations of pitch, tone, volume, and loudness.
The most common cause of a voice change is acute laryngitis due to a viral infection or screaming. If laryngitis lasts more than one month, it is considered chronic laryngitis, which is most commonly associated with smoking, vocal abuse, and prolonged exposure to dust or air pollution. If the problem lasts more than two weeks, you should make an appointment for an ENT evaluation, as this condition can be a sign of cancer of the larynx. This cancer, commonly caused by excessive smoking and drinking, presents as a bump or ulcer on the vocal cord, causing the voice to sound hoarse. If a bump or ulcer is found, a biopsy can be performed to determine if cancer is present. If it is, we can plan your treatment, which usually includes radiation and possibly chemotherapy.
However, not all vocal cord lesions are cancerous. Polyps, cysts, papillomas and nodules can be seen on unhealthy vocal cords due to both smoking and vocal abuse. Generally, nodules can be treated by resting the voice and through vocal therapy. Polyps, cysts, and papillomas, however, generally are removed through microsurgery and laser techniques.
Ulcers and granulomas are changes in the back part of the larynx that generally result from intubation for a surgical procedure or ICU care or from reflux esophagitis. These injuries usually respond to medical therapy and only occasionally require surgery.
Some newborns are diagnosed with Laryngomalacia, a condition in the newborn larynx caused by weak cartilage, which can result in intermittent tissue collapse over the breathing passage. Infants with this condition need to be monitored closely until the larynx matures and stiffens, typically in 6 to12 months.
Presbylarynx—aging voice— is common as loss of suppleness and muscle bulk occur due to the aging process. This condition results in a voice that is weak, has difficulty with projection and lacks stamina. Some aging patients are candidates for injection or implant procedures to help restore voice function.
Laryngealpharyngeal reflux (LPR) and reflux esophagitis (GERD) occur when acid and stomach contents backflow from the esophagus into the upper throat and larynx causing burning and swelling that results in hoarseness, chronic cough, excess throat mucous, heartburn, and difficulty swallowing. Changes in diet and lifestyle, along with proper medications, can help correct this problem. Taking these steps is important because prolonged symptoms are associated with Barrett’s esophagus, a precancerous finding in the gastro-esophageal region, and esophageal cancer.
Paresis (weakness) or paralysis of a vocal cord(s) may cause a breathy, high-pitched vocal change. These deficits in motor function are commonly caused by viral infections, but also can be caused by cancer, a neurologic disorder, stroke, trauma, an accident or an inadvertent injury during neck surgery. The voice may improve with speech therapy, a vocal cord injection or by larynx implant procedures.
Dr. Agresti is experienced at diagnosing each of these voice disorders. Along with her diagnostic skills, she is one of only a few local ENTs who can perform many of the highly specialized surgical procedures that can help patients return to more normal voice function and even to professional voice use.
Videostroboscopy is a state-of-the-art procedure used to examine the larynx in great detail. The most common reason to perform the exam is to evaluate hoarseness, voice changes or difficulty singing, speaking or swallowing. To perform this procedure, Dr. Agresti places a scope with a camera and a microphone into the patient’s mouth. The angle of the camera allows for visualization of the throat and larynx, and it records what takes place when the patient performs vocal tasks. Dr. Agresti then reviews the findings with the patient immediately following the exam and makes treatment recommendations, such as medications, voice therapy, and/or surgery.
12 Tips for a Healthy Voice
Your voice is an important reflection of who you are and how you are feeling. It may tremble when you are nervous or may be raspy if you sang the night away. Lifestyle choices can have a real effect on your voice. Here are a few tips to help keep your voice healthy and avoid vocal misuse or overuse:
- Water is essential. Drink a minimum of 64 oz. of water per day.
- Stop clearing your throat – it can result in irritation and swelling of the vocal chords.
- Don’t smoke.
- Reduce alcohol consumption – Alcohol irritates the larynx and is linked to larynx and throat cancer.
- Avoid alcohol-based mouthwashes.
- Avoid screaming when you speak. Avoid singing while you’re hoarse. Avoid whispering when you have a voice problem.
- Use a microphone when necessary to reduce stress and strain on the voice.
- Rest your voice, especially when hoarse.
- The lungs are the power source for vocal production, so take a deep breath before speaking.
- Improve posture to promote better airflow and reduce muscle tension and strain.
- Warm up your voice for singing or lengthy speaking engagements.
- Get some sleep. Rest is essential for preservation of vocal function.
The esophagus or food pipe is a muscular tube that allows the passage of food from the mouth to the stomach. It is approximately 25 cm long and travels behind the trachea in the chest on its way to the stomach. It has two muscular rings called sphincters—one at the top and one at the bottom. The sphincter at the bottom helps to prevent reflux or backflow of acid and stomach contents into the esophagus and throat. During a normal swallow, the epiglottis or flap in the larynx closes the tracheal inlet to prevent food and liquid from entering the windpipe. At the same time, the upper esophageal sphincter relaxes, allowing food to enter. Rhythmic contractions called peristalsis push the food down the esophagus where the lower esophageal sphincter opens and lets food enter the stomach.
Transnasalesophagoscopy (TNE) is a very safe, cost effective procedure that can be done in our office. During this procedure, Dr. Agresti can biopsy a larynx lesion, biopsy stomach esophagus junction and examine the esophagus and stomach to evaluate symptoms of gastroesophagealreflux (GERD), including: trouble swallowing, chronic cough, hoarseness, dry throat, and silent reflux.
The procedure takes just four minutes to complete and is performed with the patient sitting up in the exam room chair. It is important that the patient hasn’t eaten for the four hours prior to the procedure. Dr. Agresti begins by spraying the nasal cavity with anesthetic. Then she passes a thin, flexible scope through the nose and into the esophagus and stomach. At this point, she can take a biopsy of the important junction between the esophagus and stomach to check for Barrett’s Esophagus, a precancerous lesion.