The larynx (voice box) is the organ for voice production and is critical for normal swallowing and breathing. Disorders of the larynx will typically lead to hoarseness and/or breathing difficulties, and can be caused by a variety of reasons including:

  • Benign or malignant lesions
  • Neurological disorders
  • Medical illnesses
  • Trauma

Common signs and symptoms of a swallowing disorder include:

  • Coughing while eating or right after
  • Wet or gurgly sounding voice during or after eating or drinking
  • Extra effort or time needed to chew or swallow
  • Food or liquid leaking from the mouth or getting stuck in the mouth
  • Recurring pneumonia or chest congestion after eating
  • Weight loss or dehydration from not being able to eat enough

At MedStar Washington Hospital Center, our physicians evaluate and treat the spectrum of common disorders and diseases that affect the larynx, including:

Dysphonia

Dysphonia is a medical term for voice disorders and hoarseness. Hoarseness that lasts more than four weeks can sometimes indicate a more serious problem. Symptoms of dysphonia may include:

  • Dry, scratchy throat
  • Hoarse voice
  • Sore throat

Causes

  • Inflammation of the larynx or voice box over a short or long period of time
  • Lumps (nodules) on the vocal cords
  • Underactive thyroid gland (hypothyroidism)
  • Trauma to the vocal cords can cause scarring and affect the voice function.
  • Reinke's edema of the larynx
  • Psychological:  voice changes can occur when people are under stress, or, you may lose your voice suddenly, usually after a cold. It is important to identify and remove the underlying stress. Speech therapy can be useful for treating this cause.

Depending on the cause of your hoarseness, your doctor will order more tests, or prescribe a regimen of medical and speech therapies for treatment. If your hoarseness is a symptom of a more serious condition, your doctor will guide you in seeking treatment from our other experienced specialists.

Laryngopharyngeal Reflux

Laryngopharyngeal reflux occurs when the sphincter, a ring of muscle that helps keep the acidic contents of the stomach out of the throat, does not work properly. It can be caused by:

  • Malfunctioning or abnormal lower and/or upper esophageal sphincter muscle
  • Hiatal hernias
  • Abnormal esophageal contractions
  • Slow emptying of the stomach

Other factors may include diet choices including chocolate, citrus, fatty foods, and spices; overeating; alcohol and tobacco abuse; and sometimes pregnancy. People with laryngopharyngeal reflux frequently do not have the typical symptoms associated with heartburn (burning pain in the chest after meals). Instead they may experience

  • Bitter taste in the back of the throat, more commonly in the morning upon awakening
  • Feeling that something is stuck in your throat
  • Hoarseness
  • Throat pain
  • Burning sensation in the throat
  • Difficulty swallowing
  • Chronic cough

Your doctor will most likely prescribe a medication to decrease acid production in the stomach, as well as suggest certain dietary and lifestyle changes that will help in reducing the reflux symptoms.

Reinke’s Edema

Reinke's edema is caused by swelling of the vocal chords due to trauma, misuse of the voice, irritating conditions (like gastric reflux), and cigarette smoking. It results in a deep, husky voice and typically occurs in middle-aged/post-menopausal women who have a long-term history of smoking cigarettes.

Your doctor will try to address the underlying cause Reinke's Edema. If you are a smoker, you will be strongly encouraged to stop. If your condition is caused by gastric reflux, your doctor will prescribe treatment to treat that problem. Speech therapy is also prescribed to encourage proper use of your voice and vocal folds.

In some cases, surgery is recommended. The surgery performed to treat Reinke's Edema is called vocal fold phonomicrosurgery, a surgery of the vocal folds using endoscopic tools, microlaryngeal​ instruments, and techniques to repair the vocal folds.

Subglottic Stenosis

The subglottis is the area of the voice box below the vocal folds. Subglottic stenosis is a narrowing of this area, which can make breathing difficult. It commonly misdiagnosed as asthma, as both are due to trouble breathing. However, with asthma, patients usually have trouble breathing out, while patients with subglottic stenosis usually have trouble breathing in.

Depending on the degree and level of the narrowing, different treatments may be recommended. These include:

  • Laser resection: The surgeon will widen the narrowed part of the throat, making it easier for the patient to breathe. This may require multiple surgeries. Mitomycin, a chemical that decreases scar tissue formation, may be applied to decrease the chance of recurrent narrowing.
  • Balloon dilation: The area of narrowing may be dilated with an inflatable balloon. This method is gentler than the traditional method of placing rigid endoscopes through the area of narrowing. Multiple dilations may be required to ensure that the area of narrowing remains open.
  • Tracheal resection: This procedure is usually performed with the thoracic surgery service. The area of narrowing is removed through an incision in the neck, and the two ends are brought back together. This procedure usually requires a hospitalization period of approximately four-seven days after surgery.

Vocal Fold Nodules and Polyps

Vocal fold nodules are benign growths on both vocal folds. Repeated misuse of the vocal folds results in swollen spots on each vocal fold that develop into harder, callus-like growths. The nodules will become larger and more rigid the longer the vocal abuse continues.

Polyps can take a number of forms and are frequently caused by vocal abuse. Polyps appear on either one or both of the vocal folds and present as a swelling or bump, a stalk-like growth, or a blister-like lesion. Most polyps are larger than nodules. Nodules and polyps cause similar symptoms and include:

  • Hoarseness
  • Rough or scratchy voice
  • Shooting pain to the ear
  • Lump in the throat sensation
  • Neck pain
  • Voice and body fatigue

Nodules are most frequently caused by vocal abuse or misuse. Polyps may be caused by vocal abuse over a long period of time, but may also occur after trauma to the vocal folds. Other causes of polyps include:

  • Long-term cigarette smoking
  • Hypothyroidism
  • Gastric reflux

Nodules can be treated medically and with behavior modification, while polyps usually require surgery followed by speech therapy. The underlying cause will be addressed first with medicine and speech therapy. Voice therapy includes learning proper vocal techniques, eliminating behaviors that harm the voice, and stress- reduction techniques.

Vocal Fold Paralysis

The vocal cords are two elastic bands of muscle tissue located in the voice box (larynx) directly above the windpipe (trachea). These cords allow you to speak because when air held in the lungs is released and passed through the closed vocal cords, it causes them to vibrate. When you are not speaking, the vocal cords remain apart so you can breathe.

Vocal cord paralysis occurs when one or both of the vocal cords (vocal folds) do not open or close properly. The paralyzed cord or cords remain open, leaving the airway passage and the lungs unprotected. The condition makes it difficult to swallow or cough because food or liquids slip into the trachea and lungs.

Symptoms include:

  • Breathy or hoarse voice
  • Inability to project the voice loudly
  • Inability to speak loudly
  • Limited pitch and loudness variations
  • Coughing or choking while eating
  • Difficulty breathing

The two types of vocal cord paralysis are:

  1. Bilateral vocal fold paralysisaffects both vocal folds, which become stuck between open and closed and do not move either way. Bilateral vocal fold paralysis can be medically treated but frequently requires a tracheotomy to allow the person to eat and breathe safely. Other surgical procedures to open the airway may include a cordotomy (and incision in the vocal fold), and an arytenoidectomy (removal of part of the voice box).
  2. Inunilateral vocal fold paralysis, only one side is paralyzed between open and closed or has a very limited range of motion. People affected with unilateral vocal fold paralysis will run out of air easily and be unable to speak clearly and with sufficient loudness to be understood. Unilateral vocal fold paralysis can be treated medically and/or with speech therapy. Surgical treatment includes:
    1. Injections to increase the size of the paralyzed vocal fold. Injection with different materials may be indicated depending on how long the effect is desired.
    2. Thyroplasty: moving the paralyzed vocal fold toward the center of the voice box through an incision in the neck
    3. Arytenoid adduction: rotating part of the voice box through and incision in the neck). This is usually performed with thyroplasty.

Speech therapy from a speech-language pathologist is a critical part of any treatment and may be the only treatment you will need. Speech therapy for vocal fold paralysis includes learning proper vocal techniques, eliminating behaviors that harm the voice, and stress reduction techniques.

 

 

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