Voice Disorders

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Specialists from the Voice and Speech Laboratory care for patients suffering from a variety of disorders of the voice system. View more information about the most common conditions seen in our clinic below.

Source: Barbara M. Wilson Arboleda, M.S., CCC-SLP

Vocal Fold Nodules

Vocal fold nodules are like blisters or callouses that appear on the vocal folds, usually approximately in the middle (front to back). They occur when the vocal folds vibrate too strongly against one another and are most often associated with chronic straining of the voice in some way. The first line of treatment for vocal fold nodules is usually voice therapy.

Vocal fold lesions may resolve completely with voice therapy, or they may not. The most important outcome measure for voice therapy is your level of voice function. Softer, less developed nodules are more likely to go away. Firmer nodules are more likely to stay. Quite often your function will be quite good despite the continued presence of vocal fold nodules. As your treatment progresses you, your therapist and your doctor will need to communicate regarding your level of function in order to determine if some kind of surgical intervention is warranted.

Paradoxical Vocal Fold Motion (PVFM)

Often confused for asthma, PVFM is a laryngeal spasm that causes a feeling of not being able to breathe. Frequently, these spasms occur during periods of intense exercise and may result in a trip to the Emergency Room. PVFM is sometimes called Vocal Cord Dysfunction (VCD). There are therapy strategies available to minimize and often eliminate these laryngeal spasms.

Vocal Fold Paralysis

Vocal fold paralysis is a condition in which one of the two vocal folds is not swinging open and closed. Therefore making contact between the vocal folds in order to generate sound can be difficult or impossible. A vocal fold can be paralyzed in either an open or a closed position. Vocal fold paralysis can happen because of a throat or neck injury, certain surgical procedures or sometimes a virus. Voice therapy may be able to restore voice function, though some people may need a surgical procedure as well.

Vocal Fold Paresis

Vocal fold paresis is a partial paralysis of the vocal fold. This means that there is some movement noted, but it is reduced from normal. Vocal fold paresis has the same causal factors as vocal fold paralysis. Similarly, voice therapy with or without a surgical procedure may be required.

Chronic Cough

Chronic cough is usually the result of a throat or larynx irritation, such as allergies or reflux. Once the source of the irritation is eliminated, the cough may remain. This is when you may be said to have “irritable larynx” syndrome. In most cases the cough can be eliminated with the use of specific strategies designed to stop the throat from being hyper-reactive.

Spasmodic Dysphonia

Spasmodic dysphonia (SD) is a dystonia of the larynx. This means that there are involuntary contractions that disrupt voice. Usually symptoms are only present during speaking/voicing. There are two basic kinds: abductor SD spasms open unpredictably in speaking, leading to breathy breaks; adductor SD spasms closed unpredictably in speaking, leading to a strained/strangled sound. The primary first line of treatment for SD is the periodic administration of Botox into the larynx. Voice therapy has been shown to optimize the results of Botox injections and may increase the length of time between injections.

Recurrent Respiratory Papilloma

Recurrent respiratory papilloma (RRP) is a viral disease that may manifest in the throat, larynx, vocal folds, and or airway. When papilloma is active, there is a flourishing of cauliflower appearing lesions in the affected region. Papillomatous lesions may significantly disrupt the voice and at times can block the airway. Surgery is required to remove the papilloma and post-surgical voice therapy is used to rehabilitate the voice afterward. While a number of anti-viral agents are being introduced during the surgery, papilloma does tend to recur. Therefore numerous sequential surgeries may be required over the lifetime of a person who has RRP.

The Aging Voice

Similarly to many other parts of the body, the voice changes with age. The cartilage becomes hardened and the mucosa becomes thinner. Depending on voice use throughout the life, there may be cumulative scarring or recession of the vocal fold cover. These situations may result in deterioration of voice. Fortunately, there are many people who can be helped to optimize their voice in voice therapy, though vocal conditioning exercises may need to be continued indefinitely for the best results.