Young girl speaking on phone

Voice Disorders

The voice box (larynx) enables us to create sounds using air pressure from the lungs. When something goes wrong in the larynx or the nerves that control it, the voice can be adversely affected. Some of the warning signs of a serious voice disorder include:

  • Hoarseness (dysphonia) or voice loss
  • Breathing difficulties (stridor)
  • Easy voice fatigue 

Most voice problems stem from injury, nerve damage, cancer, or other growths in the body. With a team of specially trained physicians and speech-language pathologists, we are equipped to diagnose and treat the many causes of voice disorders. As a patient, you will first be seen by one of our laryngologists and then, depending on your diagnosis, you may be seen by one of our speech-language pathologists in the Voice and Speech Laboratory for therapy.

Children may also experience voice disorders. These may be congenital (present at birth) or acquired. To help such children, we also have doctors trained in the diagnosis and treatment of voice disorders in children of all ages.

To schedule an appointment, request one online or call 617-573-3557 today. You can reach the Voice and Speech Laboratory at 617-573-4050.

Learn more about the most common conditions seen in our clinic:

Vocal Fold Nodules

Vocal fold nodules are like callouses on the vocal folds. They grow when the vocal folds vibrate too hard against one another and are most often associated with chronic voice strain. 

The first line of treatment for vocal fold nodules is voice therapy. If therapy doesn’t improve the nodules, surgical intervention may be an option for some.

Paradoxical Vocal Fold Motion (PVFM)/Vocal Cord Dysfunction (VCD)

Often confused for asthma, PVFM is a laryngeal (voice box) spasm that causes a restriction in breathing. Often, these spasms occur during exercise and may result in a trip to the emergency room. There are voice therapy strategies to control and often eliminate these spasms.

Vocal Fold Paralysis and Paresis

Vocal fold paralysis is a condition in which one or both of the vocal folds is not swinging open and closed, or is too floppy. It can happen because of a throat or neck injury, certain surgical procedures, or, sometimes, a virus. Paralysis may make voice quiet, breathy, and/or unstable. 

Paresis is a partial paralyzation and may have similar symptoms.

Symptoms of vocal fold paralysis and paresis can vary depending on the resting position of the vocal folds and the degree of compensation. Symptoms may include a weak, breathy voice; shortness of breath; difficulty swallowing liquids, solids, and pills; vocal fatigue; and a decrease in vocal stamina. This can have a significant impact quality of life.

Treatment for vocal fold paralysis and paresis depends on a variety of factors, including degree of voice loss, vocal demands, presence of aspiration, and airway and swallowing symptoms. There is potential for vocal fold motion recovery and treatment options are tailored according to prognosis for recovery, symptoms, and individual voice needs. 

In some cases, laryngeal electromyography may be appropriate and can provide additional prognostic information. Other treatment options include observation and monitoring, voice therapy, and vocal fold augmentation or medialization procedures. Treatments of vocal fold paralysis and paresis are designed to enable the working vocal fold to better contact the weak side.

Chronic Cough

Chronic cough is often the result of a throat or larynx (voice box) irritation, such as allergies or reflux. Once the source of the irritation is eliminated, however, the cough may remain. This is called “irritable larynx” syndrome. In many cases, the cough can be eliminated with the use of specific strategies designed to stop the throat from overreacting.

Spasmodic Dysphonia

Spasmodic dysphonia (SD) is neurological abnormal spasming of the larynx (voice box). These symptoms are only present during speaking. 

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 first-line 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 (RRP)

RRP is a viral disease that may manifest in the throat, larynx (voice box), vocal folds, and/or airway. When papilloma is active, cauliflower-appearing lesions grow in the affected region. These 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. 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 your life, there may be cumulative scarring or thinning of the vocal fold cover. These situations may result in deterioration of voice. Fortunately, many can be helped in voice therapy with conditioning exercises.