Voice Problems Part 2
Vocal Evaluation – What Now?
By Spencer Gilleon, M.D.
So now you have made it to the Ear, Nose and Throat physician’s office for ongoing voice problems, and you’re feeling somewhat nervous about this evaluation. Be reassured the examination is well tolerated and involves only a few minutes of direct visualization of the vocal cords. The ENT physician is well trained in recognizing problems of the throat and larynx that might affect your voice. Further examination may entail a strobe light exam and video recording of the vocal cords as you vocalize. Rarely, a patient may have to go to the operating room for microscopic examination of the vocal cords. This often occurs with children, as they are usually uncooperative with an endoscopic examination in the office.
What are the most common causes of voice change? We mentioned in our last article that hoarseness is the most common presenting symptom. Laryngitis is probably the most common cause of hoarseness. This is a viral illness, usually associated with a recent upper respiratory infection, and the loss of voice is quite temporary. It is usually painless and resolves in a rather short time after a mild to moderate amount of voice rest and hydration. Another common cause of hoarseness in the vocalist is singer’s nodes (nodules) and these are often described as small callouses on the edges of the vocal cord. They occur as a result of improper technique during singing and vocal overuse. The treatment involves the help of a speech pathologist, cutting back on vocal use, control of acid reflux, and review of vocal technique by a trained voice coach. It is extremely rare that surgery will be needed for this problem.
Gastroesophageal reflux is a common problem in our society and is often associated with hoarseness. This can occur without classic symptoms of heartburn and indeed the only symptom may be a change in voice. Obvious treatment would be to control the acid reflux and the voice problem should improve.
Vocal cord polyps are a common problem associated with smoking and involves a rather exaggerated amount of swelling of the vocal cord, but not enough to be called callouses. Stopping smoking often results in gradual resolution of the polyp.
Vocal cord cancer is probably in the back of the mind of all patients who present with voice change. This occurs as the result of smoking; however, can occur in other settings also. Early diagnosis is imperative and takes only an examination in the office and eventually a biopsy. If caught early, the problem can be cured.
There are certainly other causes of voice change that are more uncommon such as bacterial or fungal infections, small warts of the vocal cords known as papillomas, or even paralysis of a vocal cord resulting in a weak, whispery voice. The bottom line is, if your voice is not improving or worsening, then do not hesitate to have it evaluated. Your Ear, Nose and Throat physician has the best equipment for evaluating your vocal cords and treating the problem accordingly. He or she also has access to other voice professionals with whom you can receive voice success. Remember surgery is a rare necessity when dealing with voice problems, but is available if necessary. Reassurance and minor treatment is often all that is needed. Here’s to your clear voice!