Vocal Cord Problems
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Recurring hoarseness comes and goes, is there an issue with the vocal cords?

Vocal Cord Problems

QUESTION:

I have acid reflux, small hiatal hernia and gerd.  I am a female senior.  My hoarseness comes and goes.  When I feel stressed I believe it tightens up my vocal cords and I sound raspy and it is very embarrassing.  What can I do?  Is there anything to permanently cure this?  Have my vocal cords atrophied?

ANSWER:
First of all, thank you for your question.

There are many reasons that one can have problems with your voice- as you describe.

The vocal cords are muscles, covered with a thin membrane. When we breath the vocal cords open and when we speak the vocal cords come together. They must come together smoothly and close completely for a normal voice.
Anything that keeps the vocal cords from coming together smoothly, will affect your voice quality.

The first thing one needs to be certain of is that there is no tumor, nodule or polyp on one or both cords. This will keep the cords from closing completely, and leave the speaker with a hoarse or raspy voice. At times one can push through this by forcing the cords closed- but the more this is done, the more hoarse one gets.

A hiatal hernia, or a weakness in the valve that keeps acid in the stomach, can cause reflux of acid contents as high as the voice box. Should the acid – even a small amount- hit the vocal cords, it causes irritation, swelling of the cords and hoarseness. It often causes the feeling that we have to clear our throat- and clearing the throat bangs the cords together and actually makes the swellling and voice worse. Treatment for reflux- diet, positional and at times medication can help this.

The vocal cords are muscles and like any muscle they can loose bulk. In that case, which is quite common, the vocal cords do not close completely without forcing- and this can also cause symptoms as you describe. At times one can force through this, but then the muscles fatigue and the voice gives out. This may respond to vocal exercises- and sometimes your ENT voice specialist may recommend a procedure to “bulk up” the cords so that they can close more readily.

Other less common causes include neurologic issues (stroke, Parkinson’s, neuropathies) that can cause similar complaints.

Obviously, I cannot tell you if the problem is one or more of these issues. Clearly, the most important first step is to have your ENT doctor closely examine you and your vocal cords and figure out the cause of your vocal problems- and then together with you figure out how to help.

I hope this helps clears things up.

Robert L Pincus MD
NY Otolaryngology Group
Weill Cornell Medical College

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Is there a way to treat a recurring tightening of the muscles around the voicebox?

QUESTION:

Muscle Tension Dysphonia Treatment

Please help if you can! Several years ago I had laryngitis and had to continue talking (retail work). As a result I ended up with muscle tension dysphonia that went incorrectly diagnosed for several years. Finally I got a diagnosis and 2 years of speech therapy have improved things, but I still can’t sing and, at the end of each day, my throat is tight and painful.

I desperately want to be able to sing again. There MUST be a way to reverse what is really just a habitual tightening of the muscles around the voicebox. Can you suggest anything? Hypnotherapy? ANYTHING.  Please.
Thanks Aarjaun Johnston

 

ANSWER:
Thank you for your question.

There are many different factors that are important in allowing us to have full use of our voice.  Obviously, overuse, either through yelling or speaking incorrectly is one major factor.

However, in order for one’s voice to be normal, it is important to look at hormonal factors (thyroid functions and well  estrogen/androgen) as well as the possibility of inflammation from reflux, chronic sinus infection and scarring of the thin layer protecting the vocal fold muscle.

Lastly, there can be a damage to the nerves controlling the voice box- either after an upper respiratory tract or other throat infection.

It seems unlikely that muscle tension is the only cause of your problem. This  frequently will be a counter-productive adaptation that you are doing because of another underlying issue.

I hope this clears things up.

Robert L Pincus MD
NY Otolaryngology Group
Weill Cornell Medical College

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Sudden Hoarseness and Oral Candidiasis

Question:
My baby developed sudden hoarseness of voice then developed oral candidiasis then fever. After treatment, the candidiasis and fever were gone, but after about 3 weeks still has hoarseness. It should be known that he has attopic dermatitis and he was on hydrocortisone therapy, but we stopped that too for more than 3 weeks.
Best regards
BK
Answer:
I would suggest a consultation with an ENT specialist who sees babies. It may just take a little longer for the hoarseness to improve but an otolaryngologist could examine the voice box in the office with a Fiberoptic telescope.
Hope this helps clear things up.
Scott D. Gold, MD
If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I am a teacher with a vocal cord polyp. What can I do to reduce it?

Question:

I have been teaching for 24 years. I suffer with laryngitis. March 5th, 2014, the ENT told me I have a polyp in my throat and by April 23rd, 2014 he said it had grown a little bigger. What can I do to reduce it? If I can’t reduce and need surgery, what would be the cost?

Answer:

Thank you for your question.  Vocal cord polyps are growths on the vocal cords.  It is first, most important, to make sure that these are not tumors or cancers.  Often, your ENT doctor can tell pretty well by the examination- but not always.  If there is any question, a vocal cord polyp needs to be removed and biopsied-  This is generally done in the operating room, with a microscope and a lighted tube in the throat, and takes but a few minutes to do in the operating room as an outpatient.   Generally,  but not always, the voice will improve from this procedure.

Benign vocal cord polyps and nodules may be caused by vocal abuse- and are quite frequent in teachers.  It your doctor feels that is the case,  he or she would likely recommend voice/speech therapy.  Additionally, we might recommend vocal rest (difficult for teachers) and sometimes a brief course of prednisone to bring down swelling.   Speech therapy is to help train you to project your voice in the suboptimal acoustic environment that is the classroom, without as much trauma as you may be having.  We may also treat for reflux, as gastric acid can irritate the vocal cords and predispose you to forming polyps and nodules.  Of course, smoking and alcohol are also risk factors for developing growths on the vocal cords- and can predispose to both benign and cancerous growths.

Most benign vocal cord polyps and nodules are medically treatable, and do not frequently require removal- especially since they are likely to come back if the cause has not been resolved.

Robert Pincus MD, FACS

NY Otolaryngology Group- NY Voice Center

Associate Professor Otolaryngology NY Medical College

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

I have a cyst on my arytenoid (in the larynx or voice box)-

Question:  
Hi Drs.  I have been diagnosed with a mucosal retention cyst on my arytenoid process.  I  know it has been there at least 1.5 yrs (I could feel it when breathing hard – it restricted my breathing) but I just had it checked out recently.  The CAT scan showed it was @1.1 cm in diameter.  My Dr. says I should have it removed and that it is a “simple” procedure.  I am most worried about the general anesthesia and possible damage to my teeth or trachea or wherever else the breathing tube goes.  So 2 questions: 1) Do you think I should get a 2nd opinion?  and 2), are these cysts ever aspirated instead of cut out?  Thanks you so much for your thoughts-

Answer:

The arytenoids are paired cartilages that attach to the back of the vocal cords.   By moving the arytenoids, we move the vocal cords-  apart for breathing and together for speaking.  While there can be a cyst (mucous containing sac) on an arytenoid- one more commonly sees granulomas-  which are areas of inflammation.   Granulomas usually come from reflux-  and treatment for reflux will often get these to resolve without intervention.  Cysts come from tissue getting filled with mucous from one of the many many mucous secreting tiny glands throughout the airway.  Usually after some type of trauma to the tissues-  swallowing the wrong way, acid reflux or some other unknown cause.

While cysts can be tumors or even cancers, this one clearly is felt to be nothing worrisome.  If there is a question of there being a tumor or cancer, clearly one should have it removed.

Otherwise, I would suggest removing this should it be growing or causing symptoms- such as hoarseness, difficulty breathing or discomfort.   Removing the cyst is a relatively easy, quick, simple procedure and can be done by most Ear Nose and Throat surgeons- or by a Laryngologist (subspecialist in voice)   It almost always is done with general anesthesia- and the risks are basically as you describe- but they are quite rare-

Removing the cyst involves taking the top off, so that it drains and heals open.  Usually, this would take a couple of minutes, total.   There is no advantage to to aspirating (suctioning out the cyst) as it is likely to refill- and is not really much less of a procedure.

In general, it never hurts to get another opinion…

I hope this helps clear things up.

Robert Pincus MD

Associate Professor Otolaryngology

NY Otolaryngology Group/ NY Voice Center

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