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.

Am I a candidate for Laryngeal Framework Surgery?

Question

Pitch Lowering Surgery I am a 38 year-old male with a high-pitched voice, especially over the phone. I found out about you while searching for answers to fixing high pitched voice for men. I saw on your website your replied to a 19 year-old man with a high-pitched voice suggesting Laryngeal Frame Work Surgery.

I live in California and went to a speech therapist, and they told me my voice can be fixed with the surgery. When I went to an ENT doctor he mentioned that my vocal cords seem normal. He said I just have to live with the high-pitched voice and surgery can damage my voice.

But I was somewhat relieved when I found you can fix this.

I wanted to ask you if I can be a candidate for Laryngeal Frame Work Surgery and if there are any risks associated with it ?

Also, I was not able to find out any doctor in California that performs this kind of surgery. Would you know any doctor here in California who is good at performing this surgery ? If not, then I don’t mind coming  to NY for this surgery. Thank you.

Answer

It sounds like you would be a candidate for the surgery. We do recommend evaluation first by a speech therapist with testing of your vocal frequency (natural pitch).

Laryngeal framework surgery is done with local anesthesia as an outpatient.

It involves removing one or two strips of cartilage from the larynx or voice box and allows the vocal folds to relax thereby lowering the pitch.

Certainly, any surgery has risks, and these include that of having a breathy or weaker voice among other unlikely problems. But these should be discussed further with your surgeon time when it’s time to have the procedure done.

I am unsure who does surgery on the west coast. However, I would speak to someone who specializes in laryngology or voice problems rather than a general ear nose and throat physician.

Click here to learn more about voice altering surgery

I hope this helps clear things up.

Robert Pincus 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.

Is my son’s Speech Therapy causing more harm than good?

Question:

I am concerned that while my son (aged 5) is attending a Speech and Language Therapist (SALT) for voice retraining for over a year, I feel it is causing more harm than good.

Speech Evaluation NYCHe had a nodule removed about a year ago. He continues to talk deep and hoarse and becomes high pitched when self-conscious, especially when with SALT.

Very concerned as he knows she not only thinks he talks wrong but watches how he walks, etc as attending physio for tippy toe walking.

My child is bright but has little developmental problems due to prematurity. Born at 26weeks. He is extremely social and totally tuned in. But as soon as he goes into the clinic his voice changes and the poor child tries to walk correctly as feels she is checking that out as well.

I am a Nurse and am increasingly concerned. I do not want my son to stop going if he will benefit but feel the negative effect will outweigh any possible benefit at this stage. Do you think his therapy is causing him more harm than good? Any suggestions?

Answer:
I would suggest a fresh ENT and SALT evaluation. New opinions can always help.

If you are in the New York area I would start with Dr. Robert Pincus at our practice.

Hope this clears things up!

Dr. Scott Gold

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.

My voice has too high a pitch- what can I do?

Question:

I am 19 years old, male. I have a girly voice, I mean I am misunderstood as a lady most frequently when I answer the phone. this has been a great concern to me since most of my life but it really affected me after my friends got their voices roughen. And also once I am too tired or under a pressure situation words don’t come out, time to time once or two comes out, in these occasions people ask whether I am ill. Now I am fed up of this situation. Please……..can I know what the reason might be for this? Can I get a remedy for this, specially a non surgical one, please help me…….

Answer:

As a young male enters puberty, there is a change in the voice box (or larynx) that general makes the voice become lower in pitch.  This is the same change that makes a male’s “adam’s apple” more visible at this time.  In some, the change comes earlier and in others, later.

Having a voice that is “too high” can be quite stressful for a young man.  However, in most this will resolve-  If not, we would first recommend speech therapy, to help change how you use your vocal cords.

If that should fail, there is a simple surgical procedure, a type of thryoplasty, which removes some of the tension on the vocal cords and is generally  successful in lowering pitch.

I hope this clears things up.

Robert Pincus 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.

My 5 month’s voice has gone hoarse after a long crying episode

Question:  

My 5 month’s voice has gone hoarse after a long crying episode…it happened about two days ago and I think his voice sounds raspy now and not as hoarse…he seems to have a hard time making the same high pitched sounds he used to be able to make during spontaneous vocalizations and during vocal play…what should I do? Any help from your specialists would be greatly appreciated. Thank you!

Answer: 

Thanks for your question.   It is not uncommon for anyone, babies included, to develop hoarseness after vocal abuse.  Certainly a long crying episode would fit.

When we breath- our vocal cords open to allow air to pass.   When we speak or make noise, the vocal cords come together.  They must come together smoothly for us to have a normal voice.  However, when we  speak loudly, or yell (or cry) – we are often banging the vocal cords together.   This causes swelling, so that the closure becomes uneven and we percieve hoarseness.   Most often, this is temporary, until the swelling goes down.   Sometimes, we can develop a nodule or a polyp from this-  which is really like a callus on the vocal cords.  This would cause the poor voice to persist.

Using your voice minimally (modified voice rest) would help in the healing process.   However, it is really impossible to get your baby to do so.

Almost always, his voice will come back to normal over the next few days or a week.  If not, he should have an ear nose and throat doctor take a look at the vocal cords, (laryngoscopy) to make sure there has been no significant damage.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology NY Medical College

NY Otolaryngology Group

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.

My throat closes and I have difficulty breathing in

Question:    

I am a 56 yr old female in healthy condition. I stopped smoking 25 yrs ago.

I have noticed that my throat feels like it is closing and I have difficulty breathing in. It seems like I am smelling a smoking type smell. I have had this happen in the car, lying in bed and even at my workplace. No one is either around or smoking when this occurs. I have asked people at work if they smell anything and they say no. I do have a sensitivy when someone is smoking my throat closes up and feels like I can’t breath.

Any recommendations or suggestions?

Answer:

When we breath our vocal cords open, to allow air to pass through.  They close when we speak.   Difficulty breathing in implies that the vocal cords are closing when you inhale, instead of opening.  With asthsma, one tends to have trouble breathing out.  The vocal cords can close inappropriately from reflux- when acid gets up from the stomach to the level of the voice box-  as well as from nerve injuries that cause the vocal cords to not work correctly.  (paradoxical vocal cord motion).  Mucous dripping on the vocal cords can cause them to close as well.  Finally, a growth on the vocal cords may present like this.

This type of problem really requires a thorough ear nose and throat examination and visualization of the vocal cords (laryngoscopy) to determine the cause and treatment.

I hope this helps clear things up..

Robert Pincus MD

Co-Director NY Sinus Center

NY Otolaryngology Group

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