June 16, 2016

Voice Disorders


Vocal disorders commonly present with a gravelly and hoarse voice. The cause can be a spectrum of disorders and pathologies ranging from benign respiratory infections to pervasive forms of laryngeal cancer. Peak ENT specializes in the early diagnosis and effective treatment of all presenting disorders.

Voice Disorders: Wide Range of Pathologies Can Result in Laryngeal (voice box) Disorders.

Patients typically present “hoarseness”, which is a general term that describes an abnormal sounding voice. There are many causes of hoarseness ranging from benign diseases of the larynx to more concerning malignant cancers.

NORMAL LARYNX

This video shows an example of normal vocal cords seen on a videostrobe.

 LARYNGEAL CANCER

Laryngeal cancer is the result of squamous cell carcinoma forming in the larynx tissue (voice box). While this cancer represents only 2-5% of all malignant cancers, its effects on swallowing and the voice are devastating.  Though other forms of cancer are steadily decreasing, this specific type of cancer is increasing. The most common indication of this cancer is change or hoarseness of the voice.

Throat cancer can affect different areas. In this video, the cancer is eroding the left vocal cord entirely, causing a very hoarse voice and left vocal cord paralysis.

Other Symptoms Include

  • Constant coughing
  • Throat & Ear pain
  • Difficulty swallowing
  • Breathing difficulty
  • Mass or lump in the neck
  • Weight loss

Common Causes Include

  • Alcohol and tobacco use
  • Genetics
  • Viral factors
  • Prolonged exposure to toxins/fumes
  • Nutritional deficiencies

While these symptoms are often indicative of more mild conditions such as viruses, it is important to be vigilant regarding this cancer as early diagnosis is crucial. Early detection greatly increases the success rate of treatment. When caught early, this cancer is readily curable. Peak ENT provides in office biopsy lesions to identify this type of cancer directly. Utilizing the most effective and current endoscopic equipment, Dr. King represents the top of the field in treating laryngeal carcinomas.

This video shows a smaller cancer starting on the patient’s right vocal cord. She has a hoarse voice, but the cancer is confined to the edge of the vocal cord and there is no paralysis of the cord on that side.

 

LARYNGEAL DYSPLASIA (PRE-CANCER)

Laryngeal Dysplasia is the term for precancerous white or red patches on the vocal cord. While they are non-malignant, they can transition into malignant cancer if left untreated. Peak ENT offers in office laser procedures which treat laryngeal dysplasia on site.

This video shows a smaller cancer starting on the patient’s right vocal cord. She has a hoarse voice, but the cancer is confined to the edge of the vocal cord and there is no paralysis of the cord on that side.

This gentleman was found to have a white plaque (Leukoplakia) on his right vocal fold. A biopsy confirmed it was a high-grade, severe pre-cancerous lesion called dysplasia. This was successfully treated with a KTP Laser to prevent progression to cancer.

This is the same gentleman with the right vocal fold high-grade dysplasia undergoing an in-office KTP Laser procedure. The laser fiber is visible as it ablates the abnormal tissue. This patient is awake in the office with only local anesthesia.

LARYNGEAL GRANULOMAS

Laryngeal granulomas are vascular lesions that occur on the back of the larynx. They are typically in response to trauma including extreme coughing, severe esophageal reflux, or laryngeal intubation. Symptoms often include vocal fatigue, hoarseness and pain, and can cause chronic irritation if left untreated. While surgery has been offered as a treatment, the use of KTP lasers has been proven as a less invasive and more efficient treatment method. Peak ENT offers this precise and modern treatment option for patients suffering from laryngeal granulomas.

This gentleman presented with difficulty singing and intermittent breathing problems. This video is an example of a large left vocal process granuloma. The left vocal fold is also red from excessive coughing, resulting in hemorrhaging (bleeding) under the surface of the cord.

This is the same patient with the granuloma undergoing a KTP Laser ablation procedure in the office. You can see the laser fiber ablating the mass. This procedure was done in the office with the patient awake without sedation or general anesthesia.

This is the same patient after receiving two KTP Laser procedures in the office with only local anesthesia. You can see the granuloma is now very small compared to before treatment. The patient no longer has any voice concerns, and his breathing difficulties resolved.

LARYNGITIS

Laryngitis refers to inflammation of the larynx. Causes vary and are often linked to respiratory infections. Symptoms include hoarseness, swelling, mucous, and coughing.

This patient has hoarseness due to a viral infection around the vocal folds resulting in swelling and poor vibration.

LARYNGOPHARYNGEAL REFLUX

Laryngopharyngeal Reflux (LPR) is detected through symptoms including a chronic cough, the feeling something is lodged in the throat, hoarseness, post nasal drip, the need to clear one’s throat, irritation or redness of the voice box etc. Though similar to GERD, the necessary symptoms of acid reflux, indigestion and regurgitation does not present with LPR, separating it from this condition. If left untreated, both GERD and LPR may increase the risk factor for Esophageal Cancer.

This video is an example of the vocal cords affected by acid reflux. Patients with this type of reflux usually have hoarseness, excessive throat-clearing and a sensation like something is stuck in their throat. The acid causes subtle damage around the voice box.

SPASMODIC DYSPHONIA

Spasmodic Dysphonia (or laryngeal dystonia) is a vocal disorder characterized by involuntary spasms, contractions or movements of the muscles in the larynx region. It is classified as a neurological disorder known as a focal dystonia. The defining attribute of this disorder is its effects on the muscles, causing involuntary movement in a localized region. Spasmodic Dysphonia may also affect the muscles of the eye, face, jaw, tongue, and neck. Symptoms present gradually, and while there is currently no definitive cure, Botox injection to the larynx proves extremely effective in negating symptoms. Visit www.dysphonia.org to learn more.

RECURRENT RESPIRATORY PAPILLOMATOSIS

Recurrent Respiratory Papillomatosis (or PRR) is a disease in which tumors begin to grow in the air passages of the respiratory tract. While this often includes the nose and mouth, the larynx (voice box) is the most problematic location. Tumors tend to be recurring and grow rapidly. The cause is linked to two types of human papilloma virus: HPV 6 and HPV 11. Children and young adults are most commonly affected; however adults may experience this disease as well. While the presentation of this disease is rare (approximately 4.3% of all individuals exposed) possible transformation into squamous cell carcinoma is a risk factor. Hoarseness is the most common symptom, however coughing, difficulty breathing while lying down and difficulty swallowing may also present. Visit www.rrpwebsite.org to learn more.

Vocal cord papilloma (RRP) is caused by the Human Papilloma Virus (HPV). In this video, it is mostly involving the patient’s entire right vocal cord. Vibration on that side is severely affected which results in a hoarse voice.

This video shows how the KTP Laser is used to treat (ablate) the papilloma. This procedure was done in the office with the patient awake. After two treatments, the papilloma was imperceptible!

This video shows the same patient after two KTP Laser procedures in the office. The papilloma has been completely ablated and his voice is back to normal.

VOCAL CORD POLYPS, CYSTS AND NODULES

Vocal cord polyps, cysts and nodules present as lesions on the vocal cord. They are noncancerous growths of varying size and structure. Their major symptom is vocal hoarseness, typically caused by vocal trauma or overuse.

Nodules

    • Caused by repetitive overuse of the voice
    • Often referred to as “singer’s nodules”
    • Most common in women between the ages of 20 and 50 years
    • Appear as calluses under a microscope
    • Can affect both men and women

Vocal misuse or overuse can result in vocal cord nodules or small bumps on each side of the vocal cords. Nodules don’t allow the cords to fully come together and vibrate normally. Patients with nodules have voice cracks or pitch breaks when talking or singing.

Polyps

    • Caused by misuse/overuse of the voice
    • Appear as red blisters of varying shape and size
    • Can affect one or both vocal cords
    • Generally larger than nodules
    • Is often caused by vocal cord abuse such as shouting, singing, & excessive talking
    • May also be attributed to smoking, allergies, sinusitis, and in rare cases hypothyroidism

This patient has hoarseness due to a polyp on his left vocal cord. You can see how it impairs vibration while he is talking.

The same patient seen a few weeks after the left vocal cord polyp was surgically removed. Normal vibration of the cords has been restored and his voice is back to normal.

Cysts

    • Fluid filled sac with a semi solid center
    • Present as mucus retention cysts or sebaceous cysts
    • Less common than nodules or polyps
    • Result of injury to the vocal cord

This patient has hoarseness due to a left vocal fold mass under the surface of the cord. You can see it affects the vibration and closure of the vocal folds when she is talking. The mass is a benign cyst.

This video shows the same patient a few weeks after surgical microflap excision of the left vocal fold cyst. Normal vocal fold closure and vibration have been restored, and her voice is back to normal.

Dr. King is a lead surgeon in endoscopic microsurgical procedures to correct and remove vocal cord lesions. Working in conjunction with a team of vocal therapists, Peak ENT dominates the field in comprehensive and effective vocal cord care.

VOCAL CORD PARALYSIS

Vocal cord paralysis can range from vocal cord weakness to total loss of movement and use. This debilitating condition makes communication extremely difficult for the sufferer. Causes include:

  • Stroke
  • Tumors
  • Neck or chest injury
  • Neurological conditions such as Parkinson’s
  • Injury to the vocal cords sustained during surgery due to nerve damage in the neck or chest region
  • Viral Infections including Epstein-Barr, Lyme Disease, and herpes virus


Vocal cord paralysis can be highly detrimental to verbal communication. Surgical and non-surgical treatment options are provided by Peak ENTs team of highly trained specialists. We utilize the utmost degree of modern medicine’s capability to restore patient’s quality of life.

PRESBYPHONIA

As the vocal cords and supporting muscles age, they experience structural changes resulting in hoarseness, change in pitch, breathiness, and vocal strain. Symptoms begin occurring at approximately 60-70 years of age. This disorder can make articulation and vocal projection strenuous. It is important to rule out other causes with a laryngeal scope exam since these could also be signs of a vocal cord paralysis.  Presbyphonia can often be treated through voice therapy or in some cases a surgery to enhance (augment) the laryngeal muscles.

This video shows an example of bowed vocal folds that results from ageing atrophy of the vocal cord muscles. This results in a hoarse, weak, breathy quality voice.