Voice Clinic in Denver, CO

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 (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 be present.

 

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.

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 aging atrophy of the vocal cord muscles. This results in a hoarse, weak, breathy quality voice.

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

Nodules are common vocal cord lesions that typically result from vocal overuse or misuse. By definition they are bilateral, meaning they occur on both vocal cords directly opposite each other. Therefore, nodules are always plural. Nodules are like “calluses” that result from chronic abnormal friction between the cords. Over time these raised “bumps” on the cords affect how well the vocal cords can vibrate during phonation. Nodules result in the cords incompletely closing during phonation so patients’ voices often sound airy or breathy and pitch breaks are common. Singers may notice their upper register is erratic or absent.

Vocal cord nodules can occur in all age groups affecting both men and women. They appear more commonly in young boys before puberty, but beginning during the teenage years, nodules are far more common in women. Persons most affected or susceptible to develop nodules talk a lot or have vocally demanding jobs.

Like many voice disorders, nodules are best diagnosed by an experienced ENT who can perform a laryngoscopy or stroboscopy to directly look at the vocal cords. This is a simple and painless in-office procedure. Of note, it’s worth mentioning that many vocal cord masses are incorrectly labeled as “nodules.” It’s important to be evaluated by experienced ENTs who understand vocal lesions to make the correct diagnosis and ensure nodules are not mistaken for other common problems like cysts or polyps that are distinctly different.

Recommended treatment of vocal nodules is typically voice therapy and rarely requires surgery. Voice therapists help identify the underlying behavioral problems that created the nodules in the first place. By modifying how one uses their voice and creating healthy vocal habits, nodules usually resolve on their own.

• • 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, and 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 leads the field in comprehensive and effective vocal cord care.

Vocal cord paralysis is diagnosed and treated at Peak ENT with non-surgical and surgical methods. Specialized in-office equipment and fellowship training makes the Voice Center at Peak ENT unique and sought after by professional and non-professional individuals relying on their vocal abilities.

The video below shows a patient (not the one above) with left vocal cord paralysis that resulted from a lung cancer. In this case the recurrent laryngeal nerve that is responsible for vocal cord movement is affected by the cancer.

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.