There are a variety of medical conditions that can lead to voice problems. In the event that a person’s voice becomes hoarse frequently or changes without warning and for a prolonged period of time, it is ideal to see an otolaryngologist for evaluation.
Acute Laryngitis
This pathology is the most common cause of voice loss and hoarseness, which begins suddenly.
Most cases of acute laryngitis are caused by a viral infection that results in inflammation of the vocal cords. When the vocal cords become inflamed, they vibrate differently, leading to hoarseness.
Hydration is the best treatment for this condition, in addition to resting or reducing the use of the voice. Antibiotics are not effective as a treatment.
In the case of bacterial infections of the larynx, which are much less frequent, they are often associated with shortness of breath.
Chronic laryngitis
Chronic laryngitis is a non-specific term, as it is an underlying cause of another pathology. Usually chronic laryngitis can be caused by:
- Acid reflux disease
- Exposure to irritants, such as smoke.
- Low-grade infections, such as fungal infections of the vocal cords in people who use inhalers for asthma.
Patients undergoing chemotherapy or others whose immune system is not working well may get these infections as well.
Laryngopharyngeal Reflux Disease (LPRD)
Reflux of gastric juices into the throat can cause different symptoms in the esophagus as well as the throat.
- Hoarseness (chronic or intermittent)
- Swallowing problems
- Lump in the throat sensation
- Sore throat
These are common symptoms of acid stomach irritation of the throat. It should be noted that LPRD can occur without any symptoms of heartburn and frank regurgitation, which traditionally accompany gastroesophageal reflux disease (GERD).
Voice: misuse and abuse
Speaking is a physical task that requires the coordination of breathing with the use of various muscle groups. It should come as no surprise that, as with any physical task, there are efficient and inefficient ways of using the voice.
Excessively loud, prolonged and/or inefficient voice use can lead to vocal difficulties: excessive tension of the neck and laryngeal muscles, along with breathing technique during speech leads to vocal fatigue, increased vocal strain and hoarseness. Voice misuse and overuse that puts you at risk for developing benign vocal cord lesions or vocal cord hemorrhage.
Common situations that are associated with voice misuse:
- Speaking in noisy situations
- Excessive cell phone use
- Using the phone with the handset cradled on the shoulder
- Improper use of pitch (too high or too low) when speaking
- Using amplification when speaking in public
Benign lesions of the vocal cords
Benign non-cancerous tumors on the vocal cords are often caused by misuse or overuse of the voice, resulting in trauma to the vocal cords.
The most common vocal lesions are:
- Nodules: Vocal nodules, also known as nodes or singer’s nodes, are similar to “calluses” on the vocal cords. They occur on both vocal cords facing each other at the point of maximum wear and tear, and are usually treated with voice therapy to eliminate the vocal trauma they are causing. Contrary to common belief, vocal nodules evolve very well to treatment and intervention leads to improvement in most cases.
- Polyps and cysts: are the other common benign lesions. They are sometimes related to misuse or overuse of the voice, but can also be suffered by people who do not use their voice correctly. These types of problems usually require microsurgical treatment for healing, along with voice therapy.
Vocal cord hemorrhage
Sudden loss of voice after shouting or having performed other vocal tasks of intensity can develop vocal cord hemorrhage.
This is considered a vocal emergency and is treated with complete voice rest until the hemorrhage resolves.
Vocal cord paralysis and paresis
Hoarseness and other problems may be related to problems between the nerves and muscles of the voice box or larynx.
The most common neurological condition affecting the larynx is a paralysis or weakness of one or both vocal cords. Involvement of both vocal cords is usually manifested by noisy breathing or difficulty getting enough air when breathing or speaking. When one vocal cord is paralyzed or weak, the voice is usually the problem rather than breathing. One of the vocal cords may be paralyzed or weakened (paresis) due to:
- A viral infection of the throat
- After surgery on the neck or chest
- The appearance of a tumor or growth along the laryngeal nerves.
- Unknown reasons.
Vocal cord paralysis usually presents with a soft, breathy voice. Many cases of vocal cord paralysis recover within several months. In some cases, however, the paralysis will be permanent and may require active treatment to improve the voice.
The choice of treatment depends on:
- the nature of the vocal cord paralysis
- the degree of vocal impairment
- the patient’s vocal needs
While treatments are not able to make the paralyzed vocal cords move again, there are good treatment options to improve the voice. One option includes surgery for unilateral vocal cord paralysis, which involves repositioning the vocal cords to improve the contact and vibration of the paralyzed vocal cord with the non-paralyzed vocal cord. There are a variety of surgical techniques used to accomplish this. Voice therapy can be used before or after surgical treatment of paralyzed vocal cords, or it can also be used as the sole treatment.
Cancer of the larynx
Throat cancer is a very serious condition that requires immediate medical attention. In patients with chronic hoarseness, it is important to be evaluated by an otolaryngologist to rule out laryngeal cancer.
Seeing a specialist in the event of sudden voice changes facilitates early diagnosis. In addition, laryngeal cancer is highly curable if diagnosed in its early stages.