Causes of Voice
Disorders
Laryngitis
Laryngitis is a swelling
of the
vocal cords usually due to an infection. A
viral infection (a “cold”) of the upper respiratory track is the most
common
cause for infection of the voice box. When the vocal cords swell in
size, they
vibrate differently, leading to hoarseness. The best treatment for this
condition is to rest or reduce your voice use and stay well hydrated.
Since
most of these infections are caused by a virus, antibiotics are not
effective.
It is important to be cautious with your voice during an episode of
laryngitis,
because the swelling of the vocal cords increases the risk for serious
injury
such as blood in the vocal cords or formation of vocal cord nodules,
polyp, or
cysts.
Vocal
Cord Lesions
Benign
noncancerous growths on the vocal cords are caused by voice misuse or
overuse
and from trauma or injury to the vocal cords. These lesions (“bumps”)
on the
vocal cord(s) alter vocal cord vibration. This abnormal vibration
results in hoarseness
and a chronic change in one’s voice quality, including roughness,
raspiness,
and an increased effort to talk. The most common vocal cord lesions
include
vocal nodules also known as “singer’s nodes” or “nodes” which are
similar to
“calluses ” of the vocal cords. They typically occur on both vocal
cords
opposite each other. These lesions are usually treated with voice rest
and
speech therapy (to improve the speaking technique thus removing the
trauma on
the vocal cords). Vocal cord polyp(s) or cyst(s) are other common vocal
cord
lesionscaused by misuse, overuse, or trauma
to the vocal cords and
frequently
require surgical removal after all nonsurgical treatment options (i.e.,
speech
therapy) have failed.
Reflux
Diseases
Reflux
(backflow of gastric contents) into the throat of stomach acid can
cause a
variety of symptoms in the esophagus (swallowing tube) as well as in
the
throat. Hoarseness (chronic or intermittent), swallowing problems, a
foreign
body sensation, or throat pain are common symptoms of gastric acid
irritation
of the throat, called laryngopharyngeal reflux disease (LPRD).
Vocal
Cord Paralysis
Hoarseness
and other problems can occur related to problems between the nerves and
muscles
within the voice box or larynx. The most common condition is a
paralysis or
weakness of one or both vocal cords. Involvement of both vocal cords is
rare
and is usually manifested by noisy breathing or difficulty getting
enough air
while breathing or talking. However, one vocal cord can become
paralyzed or
severely weakened (paresis) after a viral infection of the throat,
after
surgery in the neck or cheek, or for unknown reasons.
The immobile or paralyzed vocal cord typically causes a soft, breathy,
weak
voice due to poor vocal cord closure. Most paralyzed vocal cords will
recover
on their own within several months. Surgical treatment is required if
paralysis
becomes permanent. Surgery for unilateral vocal cord paralysis involves
positioning of the vocal cord to improve the vibration of the paralyzed
vocal
cord with the non-paralyzed vocal cord.
Stroke and other Diseases
Language
impairment -- or aphasia -- occurs in more than a third of people who
survive a
stroke on the left side of their brain. Many recover within a few
months after
the stroke, but up to 60% still have language impairments more than six
months
after a stroke, a condition known as chronic aphasia.
A large
percentage (89%) of people with Parkinson's disease have speech and
voice symptoms, but only 3% to 4% of them receive speech treatment.
Most people with Parkinsons have soft voices because the disease makes
it harder to force the neccesary amount of air through the larynx or
voice box to produce a normal speaking volume, and the vocal cords are
often weakened and don't vibrate adequately to produce sound.
Cancer
When
cancer attacks the vocal cords, the voice changes in quality, assuming
the
characteristics of chronic hoarseness, roughness, or raspiness. These
symptoms
occur at an early stage in the development of the cancer.
Persistent hoarseness or
change in
the voice for longer than two to four weeks in a smoker should prompt
evaluation by an otolaryngologist to determine if there is cancer of
the larynx
(voice box). Different treatment options for this cancer of
the
voice box include surgery, radiation therapy, and/or chemotherapy. When
vocal
cord cancer is found early, typically only surgery or radiation therapy
is
required, and the cure rate is high (greater than 90 percent).
Laryngeal cancer
Cancer
of the larynx (the voice box
including vocal chords
and epiglottis) is a rare disease and the incidence varies from country
to
country. Laryngeal cancer accounts for less than 1% of all cancers.
More than
one hundred thousand new cases are reported worldwide each year, but
the
prognosis is usually good. This is because the larynx is sensitive even
to very
small changes, so it is normally discovered early. The cause of this
cancer is
not absolutely clear, although links with tobacco and alcohol have been
established. However, both nonsmokers and nondrinkers have also been
diagnosed
with this form of cancer, so there does not seem to be a definite
causal
relationship.
Laryngeal cancers
are treated by radiation- and chemo-therapies. If the tumor is too
large, it will probably have to be removed by surgery. This type of
surgery is referred to as a total laryngectomy and the patient is
afterwards
referred to as a laryngectomee. The laryngectomee breathes through an
opening in the neck and has to rely on different devices for speech
production.
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