Vocal Cords - Associated Disorders, Symptoms, Diagnosis, and Management

Introduction:

A vocal cord is present on top of the windpipe. The function of vocal cords is to vibrate as the air passes from the lungs to reach the vocal cords and produce a sound of the voice. The sound then passes through the throat, nose, and mouth. The sound of each person’s voice depends on the size and shape of the vocal cords.

What Are the Various Disorders of the Vocal Cords?

Various disorders affect the vocal cords like:

1. Laryngitis: Inflammation or swelling of the vocal cords is called laryngitis.

Causes of Laryngitis

It is caused by:

• Using a high-pitched voice continuously.

• Acid reflux.

• Viral infections.

• Smoking.

Signs and Symptoms of Laryngitis

• Sore and rough throat.

• Hoarseness.

• Dry cough.

• Fever.

Treatment for Laryngitis

• Voice rest.

• Drink plenty of fluids.

• Remove trigger factors like acid reflux disease by taking medications like proton pump inhibitors and avoid smoking.

2. Vocal Cord Paralysis: It occurs due to disruption in the nerve impulse to the voice box.

Causes of Vocal Cord Paralysis

1. Injury to Vocal Cords During Surgery: Any injury to the nerves during the surgery, like thyroid, parathyroid, and neck surgeries, results in damage to the voice box.

2. Injury to Neck or Chest: Injury to the neck or chest can damage the nerve supply of the vocal cords.

3. Stroke: It interrupts blood flow to the brain, disrupting the pathway of messages from the brain to the voice box.

4. Infections: Bacterial and viral infections can damage the nerves of the voice box.

5. Tumors: Cancerous or non-cancerous growth involving cartilage, nerves, and muscles surrounding the voice box can lead to paralysis of the vocal cord.

6. Neurological Diseases: Like multiple sclerosis or Parkinson's disease cause weakness of the vocal cord.

Signs and Symptoms of Vocal Cord Paralysis

• Hoarseness of voice.

• Vocal tone loss.

• Gasping-type breathing.

• Choking or coughing while swallowing food.

• Loss of vocal pitch.

• Ineffective coughing.

• Noisy breathing.

Treatment for Vocal Cord Paralysis

• Medicinal therapy.

• Warm water gargle to relax the throat.

• Surgical removal of the growth.

• Consult a speech therapist.

3. Vocal Polyps: It is a non-cancerous soft-tissue overgrowth. It causes hoarseness of voice.

Causes of Vocal Polyps

• Smoking.

• Allergies.

• Vocal abuse.

• Direct trauma to vocal cords during surgery.

Signs and Symptoms of Vocal Polyps

• Pain in swallowing.

• Feeling the presence of a foreign body in the throat.

• Slurring of speech.

• Pain or tenderness in the throat.

Treatment of Vocal Polyps

• Conservative Management: Voice rest, avoid trigger factors like acid reflux disease by taking medications and avoiding smoking.

• Drug Therapy: Steroid injection therapy is given to reduce the size or completely resolve the polyps.

• Endoscopic Laser Therapy: It is used to remove the polyps by using a laser. It is done in patients who do not respond to conservative and drug therapy.

4. Vocal Cord Dysfunction (VCD): Normally, vocal folds open on breathing in and closed by the migration of two bands of vocal muscles towards each other to unite in the middle and vibrate to produce sound. Vocal cord dysfunction is when vocal cords remain closed even at the time they are supposed to be open.

Prevalence of Vocal Cord Dysfunction

• Vocal cord dysfunction is more frequent in females than males.

Causes of Vocal Cord Dysfunction

• Viral infections.

• Acid reflux disease.

• Smoking.

• Side effects of neuroleptic drugs.

• Sinus infections.

Signs and Symptoms of Vocal Cord Dysfunction

• Shortness of breath.

• Hoarseness of voice.

• Feeling of tightness in the chest.

• Altered voice.

• Breathing difficulties.

5. Spasmodic Dysphonia: It is a neurological disorder causing tightening of muscles of vocal folds causing strangled voice.

Causes of Spasmodic Dysphonia

• Voice abuse.

• Vocal cord injury causes damage to nerves.

• Flu or cold.

Signs and Symptoms of Spasmodic Dysphonia

• Difficulty in speaking.

• A tremor voice.

• Hoarseness.

• Breathlessness while talking.

Treatment of Spasmodic Dysphonia

• Voice therapy to reduce the symptoms.

• Botox injections are given to improve the voice.

• Surgical therapy for the patients who does not respond to a conservative approach.

How Can Vocal Cord Disorders Be Diagnosed?

• Physical Examination and Medical History: Complete physical examination is done by the doctor to identify the extent of the disease, the reason for the change in voice, and breathing problems.

• Laryngoscopy: A thin instrument with a light attached to the tip is used to check the vocal cords. Opening and closing of the vocal folds are assessed while breathing using laryngoscopy.

• Electromyography: Electric current in the vocal folds is measured by this procedure in case of vocal fold paralysis.

• Flow-Volume Loop: This test is done to check the flow of air into the lungs while breathing in and out. In case of any airway obstruction, the loop becomes flat.

What Are the Treatment Modalities for Vocal Cord Disorders?

Change in voice for more than two weeks continuously along with breathing problems is of immediate concern, so an early visit to the doctor is mandatory. Different treatment modalities of vocal cord disorders are:

• Removing the Trigger Factors: Trigger factors like acid reflux diseases should be managed by drugs like proton pump inhibitors and antacids.

• Visit Speech Language Pathologist: Speech-language pathologist helps to normalize the throat, guides in keeping vocal cords open and breathes through the abdomen. They also recommend some breathing exercises to control the episodes.

• Get Rid of Medical Infections: Any underlying bacterial or viral infections leading to a change in voice should be treated.

• Surgical Treatment: Any cancerous or non-cancerous growth involving the vocal folds should be surgically removed.

• Heliox: In emergencies, a mixture of helium and oxygen is given through inhalation to minimize airway obstruction.

• Tracheostomy: In case of a severe problem in breathing when no other conservative treatment helps, the doctor creates openings below the vocal folds and puts a tube in the windpipe so that air can pass through the lungs.

How to Prevent Vocal Cord Disorders?

Vocal cord disorders can be prevented by:

• Drinking plenty of water to keep the body hydrated.

• Do not overuse the voice box. Try avoiding excess shouting, yelling, and singing loudly.

• Try some regular breathing exercises to provide enough oxygen to the lungs.

• Avoid smoking as it leads to swelling of the vocal folds and increases the risk of throat cancer.

• Try meditations to lower stress and anxiety.

• Do exercise daily to prevent acid reflux or indigestion.

• Avoid trigger factors like alcohol, dust, smoke, or excessive cold fluids that can result in vocal cord disorder.

Conclusion:

Various disorders are associated with the vocal cords. Any disorder affecting the vocal folds disturbs its normal functions like breathing and speech formation. These disorders thereby hamper the quality of life of a person as the daily necessities of the body like speaking, swallowing, and breathing get disrupted badly, causing severe problems. Any abnormal change in the voice associated with breathing difficulties should be noticed, and a visit to a healthcare provider should be done on a priority basis before the problems become worse.