Introduction:
Voice cords or vocal folds are the two bands of tissues that are present in the larynx (voice box). The function of these vocal cords in our body is to vibrate when the air passes from the lungs and reaches the vocal cords making them vibrate as they come closer.
The sound of each person depends on the size and shape of the vocal cords. Any defects in these vocal fold muscles or larynx disrupt the mechanism of the vocal folds to work normally and result in voice disorders.
What Are the Common Disorders That Affect the Voice?
Various disorders that affect the voice are:
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Laryngitis: It is swelling of the vocal cords due to upper respiratory tract infections, Gastroesophageal reflux diseases (acid reflux), or smoking. It results in hoarseness of the voice.
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Vocal Cord Paralysis: It occurs due to damage to the nerves supplying the vocal cords due to cancerous or non-cancerous growth involving the nerves or vocal folds, trauma to nerves during surgery, or in the case of neurological diseases like Parkinson’s disease. It results in loss of vocal tone, pitch, and slurred speech.
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Spasmodic Dysphonia: It is a disorder related to nerves that cause the tightening of the muscles of vocal folds resulting in a strangled voice.
What Are the Causes of Voice Disorders?
Causes of voice disorders include:
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Vocal Abuse: Excessive use of vocal cords like shouting or yelling causes hoarseness of voice.
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Smoking: Smoking causes swelling of the vocal folds and also increases the risk of laryngeal (voicebox) cancer.
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Acid Reflux Disease: Continuous exposure of the vocal folds due to reflux of acid causes swelling of the vocal folds.
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Presence of Soft Tissue Growth: Any cancerous or non-cancerous growth present on the vocal folds like a vocal cyst, polyps, or nodules that disturb the mechanism of the vocal folds to vibrate, leading to voice disorders.
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Nerve Disorders: Any diseases like myasthenia gravis or multiple sclerosis that affect the nerve to vocal fold, like damage to recurrent laryngeal or superior laryngeal nerve, leads to alteration of the voice or voice disorders.
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Hormonal Disturbances: Any disorders affecting the thyroid hormones or growth hormones can lead to hypertrophy (increase in size) of the vocal folds muscle, causing voice disorders.
What Are the Signs and Symptoms Related to Voice Disorders?
Signs and symptoms of voice disorders are:
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Hoarseness of voice.
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Loss of vocal tone.
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Too low or very high-pitched voice.
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A tremor in speech.
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Breathlessness while speaking.
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Vocal fatigue.
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Too much effort while talking.
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Pain in the throat.
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Feeling the presence of a foreign body in the throat.
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Stammered speech (break in the flow of speech).
How Can We Diagnose Voice Disorders?
Diagnostic techniques for voice disorders are :
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History and Clinical Examination: Complete history of any trauma to the vocal cords or any history of surgery related to vocal cords should be recorded. A complete clinical examination of the throat is done by using a laryngoscope (a thin instrument with a light on the tip) to check for any growths present in the vocal folds. The opening and closing of vocal folds can be assessed.
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Electromyography: It is done to check for electrical impulses in the vocal folds in cases of vocal cord paralysis.
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Flow-Volume-Loop: It is done to check the flow of air into the lungs while breathing in and out. Any obstruction in the airway will make the loop appear flat.
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Videostroboscopy: A flexible endoscope with an attached camera is used to visualize the movements of the vocal folds. Slow-motion video can be observed of the opening and closing of vocal folds, and a camera is used to click the magnified images of the vocal folds. It is the most reliable diagnostic technique.
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Vocal Assessment: Assessment of alteration in voice pitch, tone, frequency, and volume is done by the speech-language pathologist.
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Computed Tomography Scans: It is done to check for any cancerous or non-cancerous growth present in relation to vocal folds preventing the vocal cords from vibrating.
What Is the Treatment for Voice Disorders?
Various treatment techniques for voice disorders are:
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Conservative Management: By changing the lifestyle, like avoiding smoking and avoiding vocal abuse or fatigue by voice rest. Keeping the body hydrated by drinking adequate fluids.
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Voice Therapy: Voice therapy is provided by speech-language pathologists, which helps in relaxing the throat and teaches some vocal functioning exercises.
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Surgical Removal of the Growth: Surgical removal of the growth present on the vocal folds like vocal polyps or nodules to restore normal vocal cords movements.
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Laser Surgery: Use of endoscopic laser surgery can be done to remove soft tissue growth like vocal polyps and nodules in the bloodless field as polyps are vascularized lesions that tend to bleed easily.
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Treatment of Underlying Diseases: Underlying causes of voice disorders like viral or bacterial infections and acid reflux disease should be treated by taking medications.
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Nerve Repair: Repair of the damaged nerve is done by moving the healthy nerves to the damaged area restoring the normal vocal cord functions.
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Botox Injections: Botulinum toxin injections are a standard gold treatment for vocal fold tremors or spasms. It is given by an ENT specialist and is repeated after every eight to 12 weeks.
How Can We Prevent Voice Disorders?
Voice disorder can be prevented by:
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Avoid excessive use of voice, like screaming and shouting.
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Drink plenty of fluids to keep the membrane of the throat hydrated.
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Avoid smoking.
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Treatment of underlying conditions like acid reflux disease by taking Antacids or Proton pump inhibitors drugs.
Conclusion:
The voice of a person is an important communication tool in social life. Various disorders affect the vocal folds, like spasmodic dysphonia, laryngitis, and vocal nerve paralysis, resulting in the disruption of the mechanism of vocal folds to vibrate properly, leading to an alteration in voice, affecting the quality of life of a person. Any changes in the quality of voice, such as pitch, tone, and fluency, should be brought to the notice of an ENT surgeon for early diagnosis and management of the condition.
