Vocal Cord Disorders

Vocal cord disorders can affect your voice or your ability to talk. These disorders affect the vocal cords. The vocal cords (also called vocal folds) are 2 bands of smooth muscle tissue found in the voice box (larynx). The larynx is set in the neck at the top of the windpipe (trachea). The vocal cords vibrate and air passes through the cords from the lungs to make the sound of your voice. The sound is then sent through the throat, nose, and mouth. The sound of each person's voice is determined by the size and shape of the vocal cords. And by the size and shape of the throat, nose, and mouth.

Some of the vocal cord disorders include:

• Laryngitis — Laryngitis causes a raspy or hoarse voice due to swelling (inflammation) of the vocal cords. It can be caused by using your voice too much, infections, breathing in irritants, or GERD (gastroesophageal reflux).

• Vocal nodules — These are noncancerous growths on the vocal cords caused by vocal abuse. Vocal nodules are often a problem for professional singers. The nodules are small and callus-like. They most often grow in pairs (one on each cord). The nodules most often form on parts of the vocal cords that get the most pressure when the cords come together and vibrate. Vocal nodules cause the voice to be hoarse, low, and breathy.

• Vocal polyps — A vocal polyp is a soft, noncancerous growth. It is a lot like a blister. Vocal polyps cause the voice to be hoarse, low, and breathy.

• Vocal fold bowing — Tissue loss (atrophy) of the vocal fold can produce a bowed shape instead of the normal flat surface. This results in a gap between the folds and produces a breathy, soft voice. This is similar to what happens in unilateral paresis/paralysis (see below). Atrophy can occur in certain neurological conditions (e.g., Parkinson’s and paralysis) but can also occur as a normal function of aging. First-line treatment is voice therapy. Less often, surgery is used to bulk up the fold and restore the flat surface.

• Vocal fold hemorrhage — Rupture of a blood vessel on the surface of the vocal cord that causes sudden loss of voice following yelling, shouting or other strenuous vocal tasks. These lesions can completely resolve or they can form cysts, polyps or scars. Treatment may include regular exams, voice therapy, medicines and surgery.

• Vocal fold scar and sulcus — Irregularities in the tissue just below the outer layer of the vocal cord that disrupt the vibrations and creation of normal sound. As a result, you may experience hoarseness and breathiness and need increased effort to speak. These are difficult conditions to treat, although we have had some success with voice therapy and/or specialized surgical procedures.

• Vocal cord paralysis — This may happen when one or both vocal cords don't open or close correctly. It is a common disorder. It can range from fairly mild to life-threatening. When one or both vocal cords are paralyzed, food or liquids can slip into the trachea and lungs. A person may have trouble swallowing and coughing. Paralysis can be due to viral infection, surgical complication or tumor growth. Treatment may include surgery and voice therapy. Sometimes no treatment is needed and a person recovers on their own.

• Spasmodic dysphonia — This is a nerve problem that causes the vocal cords to spasm. It can make the voice sound tight, quivery, jerky, hoarse, or groaning. At times, the voice may sound normal. Other times, the person may not be able to speak. Treatment may include speech therapy and shots (injections) of botulinum toxin to the vocal cords. 

For normal speech, your vocal cords need to touch together smoothly inside your larynx. Anything that interferes with vocal cord movement or contact can cause a voice disorder. Many voice disorders can be cured with treatment when diagnosed early.

Voice disorders can be caused by many factors. In some cases, the cause is not known. Possible causes can include:

• Growths — In some cases, extra tissue may form on the vocal cords. This stops the cords from working normally. The growths can include fluid-filled sacs called cysts, wart-like lumps called papilloma, or callus-like bumps called nodules. There may be patches of damaged tissue called lesions. There may be areas of scar tissue. In some people, a band of tissue called a web can grow between the vocal cords. Other growths include a small area of chronic inflammation (granuloma) and small blisters called polyps. Growths can have many causes. These include illness, injury, cancer, and vocal abuse.

• Inflammation and swelling — Many things can cause vocal cord inflammation and swelling. These include surgery, respiratory illness or allergies, GERD, some medicines, exposure to certain chemicals, smoking, alcohol abuse, and vocal abuse.

• Nerve problems — Certain health conditions can affect the nerves that control the vocal cords. These can include multiple sclerosis, myasthenia gravis, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and Huntington's disease. Surgery or laryngitis can also harm nerves.

• Hormones — Disorders affecting thyroid hormone, female and male hormones, and growth hormones can cause voice disorders.

• Vocal abuse — The vocal cords can be stressed by using too much tension when speaking. This can cause problems in the throat muscles and affect the voice. Vocal abuse can also cause a voice disorder. Vocal abuse is anything that strains or harms the vocal cords. Examples include too much talking, shouting, or coughing. Smoking and constantly clearing the throat is also vocal abuse. Vocal abuse can cause the vocal cords to get nodes and polyps. These change how the voice sounds. In some cases, a vocal cord can break or burst from vocal abuse. This causes the cord to bleed (hemorrhage). You can lose your voice. Vocal cord bleeding must be treated right away.

Each person may have slightly different symptoms. They are based on the type of vocal cord disorder. They include changes in your normal voice such as a raspy or hoarse voice. Or a hoarse, low, and breathy voice. Vocal cord paralysis may also cause trouble swallowing and coughing.

If you have a voice change that lasts for a few weeks, your healthcare provider may send you to see an ear, nose, and throat specialist (otolaryngologist). This doctor will ask you about your symptoms and how long you've had them. He or she may check your vocal cords and your larynx using certain tests. These may include:

• Laryngoscopy. This lets the doctor view the throat. With indirect laryngoscopy, the healthcare provider holds a small mirror at the back of the throat and shines a light on it. With fiber-optic laryngoscopy, a thin, lighted scope (laryngoscope) is used. The scope is put through your nose down into your throat. Or it is put directly into your throat.  

• Laryngeal EMG (electromyography). This test measures electrical activity in the throat muscles. A thin needle is put into some of the neck muscles. At the same time, electrodes send signals from the muscles to a computer. This can show nerve problems in the throat. 

• Stroboscopy. This test uses a strobe light and a video camera to see how the vocal cords are vibrating during speech.

• Imaging tests. X-rays and MRI can show growths or other tissue problems in the throat.

Vocal cord disorders caused by abuse or misuse are easy to prevent. In addition, most vocal cord disorders can be reversed.

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include any of these:

• Resting the voice.

• Stopping the behavior that caused the vocal cord disorder.

• A referral to a speech-language pathologist who specializes in treating voice, speech, language, or swallowing disorders.

• Medicine.

• Surgery to remove growths.