Voice Disorders
On this page, you can find information about the following topics:
Hoarseness
Hoarseness refers to a condition where the voice sounds breathy, strained, or uncomfortable, and may exhibit changes in volume or pitch. The voice is produced by the vocal cords in the larynx, which are normally separated but come into contact during speech. Air from the lungs causes the vocal cords to vibrate, generating sound. The tongue, palate, teeth, and lips above the vocal cords shape the sound produced.
Hoarseness can arise in various conditions that disrupt the vibration of the vocal cords.
Causes of Hoarseness
The causes of hoarseness include:
- Acute laryngitis caused by viral or bacterial inflammation of the vocal cords
- Improper voice usage, such as speaking in noisy environments, prolonged vocal use, or public speaking without a microphone
- Vocal cord nodules, polyps, and cysts
- Vocal cord bleeding due to improper voice usage
- Gastroesophageal and laryngopharyngeal reflux
- Smoking
- Neurological disorders such as Parkinson’s disease and stroke
- Laryngeal cancer
Patients with persistent hoarseness should consult an otorhinolaryngologist. A vocal cord examination performed through the mouth can diagnose the underlying condition. Depending on the diagnosis, treatment may involve medication or other therapeutic methods to address hoarseness.
Vocal Cord Paralysis
The larynx contains two vocal cords, one on the right and one on the left. During speech, these cords come together, and air from the lungs creates vibrations between them, producing sound. In vocal cord paralysis, the cords cannot move or make contact, leading to difficulties with voice, breathing, and swallowing.
The nerves controlling the vocal cords travel from the brain through the neck and chest before reaching the cords. Damage to these nerves along their pathway results in vocal cord paralysis.
Causes of Vocal Cord Paralysis
The causes of vocal cord paralysis include:
- Penetrating, cutting, or blunt trauma to the head and neck
- Tumors in the head, neck, or lungs
- Surgeries involving the head, neck, or lungs
- Stroke
- Viral infections affecting nerves
Symptoms of Vocal Cord Paralysis
Symptoms of vocal cord paralysis include:
- Hoarseness
- Breathy voice
- Difficulty speaking loudly (weak voice)
- Reduced speaking endurance and fatigue while talking
- Choking sensation and coughing while eating
Diagnosis of Vocal Cord Paralysis
An otorhinolaryngologist diagnoses vocal cord paralysis through an endoscopic examination performed via the mouth.
Treatment of Vocal Cord Paralysis
The treatment of vocal cord paralysis begins with identifying its cause. The decision-making process considers factors such as the condition and duration of the paralysis. Treatment options include voice therapy and surgical procedures to help the paralyzed vocal cord make contact with the opposite cord.
Laryngeal Papillomatosis
Laryngeal papillomatosis refers to benign soft tissue growths caused by the Human Papilloma Virus (HPV) that appear in various parts of the vocal cords and larynx.
Laryngeal papillomatosis can also lead to hoarseness and shortness of breath.
Treatment for Laryngeal Papillomatosis
The treatment involves removing the papillomas through laser or microsurgical procedures. Due to the high risk of recurrence, patients may need to undergo multiple surgeries throughout their lifetime.
Reinke’s Edema
Reinke’s edema is a condition typically observed in middle-aged women who have smoked for a long time and have a habit of excessive talking. It causes a thick, rough voice that can sound like a male voice over the phone.
How Does Reinke’s Edema Develop?
It develops when a jelly-like substance accumulates excessively beneath the mucosal layer covering the vocal cords.
Treatment for Reinke’s Edema
Treatment begins with quitting smoking and maintaining proper vocal hygiene. After a specific period of following these measures, Reinke’s edema can be treated surgically by a specialist physician.
Vocal Cord Granuloma
Vocal cord granulomas occur in patients with a history of improper voice use, acid reflux, or previous surgeries performed under general anesthesia.
Treatment involves controlling acid reflux, ensuring vocal hygiene, and undergoing voice therapy. For cases that do not improve, the granuloma is removed through microsurgery. Due to the high risk of recurrence, patients must avoid reflux and improper voice use after surgery.
Vocal Cord Nodule
Vocal cord nodules are benign growths that develop due to prolonged misuse of the voice.
Who Is Prone to Vocal Cord Nodules?
This condition is commonly seen in teachers who speak for extended periods, call center workers, vocalists who strain their vocal range using improper techniques, talkative extroverted women, and boys who misuse their voices. The nodules appear as two symmetrical swellings located in the middle and front parts of the vocal cords.
Treatment for Vocal Cord Nodules
Treatment includes vocal rest, preventing acid reflux, medication, and voice therapy. Surgical intervention is recommended for patients who do not respond to voice therapy.
Vocal Cord Polyp
Vocal cord polyps are soft tissue growths with smooth surfaces that can be pedunculated (thin-stalked) or sessile (broad-based), often appearing red in color.
Who Is Prone to Vocal Cord Polyps?
Vocal cord polyps are generally seen in individuals who strain their voices through activities such as shouting, speaking loudly, or frequently talking in noisy environments. These polyps are usually red due to bleeding into the vocal cord and may appear darker if the blood within the polyp clots. They cause hoarseness and voice bifurcation.
Treatment for Vocal Cord Polyps
Treatment involves the microsurgical removal of polyps. To prevent recurrence, patients should use their voices carefully and undergo voice therapy.
Voice Test
A “Voice Test” is conducted to identify the source of the voice problem. Based on the test results, your doctor will recommend the most suitable treatment for you.
When you visit the clinic, your doctor will gather detailed information about your complaint through a written or verbal questionnaire regarding your voice problem.
You may eat and drink up to two hours before the test.
During the test, your voice will be recorded while you read, speak, and pronounce vowel sounds for extended durations.
You will also undergo an “airflow” test, which involves using a small mask that covers your mouth and nose.
A camera will be used to capture images of your larynx. Occasionally, an oral camera is used, which only enters your mouth and does not go down your throat.
Depending on the type of camera used for imaging, local anesthesia may sometimes be applied. However, capturing images of your larynx is a quick and painless process.
Following these tests, your doctor will recommend the most appropriate treatment plan for you.
Voice Analysis
Computerized voice analysis provides more reliable and reproducible results for diagnosing voice disorders. This method helps determine whether there is any pathology in the voice and, if so, the extent of the damage. It is also used to objectively and clearly evaluate the outcomes before and after voice surgeries. In the sound laboratory, the patient’s voice is recorded at a fixed frequency and intensity, then analyzed using specialized software.
Voice Therapy
Voice therapy combines vocal (singing) and physical exercises to treat functional and structural disorders of the vocal cords. It primarily addresses improper vocal cord behavior. The goal is to help patients achieve the best possible voice and to treat voice disorders caused by underlying conditions.
The objectives of voice therapy vary by patient. For example, it may involve treating vocal range issues for a professional singer or restoring voice function after vocal cord surgery or paralysis.
Voice therapy typically involves 1–2 sessions per week for 6–8 weeks, depending on the severity of the vocal cord issue. In certain cases, such as mutational falsetto, conversion aphonia, or conversion dysphonia, a single session may suffice. Each therapy session lasts approximately 40–45 minutes, during which the therapist guides the patient through specific exercises, often accompanied by piano. Some techniques also include exercises for the patient to practice at home. Before starting therapy, the therapist will teach correct posture and abdominal (diaphragmatic) breathing exercises. Throughout the therapy period, the therapist maintains communication with the ENT specialist who referred the patient, monitors progress through periodic evaluations, and ensures the therapy is effective.
Conditions Treated with Voice Therapy
- Vocal cord nodules,
- Muscle tension dysphonia (unintentional rough, harsh, weak, or absent voice),
- Hoarseness following vocal cord paralysis,
- Sulcus vocalis (congenital thinning or scarring of the vocal cords),
- Puberphonia: (mutational falsetto, where a high-pitched voice persists in males after puberty),
- Rapid voice rehabilitation following vocal cord surgery.
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