Vocal Cord Disorders

What are vocal cord disorders?

The vocal cords (also called vocal folds) are two bands of smooth muscle tissue located in the larynx (voice box). The larynx is located in the neck at the top of the trachea (windpipe). Vocal cords produce the sound of your voice, by vibration and the air passing through the cords from the lungs. The sound the vocal cords produce is then sent through the throat, nose, and mouth, giving the sound "resonance." The sound of each individual voice is determined by the size and shape of the vocal cords and the size and shape of the throat, nose, and mouth (the resonating cavities).

Vocal cord disorders are often caused by vocal abuse or misuse, such as excessive use of the voice when singing, talking, smoking, coughing, yelling, or inhaling irritants. Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord paralysis.

laryngitis

Laryngitis is often characterized by a raspy or hoarse voice due to inflammation of the vocal cords. Laryngitis can be caused by excessive use of the voice, infections, inhaled irritants, or gastroesophageal reflux (the backup of stomach acid into the throat).

vocal nodules

Vocal nodules are benign (non-cancerous) growths on the vocal cords caused by vocal abuse. Vocal nodules are a frequent problem for professional singers. The nodules are small and callous-like and usually grow in pairs (one on each cord). The nodules usually form on areas of the vocal cords that receive the most pressure when the cords come together and vibrate (similar to the formation of a callous). Voice nodules cause the voice to be hoarse, low, and breathy.

vocal polyps

A vocal polyp is a soft, benign (non-cancerous) growth, similar to a blister. A polyp usually grows alone on one vocal cord and is often caused by long-term cigarette smoking. Other causes of vocal polyps include hypothyroidism (underactive thyroid gland), gastroesophageal reflux, and continuous voice misuse. Voice polyps cause the voice to be hoarse, low, and breathy. Vocal polyps are also called Reinke's edemas or polypoid degeneration.

vocal cord paralysis

Paralysis of the vocal cords may occur when one or both vocal cords or folds does not open or close properly. A common disorder, this condition can range from relatively mild to life threatening. When one or both vocal cords are paralyzed, the open cord(s) allows food or liquids to slip into the trachea and lungs. A person may experience difficulty swallowing and coughing. Vocal cord paralysis may be caused by the following:

  • head trauma

  • neck injury

  • stroke

  • tumor

  • lung or thyroid cancer

  • certain neurological disorders, such as multiple sclerosis or Parkinson's disease

  • viral infection

Treatment may include surgery and voice therapy. Sometimes, no treatment is necessary and a person recovers on his/her own.

What are some other vocal cord disorders?

Sometimes, less common disorders of the vocal cords occur due to voice misuse or disease, such as contact ulcers and laryngeal papillomatosis.

contact ulcers on the vocal cords

Contact ulcers on the vocal cords can occur when too much force is used in speech. When the vocal cords are excessively forced together, ulcerated sores may occur. Tissue may also wear away on or near the larynx cartilages. Ulcers sometimes are also caused by gastroesophageal reflux. Contact ulcers may cause the voice to tire easily and may cause a sore throat.

laryngeal papillomatosis

Laryngeal papillomatosis is a rare disease caused by the human papillomavirus (HPV). More than 60 HPVs exist. Laryngeal papillomatosis causes the growth of tumors inside the voice box, vocal cords, or the air passage from the nose to the lungs. Most laryngeal papillomas (tumors) occur in children before the age of three. The tumors are usually quick growing and can vary in size, causing breathing and swallowing problems. Other symptoms may include coughing and hoarseness.

Treatment for laryngeal papillomas may include surgery to remove the tumors. Other treatment options may include:

  • chemotherapy

  • antibiotics

Because the tumors tend to return, repeat surgery may be necessary. Always consult your physician for a diagnosis.

How are vocal cord disorders diagnosed?

Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of your physician. (Sometimes the hoarseness may be indicative of laryngeal cancer.) In addition to a complete medical history and physical examination, the physician may examine the vocal cords internally with a small, long-handled mirror (a procedure called indirect laryngoscopy in which the mirror is inserted into the throat so parts of the larynx can be examined) or with a lighted tube (a procedure called direct laryngoscopy in which an instrument called a laryngoscope is inserted through the nose or mouth. The scope is lighted to provide a better view of the area than the indirect laryngoscopy.).

Treatment for vocal cord disorders:

Vocal cord disorders caused by abuse or misuse are easily preventable. In addition, most disorders of the vocal cords can be reversed. Specific treatment for vocal cord disorders will be determined by your physician based on:

  • your age, overall health, and medical history

  • extent and type of vocal cord disorder

  • your tolerance for specific medications, procedures, or therapies

  • expectations for the course of the disease

  • your opinion or preference

Treatment may include any of the following:

  • eliminating the behavior that caused the vocal cord disorder

  • a referral to a speech-language pathologist who has specialized training in treating voice, speech, language, or swallowing disorders that affect communication

  • medication

  • surgery to remove growths

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