Voice Disorders Health Article

Diagnosis

A variety of technologies are available to examine the larynx for abnormalities, including:

• Laryngoscopy: The indirect examination involves holding a small mirror at the back of the throat in order to visualize the larynx. In a direct examination, a flexible (inserted through the nose to the back of the throat) or rigid (held at the back of the mouth) tube-like instrument is used to more clearly visualize the interior of the larynx.
• Video stroboscopy: A strobe light is used in this test to help visualize the rapidly vibrating vocal folds as if they were in slow motion, potentially revealing changes in the vocal folds not readily seen using other methods.
• Electromyography (EMG): A laryngeal EMG is used to examine the electrical activity of the muscles of the larynx as they contract; this may reveal injury to nerves that are important in voice production.
• Double-probe pH monitoring: Special probes are placed in the esophagus and larynx to measure the extent of laryngopharyngeal reflux (LPR) over a 24-hour period. This test is therefore useful in diagnosing LPRD.

Treatment

How a voice disorder is treated depends largely on how it was caused. Often, voice therapy with a certified speech-language pathologist can dramatically improve a person's voice. Voice therapy may include vocal and listening exercises, information on vocal hygiene (appropriate uses of voice), and education regarding proper voice technique. Treatment may also be the medical management of contributing health factors such as allergies and, in some cases, surgery. Other than medical treatment, therapy may include modification of the environment and psychological counseling.

A promising treatment for SD is injection with small amounts of a bacterial toxin called botox into the muscles of the larynx. The toxin temporarily weakens the laryngeal muscles, resulting in several months of improved voice quality.

Occasionally, surgery may be required to repair damaged vocal folds or remove cancerous tumors. Laser surgery has been used successfully in laryngeal surgery due to its precise cutting beam. Treatment of laryngeal cancer may include chemotherapy, radiation therapy, and/or partial or total laryngectomy, in which part, or all, of the larynx is removed. Voice therapy before and after surgery is recommended to provide the patient with a new mode of speech, if necessary.

Health care team roles

Common health care professionals involved with the care of a patient with a voice disorder may include:

• speech-language pathologists
• otolaryngologist, specialists who treat disorders of the ears, nose, and throat
• respiratory therapists
• psychiatrist or psychologist
• oncologists, cancer specialists
• audiologists, hearing specialists

Prevention

In order to prevent the development or deterioration of a voice disorder, patients are recommended to:

• Drink six to eight glasses of water a day and minimize intake of alcoholic and caffeinated beverages.
• Decrease exposure to cigarette smoke.
• Avoid unnecessarily coughing or clearing the throat, or speaking or singing out of range.
• Seek medical care if hoarseness or other voice changes persist for longer than 10 days.

KEY TERMS

Botox—A toxin produced by the bacteria Clostridium botulinum that can provide temporary relief to people suffering from spasmodic dysphoria.

Neuromuscular—Relating to the muscles and nerves.

Otolaryngologist—A specialist who treats disorders of the ear, nose, and throat.

Trachea—The windpipe.

ORGANIZATIONS

American Speech-Language-Hearing Association (ASHA). 10801 Rockville Pike, Rockville, MD 20852. (888) 321-ASHA. <http://www.asha.org>.

National Institute on Deafness and Other Communication Disorders (NIDCD) Information Clearinghouse. 1 Communication Avenue, Bethesda, MD 20892-3456. (800) 241-1044. <http://www.nidcd.nih.gov>.

The Voice Foundation. 1721 Pine Street, Philadelphia, PA 19103. (215) 735-7999. <http://www.voicefoundation.org>.

OTHER

"Frequently Asked Questions Regarding Voice Problems." University of Pittsburgh Voice Center 5 July 2001. <http://www.upmc.edu/upmcvoice/faq.htm>.

"The Larynx and Voice: Basic Anatomy and Physiology." The Johns Hopkins Center for Laryngeal and Voice Disorders August 1997. <http://www.med.jhu.edu/voice/larynx.html>.

"Questions/Answers about Voice Problems." American Speech-Language-Hearing Association 5 July 2001. <http://www.asha.org/speech/disabilities/Voice-problems.cfm>.

"Voice and Laryngeal Disorders." The Voice Center at Eastern Virginia Medical School 3 July 2001. <http://www.voice-center.com/dis_index.html>.

"What are Voice Disorders and Who Gets Them?" Center for Voice Disorders of Wake Forest University 1 November 1999. <http://www.wfubmc.edu/voice/voice_disorders.html>.

Stéphanie Islane Dionne