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Definition
Voice disorders characterized by hoarseness, weakness or even loss of voice are called dysphonia.
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Description
Your voice box or larynx is a framework of cartilage containing vocal cords. These structures vibrate to produce the sound of your voice.
Spasmodic dysphonia is a voice disorder characterized by intermittent, involuntary tightening or constriction of the larynx (voice box) during phonation. The interruption of air flow results in staccato, jerking, labored speech. Occasionally, vocal spasms can abduct or separate the vocal folds resulting in breathy voice breaks (abductor spasmodic dysphonia).
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Causes and Risk Factors
Overuse, emotional stress, trauma and illness can cause chronic spasm, weakness, or scarring of the vocal cords. Sometimes trouble stems from paralysis that damages nerves that move the vocal cords. The injury interferes with the smooth passage of air over the cords, making voice production less efficient and altering the sound produced.
Chronic dysphonia can occur in people such as teachers who use their voices a lot, and in people who have experienced trauma or surgery that affects the larynx. It can also start out as a virus that causes chronic laryngitis. In some cases, gastroesophageal reflux can cause chronic hoarseness.
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Diagnosis
Some voice changes can signal disorders such as vocal cord polyps or the onset of cancer or other diseases, so that it is important to pinpoint the source of the problem promptly. To do so, the physician can refer you to an ear, nose and throat specialist who can perform a diagnostic procedure called indirect or direct laryngoscopy, or video-laryngoscopy.
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Video-laryngoscopy
This procedure involves the insertion of a fiberoptic tube (endoscope) into your mouth or nose and the positioning of the instrument above the vocal cords in order to view the voice box. With a tiny video camera that is mounted on the endoscope, the doctor observes and records the vocal cord activity on videotape while you speak or sing.
If needed, a strobe light can provide stop-action photography (video-stroboscopy) that details the precise movements of your vocal cords in slow motion. This is much like an instant replay on television. The videotape obtained helps the specialist determine whether a procedure such as thyroplasty surgery can help you. If adjustments in vocal cord position might help, the videotaped record can also guide the specialist in planning the operation.
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Treatment
Conservative treatment includes avoiding vigorous use of the voice (singing, shouting) and throat lozenges. Acute laryngitis from a virus should resolve on its own. Acute laryngitis from a bacteria may be improved with an antibiotic. In gastroesophageal reflux disease, treatment with an acid blocker may be effective. Some cases of dysphonia can require surgical intervention.
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Thyroplasty Surgery
Thyroplasty is done under local anesthesia. First, the surgeon makes a small incision in the neck to reach the thyroid cartilage surrounding the vocal cords. Then, by cutting, manipulating, and suturing the cartilage into new positions, the surgeon alters the tension or position of the vocal cords. This makes the vocal system work more efficiently.
Because recovery is prompt, you can usually go home the same day. Although most people can speak immediately after surgery, recovery may take up to two months.
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Questions to Ask Your Doctor
Do you have a specialist you can recommend?
What tests need to be done to determine if the difficulty in speaking is due to disease or stress?
Are there any risks or complications to laryngoscopy?
What is the cause of the condition?
What treatment do you recommend? How successful is this treatment?
Will you be recommending surgery?
What are the risks or complications of this surgery?
After surgery, what are the chances the condition will return?
What can I do to prevent this condition from returning?
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