Voice problems, such as hoarseness and vocal weakness, are common, especially as we get older. New evidence suggests, however, that most people with vocal ailments aren’t getting needed treatment.
In a recent study of 248 octogenarians that I coauthored, one in five had chronic hoarseness or vocal weakness. Yet three-quarters hadn’t consulted a doctor. People with these symptoms have been found to have increased levels of anxiety, depression and social withdrawal.
Even more surprising: Most of our study subjects didn’t even know that vocal conditions were treatable.
The good news: Not only can most vocal conditions be treated, new approaches make it easier than ever to keep your voice strong and healthy as you get older.
Normally, when you start to speak, your two vocal cords move closer together and vibrate as air passes over them. Viral laryngitis — one of the most common causes of voice problems — occurs when a respiratory virus causes the cords to swell, inhibiting normal vibration. Viral laryngitis is usually not serious.
However, if laryngitis persists for more than three weeks, you should consult an otolaryngologist (ear, nose and throat specialist) with expertise in vocal problems. Important: He/she should be part of a practice that encompasses many disciplines, such as speech-language pathology. Your otolaryngologist also may need to work closely with pulmonologists, allergists, gastroenterologists, neurologists and rheumatologists. Reason: Chronic vocal problems often have multiple causes, and effective therapy may involve multiple treatment modes.
The doctor will visually examine your vocal cords and throat muscles with a small camera introduced into the throat via the nose or mouth to determine what’s causing the problem.
New: A number of voice-disorder centers now use equipment that allows detailed assessment of the vocal cords, including vibratory function. Also, the acoustic properties of the voice and aerodynamic aspects of vocal production can be measured.
Among the most common causes of chronic vocal problems are benign lesions (growths) on the vocal cords, typically due, at least in part, to vocal strain from shouting, yelling, singing or simply talking too loudly or for too long. Smoking, inhaling irritating chemicals or physical trauma (such as from intubation, or insertion of a tube into the airway) also can contribute to vocal lesions.
Your doctor also will check for other underlying conditions that can contribute to voice problems, including laryngopharyngeal reflux (LPR), a condition in which stomach acid washes up into the larynx… allergies… and certain autoimmune conditions, such as sarcoidosis and Wegener’s granulomatosis — all of which can inflame the vocal cords. Among other things, this inflammation has been linked to increased risk for warts (papillomas) on the vocal cords in people who have human papilloma virus.
Vocal cord inflammation also can lead to frequent throat-clearing, which causes the cords to slam together like two hands clapping. This sort of ongoing impact, whether from throat-clearing or poor vocal habits, such as shouting or straining during speech, can lead to…
Leukoplakias — precancerous lesions, often related to smoking.
Any of these growths can impair vocal function.
More serious conditions: Voice problems also may result from vocal cord paralysis, which causes voice changes and swallowing problems. This paralysis can be caused by head or neck injury… stroke… certain viruses… spasmodic dysphonia (involving muscle movements in the larynx, making the voice sound strained)… throat cancer… as well as lung or thyroid cancer or malignancies of the chest.
In addition to treating underlying conditions, treatment may include a combination of voice rest, voice therapy, medical management and surgery. Hoarseness or vocal weakness often does improve simply with rest and removal of the irritant.
If this does not lead to improvement, however, the next step involves sessions with a vocal therapist, who will develop a customized program that may include laryngeal massage to decrease excess contraction of muscles in the larynx… diaphragmatic breathing, which involves breathing using your diaphragm (as opposed to the less efficient “shoulder” breathing that most people do)… resonance training designed to bring the voice forward out of the throat to reduce straining… and techniques for avoiding muscle strain while talking. Computer voice analysis may be used to monitor progress. Patients should also follow other “vocal hygiene” practices, including…
Drinking lots of water and minimizing intake of caffeine, alcohol and other diuretics. Reason: Thin, watery saliva and mucus are important to healthy vocal cords. As we age, saliva and mucus naturally become thicker, so staying well-hydrated becomes more important.
If rest and vocal therapy aren’t sufficient, other treatments will be needed. For vocal cord lesions, treatment has traditionally involved surgical removal.
New development: Laser surgery. Vocal cord growths can be removed in a doctor’s office using topical anesthesia. A recent study found that laser surgery results in fewer complications and faster recovery than traditional surgery. I now use a special type of laser that attacks the growth’s blood supply to treat papillomas, leukoplakia and, sometimes, granulomas and other vascular lesions.
As with traditional surgery, repeated treatments may be necessary if the growth returns. But repeat laser treatment involves much less trauma and costs far less (approximately $3,000 versus $10,000).
The other major treatment — this one for a vocal cord affected by paralysis or nerve damage — involves injecting filler material to move the cord closer to its companion, improving its function. Patients with vocal fold atrophy, vocal scarring or vocal fold paralysis could benefit from an injection into the vocal fold or an implant placed into the vocal fold to improve the closure. The filler treatment has few, if any, side effects and lasts varying amounts of time depending on filler.
While this approach has been used for more than a decade, more effective new filler materials, such as Gore-Tex and Silastic, have recently been introduced. Such injections are now increasingly being performed in the doctor’s office.
Research is being done on injectable medications for papillomas and on tissue engineering — in which the vocal cords’ vibratory layer will literally be regrown by injecting either stem cells or growth factors. This treatment offers hope for healing scarred vocal cords and vocal cords that have atrophied from age — two conditions that are difficult to treat.
