Voice and larynx disorders

When a voice should be examined

Hoarseness after a cold or a loud evening is nothing to worry about. What matters is persistence: a voice that has been altered for more than three weeks should be examined, and this applies all the more to a smoker or former smoker.

Other common reasons for consultation include a breathy or weak voice, a voice that tires by the end of the day, repeated loss of voice, a sensation of a lump in the throat with frequent throat clearing, pain on swallowing, or a chronic cough with no explanation.

Examining the larynx

The consultation begins with the history of your voice: how long it has been affected, how it has changed, how much you use it at work, and what makes it worse. The examination then involves looking directly at the vocal cords, usually with a flexible nasal endoscope passed through the nose under local anaesthesia. It takes a few minutes and allows the vocal cords to be seen moving in real time — something no imaging test can replace.

The most common causes

Vocal overuse, in teachers, singers or anyone who speaks a great deal, leads to nodules, polyps or cysts of the vocal cords. Chronic laryngitis is often sustained by acid reflux or tobacco. A vocal cord may also be paralysed following surgery of the neck or chest, or for no identifiable reason. With age the vocal cords thin and the voice weakens — this is presbyphonia. Finally, persistent hoarseness can reveal a precancerous lesion or a cancer of the larynx, where outcome depends closely on how early the diagnosis is made.

Treatment

Treatment follows the cause. Voice rest and vocal hygiene, treatment of reflux, smoking cessation and speech therapy resolve many situations without surgery. When a lesion must be removed, laryngeal microsurgery is performed under general anaesthesia, through the mouth, with no external incision.