What are voice and vocal cord disorders?

Causes and Symptoms

The human vocal apparatus consists of the larynx (voice box), the vocal tract (the pharynx and the nasal and oral cavities), and the nose and mouth (sound radiators). The main sound source is the larynx, containing the vocal cords; the thyroid, forming the projection on the front of the neck known as the Adam’s apple; and the arytenoids, which control the size of the glottis (the opening between the vocal cords). The arytenoids are usually well separated to permit breathing; however, they pull together and vibrate during vocalization. Disorders of the vocal system may occur at the larynx or the palate (the roof of the mouth). Such disorders are sometimes caused by nonorganic emotional disturbances.

Laryngitis
, or inflammation of the larynx, may be acute or chronic. The acute form may be caused by bacterial infection, chemical agents (such as chlorine), overuse of the vocal cords, or trauma. During acute laryngitis, the membrane lining the larynx swells and secretes a thick mucous substance that obstructs the vocal cords. Vocal strain following prolonged talking or singing may cause chronic hoarseness or roughening of the voice. Abuse of the voice consists of yelling or screaming, being forced to talk loudly in noisy surroundings, or having a faulty vocal technique.

Chronic laryngitis, produced by excessive smoking, alcoholism, or constant abuse of the vocal cords, dries the mucous membrane and often results in nodular growths on the vocal cords. These growths obstruct the normal functioning of the cords or cause erratic vibration. Hoarseness is symptomatic of a vocal cord problem.
Sinusitis or any pulmonary
disease that results in a chronic cough is particularly damaging to the voice. Chronic
bronchitis may permanently injure the vocal apparatus because coughing is particularly traumatic to the vocal folds, which close tightly just prior to the cough and then open abruptly to permit the explosive air blast.

When the palate is not fused, a congenital deformity termed
cleft palate, sound in the mouth cavity leaks into the nasal cavity. The resulting speech sounds have a nasal quality. (For normal speech, nasal sounds are produced when the soft palate at the back of the throat opens to allow sound into the nasal cavity.) The speaker with cleft palate may not be able to develop sufficient pressure in the mouth cavity to enunciate stops and fricatives.

Laryngeal granuloma, or contact ulcer, is a vocal cord lesion resulting from the insertion of a tube into the trachea (as with general anesthesia) or from an inappropriate configuration of the vocal cords during speech. This condition is suspected when a patient complains of pain or hoarseness after prolonged talking. Symptoms are slight hoarseness and a peculiar feeling in the throat.

A papilloma, or vocal nodule, is a small, benign, wartlike growth (polyp) attached to the vocal cords. It most often occurs in singers, announcers, and people who frequently use their voices strenuously. A patient with a vocal nodule may complain of chronic hoarseness or some ill-defined difficulty in speaking.

Laryngeal carcinoma is a malignant tumor caused by chronic irritation or by alcohol and tobacco abuse. Both types of laryngeal carcinoma—intrinsic, which attacks the vocal cords, and extrinsic, which grows in the area above the vocal cords—produce immediate symptoms of hoarseness, discomfort, and coughing. In the intrinsic form, if the symptoms are diagnosed correctly in the early stages of tumor growth, the patient has a good chance of recovery after the tumor is removed.

Treatment and Therapy

There are two treatments for chronic laryngitis. Surgery, followed by vocal exercises to correct the cause, will restore the contours of a larynx that has developed polyps or become thickened. In some cases, however, the larynx appears entirely normal but the voice tires or roughens with prolonged use. The problem is repeated vocal cord strain from excessive subglottal pressure or the inappropriate application of breath during phonation. Relief must come from a voice teacher or speech therapist.

A cleft palate is surgically corrected by closing the hole in the palate. When the original palate is inadequate for simple closure, plastic surgery may restore it to its intended purpose, or a prosthesis may be fitted to effect an artificial closure.

Laryngeal granuloma is readily corrected by surgically removing the lesion. When the ulcer occurs as a result of prolonged talking, speech therapy or vocal training will prevent a recurrence. After careful diagnosis, a vocal nodule (polyp) is also removed by means of surgical forceps. The patient is ordinarily restored to normal talking or singing within two to six weeks. Since nodules usually result from vocal abuse, the cause must also be identified and corrected.

Carcinoma of the larynx can be successfully removed surgically, or treated by radiotherapy, when detected early. The extent of surgical intervention is directly dependent on the site and extent of the tumor. If the tumor is restricted to the surface of the vocal folds, a laryngofissure may be performed, but more extensive penetration requires a laryngectomy. When the tumor is known to be of low malignancy, a hemilaryngectomy and immediate skin graft preserve the natural airway and leave a functional, although inefficient, voice.

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