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Symptoms

Surgery of the voice is most commonly performed for patients with symptoms of hoarseness. The changes to voice quality may include; breathiness, huskiness, reduced voice range and voice tiring. Voice problems are more common in those that place special demands on their voice, such as professional voice users or singers. They are also common in those that abuse their voice, for example, straining over noise, singing with a “cold” or excessive voice use. Failure of one or both vocal folds to meet in the midline produces what is known as a “glottic gap” allowing air to escape on phonation (production of “EE” sound) and can be seen when the throat is examined.

 


Vocal Fold Nodules



Vocal Fold Nodules

Vocal fold nodules are small, callous like growths on the vocal folds. We often see vocal nodules in patients who overuse their voices. The voice of someone who has vocal nodules may sound breathy, rough and patients often complain their voices break or they lose their top singing range.                                                               


Treatment

Voice therapy and surgery maybe required in rare circumstances.


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Muscle Tension Dysphonia

Muscle Tesion Dysphonia

Muscle tension dysphonia is a voice disorder resulting from excessive or unequal tension while speaking or singing. It is often the result of overuse of the voice or occurs following a upper respiratory tract infection. The voice sounds strained and patients complain that speaking is effortful.                                                     

Treatment

Voice therapy


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Vocal Fold Polyp




Vocal Fold Polyp

A vocal fold polyp is a growth similar to a vocal fold nodule but is softer, more like a blister than a callous. It most often forms on only one vocal fold. The voice of someone with a polyp may sound low in pitch, strained and rough.                                                                                                                                         

Treatment

Initially voice therapy and if necessary surgery.



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Vocal Fold Cyst




Vocal Fold Cyst

Vocal fold cyst is a fluid-filled sac in the vocal folds. It may result in a “kissing lesion” on the opposite vocal fold and can be mistaken for nodules.                                                                                                               

Treatment

Surgery preceded and followed by voice therapy if needed.



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Unilateral Vocal Fold Paralysis

Unilateral Vocal Fold Paralysis

Vocal fold paralysis is a weakness or immobility of one of the vocal folds. It may be the result of a viral infection or can occur during surgery to the neck. The voice will be weak or breathy, patients complain of vocal fatigue or difficulty getting a loud voice.                                                                                                                       

Treatment

Depending on the position of the paralysed vocal fold, voice therapy may be sufficient otherwise surgery may be required to medialise the damaged vocal fold.  As a temporary measure, a restylane injection maybe recommended.

 

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Bilateral Vocal Fold Paralysis

Bilateral Vocal Fold Paralysis

Both vocal folds are rarely affected except occasionally after surgery when they may be close together requiring surgery for breathing.  


Treatment

Surgery involves opening the back of the larynx by removing part of the arytenoids using CO2 laser


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Reflux Laryngitis

Reflux Laryngitis

Reflux laryngitis is an inflammation of the larynx caused by gastric acid irritation it frequently results in decreased vocal performance and often associated with a muscle tension dysphonia.                                              


Treatment

Medication to treat the reflux combined with voice therapy.   Reflux Patient Handout 


 
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Vocal Fold Bowing

Vocal Fold Bowing

Vocal fold bowing is commonly seen in older adults that results in vocal weakness, vocal fatigue and difficulty getting a loud voice.               



Treatment

Voice therapy and in cases that do not respond to therapy, surgery may be beneficial.  This involves injecting the vocal folds in order to strengthen or to improve the bulk and deepen the voice ..  



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Laryngitis

Laryngitis

Laryngitis is an inflammation or swelling of the vocal folds. The voice of someone with laryngitis may sound strained, breathy, and rough.


Treatment

Voice rest and if needed voice therapy.  In artists who need to perform, a short course of steroids can be helpful and humidification/fluids are very important.



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Reinke's Oedema

Reinke's Oedema

Reinke’s Oedema is an accumulation of fluid in the vocal folds usually associated with smoking. The voice is rough and low in pitch.                                               
                                                                                  

Treatment

Patients must stop smoking to gain any voice improvement with voice therapy and ultimately surgery may be required.


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Vocal Fold Granuloma

Vocal Fold Granuloma

Vocal fold Granuloma is an area of thickened, irregular tissue on the vocal fold caused by irritation usually from gastroesophageal reflux. Patients often complain of pain the voice may be rough and weaker with loss of singing range.                                                                                                                                                          

Treatment

 Aggressive treatment of reflux with medication, voice therapy may be indicated and ultimately surgery may be necessary.



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Laryngeal Papilloma
 





Laryngeal Papilloma

Laryngeal papilloma are growths on the larynx caused by a viral infection. The voice may be rough and strained with loss of singing range.                                                                                                                          

Treatment

Surgery involves use of KTP or COlaser and injection of cidoflvor is worth a try as in approximately 1/3 of patients can result in reduction of recurrent disease. Unfortunately HPV is very resistant to treatment which often be required an annual or bi-annual.


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Spasmodic Dysphonia

Spasmodic Dysphonia

Spasmodic dysphonia is characterized by voice breaks, voice arrests or sudden uncontrolled interruptions to the voice. It results in a strained strangulated voice quality and patients complain speaking is extremely effortful. 


Treatment

After confirmed diagnosis Botox is the treatment of choice and highly successful. Further information can be found at www.dysphonia.org 



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Puberphonia

Puberphonia

Puberphonia is characterised by the persistence of a high-pitched falsetto voice in males after puberty in the absence of organic, laryngeal or medical pathology.


Treatment

Puberphonia is usually effectively and quickly treated with voice therapy.


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Cancer

Cancer

Occurs mostly in smokers, ex-smokers and drinkers and is mostly a male disease in the over fifties.                                


Treatment

Can be a combination of surgery, chemotherapy and/or radiotherapy.

For further information, please see  Head & Neck Cancer Clinic  



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