Guest Post by:
Lucinda A. Halstead, M.D.
Specialist in Voice and Swallowing Disorders
MUSC Health ENT
Our voice reflects who we are. It conveys our personality and allows us to communicate with the world around us. The quality of our voice – pitch, tone, inflection – can make or break business presentations, lectures, vocal performances, jobs and daily life interactions. It can invite and cultivate relationships or deter or destroy them. A voice that is rough, squeaky, breathy and difficult to understand isolates a person from those around them, causing frustration and often depression.
It is important to have your larynx examined if you develop hoarseness that persists for more than two weeks, even if you are a nonsmoker!
Causes of hoarseness range from cancer to poor vocal habits or upper respiratory infections. Cancers of the larynx are most commonly caused by tobacco use in any form, cigarettes being the most common. It is important to realize that once a person has smoked the equivalent of 1 pack of cigarettes per day for ten years, they are permanently at risk for developing a cancer in the larynx. The cancer often develops decades after the individual has stopped smoking. This smoking related cancer risk in the head and neck differs completely from the smoking related lung cancer risk, where the relative risk of cancer decreases with smoking cessation.
Poor vocal habits and vocal abuse, reflux, allergies, asthma and many medications can irritate the surface of the vocal folds (cords) causing swelling and stiffness. Left untreated, these irritations can result in non-cancerous lesions such as nodules, dilated vessels, polyps or scarring. These lesions interfere with the normal vibration of the vocal folds and make the voice uncomfortable to use, difficult to understand, and often cause generalized fatigue from the constant effort to produce sound. When diagnosed and treated promptly, these lesions often resolve with a brief course of medication, voice rest and vocal retraining. Swelling in the larynx from reflux, allergies, and infections, particularly fungal infections from steroid inhalers can also be rapidly cured with medical treatment when caught early.
However, lesions that do not respond to medicine and voice therapy can often be treated with a variety of minimally invasive procedures in the office. For example, the KTP laser has the unique ability to change the structure of collagen and scar tissue without cutting the tissue of the vocal fold. The laser energy is applied through a tiny fiber that is passed down a flexible scope and positioned over the vocal fold lesion. The lesions then resolve over four to six weeks. Another minimally invasive technique involves injecting scar tissue with dilute steroids to disrupt tiny adhesions. This allows the vocal folds to vibrate freely, restoring the voice. If a more serious problem is suspected, cultures and biopsies can be performed in the same minimally invasive manner in the office to get a diagnosis.
Treatment of the underlying cause of these non-cancerous lesions is extremely important. Abusive vocal behaviors in particular– chronic throat clearing, yelling or loud talking with tight neck muscles, poor singing technique, smoking, reflux and allergies – must be treated with medicines and, more importantly, with retraining of the voice with voice therapy for the speaking and the singing voice. Without these in combination, the lesions will come back.
As the laryngologist for the Spoleto Festival USATM, I am proud to have established within the MUSC Evelyn Trammell Institute for Voice & Swallowing (ETIVS) a multidisciplinary team specializing in treating voice disorders in all patients, with additional expertise to treat avocational and professional performers of all musical and theatrical genres. Our most recent additions, Melissa Cooke, MS, CCC-SLP and Krysten Sears, MS, CCC-SLP are speech language pathologists with special interest in performing voice, as both have been vocal and theater performers. Our singing voice specialist, Deanna McBroom, MM, is a Professor of Voice at the College of Charleston and has worked closely with me for two decades to evaluate patients with issues in their singing voice. She additionally provides targeted singing voice retraining in appropriate cases. This interdisciplinary team provides a comprehensive approach to the treatment of voice disorders for all patients.