1. Voice disorders are common. Almost everyone experiences at least hoarseness from time to time.

2. Good vocal quality and endurance are extremely important for personal and professional communication.

3. Some changes in voice quality or endurance indicate the presence of serious diseases. Consequently, all voice disorders warrant thorough evaluation and accurate diagnosis.

4. Most voice problems are correctable.

5. Voice disorders may lead to permanent voice impairment. Accurate diagnosis and treatment often avoids long-term problems.

6. The state-of-the-art and medical standard of voice care have improved dramatically beginning in the late 1970s and 1980s.
 

What is the voice and how does it work?
The wonderful sound we call voice results from interaction among numerous parts of the body. The vocal folds are part of the larynx (voice box) and act as the oscillator or voice source (noise maker) of the vocal tract (figure 1). They produce only a "buzzing sound." The supraglottis vocal tract (above the larynx) includes the pharynx, tongue palate, oral cavity, nose, and other structures. Together, they act as a resonator and are largely responsible for vocal quality or timbre and the perceived character of all speech sounds. The infraglottic (or subglottic) vocal tract (below the larynx) serves as the power source for the voice by generating a force, which directs and controls the air stream between the vocal folds that is necessary for vocalization to occur. Phonation (using the vocal folds to make sound) requires interaction among the power source, oscillator, and resonator. The voice may be likened to a brass instrument such as a trumpet. Power is generated by the chest, abdomen and back musculature producing a high-pressure air stream. The trumpeter's lips open and close against the mouthpiece producing a buzz similar to the sound produced by the vocal folds. This sound then passes through the trumpet, which has resonance characteristics that shape the sound we associate with trumpet music. The non-mouthpiece portion of a brass instrument is analogous to the supraglottic vocal tract.

What are the symptoms of voice disorders?
Hoarseness is a coarse, scratchy sound caused most commonly by abnormalities on the vibratory margin of the vocal fold. These may include swelling, roughness from inflammation, growths or anything that interferes with symmetric vocal fold vibration. Other symptoms include breathiness, vocal fatigue, volume disturbance, prolonged warm up time, excessive phlegm, pain, and frequent throat clearing.

What does affect the voice?
Age
Voice use and training
Environmental irritants: pollution, allergens
Tobacco smoke
Various medications
Spicy foods, alcohol, caffeine

Any disturbance of the following systems: respiratory, gastrointestinal, endocrine, neurological, and psychological.
 

FREQUENTLY ASKED QUESTIONS
Can abusing the voice create problems?
Voice abuse (speaking either too much, too loudly, or improperly over extended periods of time), is an extremely common source of hoarseness, vocal weakness, pain and other problems. In some cases, voice abuse can even create structural problems such as vocal nodules, cysts and polyps.

What are vocal nodules?
Small, callous-like bumps on the vocal folds called nodules are caused by voice abuse. In most cases, nodules are associated with hoarseness, breathiness, vocal fatigue and loss of range. Voice therapy will cure the vast majority of patients.

What is reflux laryngitis?
The sphincter (a one-way valve) between the stomach and esophagus (swallowing tube) is notoriously weak. In gastroesophageal reflux laryngitism (figure 2) stomach acid refluxes through this weak sphincter into the throat allowing irritating gastric acid to come in contact with the vocal folds and even to be aspirated into the lungs. Common symptoms of reflux laryngitis are hoarseness (usually worse in the morning and improves during the day), sensation of a lump in the throat, excessive phlegm and frequent throat clearing. Typical heartburn is frequently absent.

What is acute laryngitis?
Acute laryngitis (figure 3) presents with edema (swelling) and erythema (redness) of the vocal fold. It may result from infection (common cold, upper respiratory tract infection), or irritation caused by excessive voice use such as screaming at a sporting event or concert.

What about cancer of the larynx (voice box)?
Cancers of the larynx are common (figure 4), and are usually associated with smoking. So any smokers with hoarseness lasting more than two weeks should see a laryngologist.

What are other causes of hoarseness?
Other causes of hoarseness include: allergies, thyroid problems, neurological disorders, trauma to the voice box, pregnancy, and a woman's menstrual cycle.

Who should I see for my voice disorder?
Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. A laryngologist is a Board Certified Otolaryngologist -Head and Neck Surgeon, who sub specializes in Laryngology and Care of the Professional Voice. This highly trained physician can diagnose and treat your voice problems. Treatment depends on the cause of your voice problem, but may include lifestyle modification, medication, surgery and referral to other professionals, such as a speech/language pathologist, and teachers of singing. All these professionals are part of the Voice Team that is going to guide you toward recovery!
 

How is hoarseness evaluated?
The laryngologist will obtain a thorough history of the hoarseness and of your general health. Then, she/he will proceed with a complete ear, nose, and throat exam. Then the doctor will proceed with strobovideolaryngoscopy. This technology allows for early detection of small masses, vibratory asymmetry, adynamic segments due to scar or early cancer, and other abnormalities that are missed in vocal folds that looked "normal" under continuous light (as opposed to stroboscopic light). Strobovideolaryngoscopy is a sophisticated, complex diagnostic procedure using special equipment and skills not widely available. It often allows diagnosis of problems that cannot be detected without specialized examination. The Voice Institute is equipped with a superior "state of the art" strobovideolaryngoscopy system, which is mandatory for a comprehensive voice evaluation.
 

If you are interested in making an appointment with Dr. Dean please call the Atlanta office at 404.256.7532.

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