Voice Changes
By Vien Phommachanh, MD
March 23, 2014
Category: Voice
Tags: Voice Change   Hoarseness  

Have you noticed a sudden or gradual change in your voice? This is an important reason to seek the care of an otolaryngologist or ear, nose, and throat doctor. The medical conditions that can contribute to voice changes include:

  • age related changes 
  • laryngitis
  • vocal misuse
  • acid reflux
  • allergies
  • cough
  • postnasal drip
  • upper respiratory infection
  • sinusitis
  • vocal cord paralysis
  • benign vocal lesions
  • vocal cord cancer

An otolaryngologist can help you identify and treat the source of your voice problem. Often your ENT will perform flexible, fiberoptic laryngoscopy, which is a commonly performed procedure that allows your doctor to look directly at your vocal cords. This procedure is quick and painless. During this procedure, a small flexible scope is inserted through the nose and follows the contours of the nose into the upper throat. This allows very clear visualization of the vocal cords. The nose is usually decongested and numbed so that the patient feels very little. Another procedure that is commonly used is called videostroboscopy. In this procedure, a camera is placed in the mouth and the vocal cords are recorded using a high speed camera. This allows excellent evaluation of the movement and anatomy of the vocal cords and can be reviewed in great detail and in slow-motion. 

Voice changes are common with age and can simply be a degenerative change. Our larynx, or voice box, is made of multiple muscles. This includes the vocal cords themselves. The vocal cords can become thinner with age and as a result, your voice can become breathier or weaker. Voice change, however, can be a sign of a more serious medical problem and should be evaluated. Identifying and treating medical conditions, such as reflux or postnasal drip, will improve the quality of your voice. In some cases, excessive or misuse of the voice by  people that have a high vocal demand (such as singers or coaches) can cause damage to their vocal cords. These people often develop vocal nodules. Vocal nodules are essentially calluses that form where there is friction between the vocal cords. It is important to identify and treat these early, otherwise they can become difficult to treat. Treatment for vocal nodules is typically voice therapy, the purpose of which is to optimize your voice production and minimize muscle strain and vocal cord friction. 

The biggest concern with voice change is the possibility of cancer. Often, hoarseness is the presenting symptom of a vocal cord cancer. Occasionally, there are other symptoms such as difficulty swallowing or throat pain. It is especially important to have evaluation with a history of tobacco use or a family history of cancer. Early detection and treatment significantly improves the chances of treatment and cure.