As a clinical professor of otolaryngology and neck surgery, Woo is a laryngologist and voice specialist. Since 1983, he has corrected thousands of voice problems with medical and surgical treatments.
Voice disorders are medical conditions that impair the production of speech. “Voice disorders can be the result of voice use or abuse, chronic allergies, acid reflux or cancer,” says Woo. “Clearing the throat isn’t enough to make them go away.”
For many people, voice disorders are associated with age, as 7% to 8% of elderly patients have hoarseness. “They think it’s just part of the aging process, but it doesn’t have to be,” says Woo.
Voice disorders resulting from heavy voice use fall into several categories. “Muscle-tension dysphonia is the medical term for hoarseness, which comes from straining the neck muscle and vocal-cord muscle so there’s chronic soreness,” says Woo. “It can come from being in a loud bar all night, or it can come from habitual use.”
Overuse also frequently causes calluses to form on the vocal cords. “We call these vocal nodules,” says Woo. “Nodules interfere with the vibration of the vocal cords that produces speech, so patients with nodules can start sounding like the Godfather.”
Another common problem is vocal-cord polyps, which occur when a blood vessel ruptures, often as the result of shouting.
Voice disorders are a serious problem for many professions, especially in New York, where 70,000 people depend on their voices for a living.
“We see a large number of teachers, especially gym teachers and choir directors, and even substitute teach-ers, who aren’t used to talking all day,” says Woo. “I just saw a commodities trader who works down in the pit. He screamed and ruptured a blood vessel.”
The No. 1 symptom for vocal disorders is hoarseness. “Almost all patients have an audible roughness or gravelly quality to the sound of the voice,” says Woo. “They often complain about constantly clearing their throat, and their voice can become very tired after even brief periods of voice use.”
People often attempt to compensate for these symptoms by speaking in a low or high voice, leaving them with what doctors call “a reduced dynamic range.”
Many people mistakenly assume that their throat and voice symptoms spring from a cold — but a cold doesn’t explain chronic hoarseness. “If the symptoms last more than 10 days to two weeks, you don’t have a cold,” says Woo. Chronic laryngitis or allergies are two other problems that cause symptoms that can look similar to a vocal disorder.
Pain can be a red flag for voice disorders, but it doesn’t usually originate in the vocal cords. “When people have pain, it’s from the neck muscle, which they are using in compensation to speak,” says Woo. “Or sometimes they get ear pain, which is a referred pain originating in the throat that you feel in the ear because they share a nerve.”
Voice disorders can be treated with vocal rest, medication, surgery or speech therapy, and the treatment that is right for you will depend on which primary condition you have. Resting your voice is the first step if your problem is caused by inflammation. “It’s a concentrated attempt to reduce voice exposure,” says Woo. “It can mean that you don’t go to the loud bar or the loud birthday party, or take breaks throughout the day if you’re in the trading pit.”
For many patients, the second step is working with a speech pathologist or singing therapist to see if you can improve how you use your voice and be more efficient.
Another option is using steroids to calm the inflammation. Surgical intervention is the best treatment for some patients; doctors decide when it’s appropriate by doing a stroboscopy exam, which uses a strobe light to look at the vibration of the vocal cords. “Surgery is indicated if there is a growth or bump that needs to be looked at to see if it’s precancerous, or if it’s just not going away and will continue interfering with vocal cords,” says Woo.
“In phonosurgery, we use a microscope, go through the mouth and remove these bumps,” he notes. Patients are usually on voice rest for a week, and then spend the next few weeks restoring the voice to normal function.
One of the most exciting breakthroughs for laryngologists is the use of lasers to treat lesions on the vocal cords. Some patients have bleeding into the vocal cords. “By shining a laser light on the blood vessel, you can coagulate it,” says Woo. “It’s like taking a dermatological approach — they often treat blemishes with a laser, and now we can do that in [the] throat.” This procedure is called photothermolysis, and can be done in the office without surgery.
If you are coping with chronic hoarseness, ask your doctor, “Do I have a growth or bump on my vocal cords?” And if the tests show you do have nodules or a growth, ask, “Is it on one side or both sides?” Your treatment options depend on the answer. “If it’s on both sides, we’ll usually take a voice-therapy approach first,” says Woo. “If it’s on one side, it could be surgical.”
Be aware of how you use your voice. If hoarseness is a problem for you, you need to pay more attention to how you use your vocal cords. Pay attention to how many hours you use your voice, whether you clear your throat a lot or whether you feel like you are “pushing” your voice.
Stay hydrated. “Drink lots of water to keep your throat lubricated,” says Woo, “and avoid too much caffeine and alcohol.”
See a specialist. If hoarseness persists more than two weeks, consider seeing an ear, nose and throat specialist.
Source: New York Daily News, January 27, 2010
By Mortin - Copyright 2010
Last modification 05/02/2010