How is the voice formed and what is dysphonia?
The vocal folds are two elastic muscular plates in the larynx. When speaking, they close together, and the exhaled air causes them to vibrate, creating sound. For the voice to sound clear, the edges of the folds must be smooth, the mucous membrane must be moist and mobile, and the muscles must work symmetrically. Dysphonia is divided into organic, when there are visible changes in the larynx, and functional, when voice control is impaired in the normal picture. Based on duration, a distinction is made between acute dysphonia, which is often associated with inflammation, and chronic dysphonia, which lasts more than 3 weeks and requires examination.
- Acute - for laryngitis, screaming, colds
- Chronic - longer than 3 weeks
- Organic - nodules, polyps, cysts, tumors
- Neurogenic - paresis or paralysis of the vocal fold
- Functional—violation of voice production technique
- Aphonia - complete loss of sonorous voice
Possible reasons
The most common cause is acute laryngitis due to a viral infection. In people of vocal professions - teachers, singers, salesmen, help desk operators - due to overload, nodules and polyps of the vocal folds form. Reflux of acidic stomach contents irritates the larynx and causes morning hoarseness and tickling. Smoking leads to chronic laryngitis, swelling of the vocal folds and increases the risk of laryngeal cancer. Paresis of the vocal fold occurs after operations on the thyroid gland, neck and chest, with tumors of the lung and mediastinum. Hypothyroidism, inhaled hormones and age-related changes can also change the voice.
- Acute laryngitis with ARVI
- Vocal strain, shouting, singing
- Nodules, polyps and cysts of the vocal folds
- Laryngopharyngeal reflux
- Smoking and chronic laryngitis
- Paresis of the larynx after surgery or with tumors
- Laryngeal cancer
- Hypothyroidism and use of inhaled glucocorticosteroids
Associated symptoms
The nature of the voice disorder and additional symptoms help to understand what is happening. With laryngitis, hoarseness is accompanied by soreness, dry cough, and sometimes fever. The nodules give rise to gradually increasing hoarseness in the evening and after exercise. Morning hoarseness with a feeling of a lump in the throat and frequent coughing is characteristic of reflux. A weak voice with air leakage and choking on liquid indicate impaired mobility of the fold. Persistent and slowly increasing hoarseness in a smoker, pain when swallowing, radiating to the ear, and lumps in the neck require the exclusion of a tumor.
- Soreness, cough, fever
- Increased hoarseness in the evening
- Feeling of a lump in the throat, frequent coughing
- Weak voice with air leak
- Choking when drinking
- Sore throat radiating to the ear
- Enlarged lymph nodes in the neck
What examinations are needed
The main study is examination of the larynx, or laryngoscopy. Today it is performed using a rigid or flexible endoscope, which allows you to see the vocal folds in detail and record the image. Videolaryngostroboscopy shows fluctuations of the folds in slow motion and reveals small formations and scars. If a suspicious area is detected, a biopsy is taken. If the fold is immobile, a CT scan of the neck and chest is ordered to find the cause of the nerve damage. According to indications, thyroid function is checked and referred to a gastroenterologist if reflux is suspected.
- Indirect or endoscopic laryngoscopy
- Videolaryngostroboscopy
- Biopsy for suspicious changes
- CT scan of the neck and chest for fold palsy
- TSH for suspected hypothyroidism
- Consultation with a phoniatrist and gastroenterologist
Treatment and voice restoration
Acute hoarseness due to laryngitis is treated with vocal rest, warm drinks, air humidification and smoking cessation; It is not recommended to whisper, as whispering also strains the folds. Antibiotics are not needed for viral laryngitis. The nodules often decrease after classes with a phonopedist, who teaches the correct voice technique. Polyps, cysts and other formations are removed endoscopically through the mouth using microsurgical instruments or a laser. For reflux, a diet and medications that reduce acidity are prescribed. Treatment of laryngeal paresis includes phonopedia and special operations. Any treatment is selected by the doctor after examination.
- Voice peace without whispering
- Humidify the air and drink enough fluids
- Quitting smoking and alcohol
- Phonopedic classes
- Intralaryngeal infusions as prescribed by an ENT doctor
- Endolaryngeal microsurgery
- Treatment of reflux and hypothyroidism
