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LARYNGEAL AND VOICE DISORDERS

The Voice Disorders Clinic is a multidisciplinary clinic involving the departments of Otolaryngology – Head and Neck Surgery and Rehabilitative Medicine. We have the full capabilities of a diagnostic and therapeutic voice laboratory, including video vocal cord movement analysis (stroboscopy), measurement of vocal cord movement (electromyography), and voice assessment. All patients are seen by a physician laryngologist and a speech pathologist. At the completion of each visit, a combined opinion regarding a diagnosis and a treatment plan will be offered.

Services provide in the specialty:
Laryngeal/voice testing, treatment, and rehabilitation

  • Hoarseness
  • Vocal cord lesions
  • Nerve injury to the vocal cords
  • Spasmodic dysphonia
  • Breathing difficulties related to narrowing at the larynx o9r trachea

Swallowing dysfunction is also comprehensively evaluated for:

  • Cricopharyngeal spasm
  • Zenkers diverticulum
  • GERD

Special Laryngeal Testing, Treatment, and Rehabilitation:
Our physicians provide diagnoses and treatments for a wide range of voice disorders and throat problems including vocal cord paralysis, spasmodic dysphonia, vocal cord lesions, post-traumatic laryngeal abnormalities, and laryngeal airway disorders.

Description of the Larynx:
The larynx, or voice box, is an organ in the neck that plays a crucial role in speech and breathing. The larynx is the point at which the aerodigestive tract splits into two separate pathways: the inspired air travels through the trachea, or windpipe, into the lungs, and the food enters the esophagus and passes into the stomach. Because of its location, the larynx has three important functions:

  • control of the airflow during breathing
  • protection of the airway
  • production of sound for speech

The framework of the larynx is made up of the thyroid cartilage. The anterior portion of the thyroid cartilage can be easily felt in thin necks as the "Adam's apple".

In the center of the larynx lie the vocal cords. The vocal cords are probably the most important part of the larynx, as they play a key role in all three functions mentioned above. The vocal cords are muscular bands covered by a thin layer called mucosa. There is a right and left cord, forming a "V" when viewed from above. At the rear portion of each vocal cord is a small structure called the arytenoid. Many small muscles are attached to the arytenoids. These muscles pull the arytenoids apart from each other during breathing, thereby opening the airway. During speech the arytenoids and therefore the vocal cords are brought close together. As the air passes by the closed vocal cords, they vibrate like reeds on a musical instrument and produce a sound. The sound is modified by our throat, tongue and lips to produce speech.

Examining the Larynx:
There are two special instruments that assist the physician in examining the larynx during an office visit. The instrument shown below is a nasopharyngoscope. The curved part of the scope is a flexible fiberoptic cable that can be passed through the nose and through the pharynx until it gives a view of the vocal cords.

The larynx is a flexible structure made up of cartilage called the epiglottis. When we swallow, the larynx, the epiglottis, and the vocal cords all close as much as possible to prevent food from getting into the lungs. As a protective measure, the larynx has a rich nerve supply and is very sensitive to touch. Anybody who has gotten food or liquid "down the wrong way" knows how strong a cough can be produced by contact with the larynx and the trachea; this is the body's way of clearing material out of the airway.

Hoarseness is produced by an abnormality in the function of the larynx. The problem usually lies at the level of the vocal cords. Viral or bacterial infection of the larynx can produce laryngitis. In laryngitis the vocal cords are swollen and tender.

Small nodules or cysts can also appear on the vocal cord. People who use their voices very heavily can get nodules on both cords. These nodules usually resolve over time after speech therapy and correction of inappropriate voice habits.

Hoarseness can also be a sign of a more serious condition. People who smoke are at higher risk for laryngeal cancer, and hoarseness may be the first sign of a throat cancer. Anybody who has hoarseness which has not resolved should have a thorough exam by an Otolaryngologist.

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