Voice Disorders

If you have a voice disorder, your voice will sound different from usual and may sound: 

• strained

• hoarse

• raspy 

• breathy

• gurgly

• weak

• too high or too low

• too loud or too soft

• uneven or shaky, with gaps in sound

Other symptoms of voice disorders include:

• complete loss of voice (aphonia) 

• feeling tired or strained when talking 

• a sore, tight, dry, or achy feeling in the throat, including feeling like you have a lump in your throat

• chronic cough

• frequent throat clearing

Sometimes these voice changes may be a sign of an underlying condition. It's important that you seek an urgent consultation with an ENT specialist if:

• your hoarseness has lasted for more than 2 weeks – especially if you smoke, or consume large quantities of alcohol

• you also have noisy breathing, or you’re finding it difficult to breathe

• there's prolonged pain in your throat, especially if it’s on one side of your neck, with ear pain, or if it’s painful or difficult to swallow

• you also have a neck lump, bloodstained phlegm upon coughing, or unexplained weight loss

• food or fluid seems to go down the wrong way into the windpipe and lungs when swallowing (aspiration) – this usually triggers a strong bout of coughing and spluttering just after eating or drinking

Voice disorders usually occur because of either a change in the shape of the surface of the vocal cords or in the way they move. The closure of the vocal cords is affected, altering the vibration and ultimately your voice. Most causes of this change in the vocal cords are harmless and self-limiting, but it's important to investigate the underlying cause if symptoms last for more than 2 weeks. 

Causes of voice disorders include: 

• swelling from the effects of infection, allergy, smoking and other irritants, including voice overuse/ misuse

• reflux of gastric acid and other stomach contents onto the larynx 

• nasal discharge from nose and sinus conditions, which may drip onto the larynx

• vocal cord nodules (singers’ nodules), polyps, cysts, scarring and granulations

• a cancerous growth in the larynx or in the mouth, throat, or upper gullet

• conditions affecting the nerve supply to the voice muscles, such as brain and nerve disorders, including strokes

Many voice disorders are subtle and are often overlooked or misdiagnosed. At Welbeck, we have highly experienced, internationally recognised specialists in laryngology as part of our Ear, Nose & Throat centre. 

At your initial consultation, your specialist will carry out a clinical assessment of your voice. You’ll be asked about your symptoms and medical history, and you may be asked to fill out questionnaires about your voice and swallowing. This will help assess the severity of your symptoms and provide a baseline to compare after any recommended treatment or therapeutic intervention.

An important part of the initial assessment is getting a good look at the vocal cords during speaking and breathing. At Welbeck, we use state-of-the-art flexible endoscopes (tubes with cameras attached), which have high-definition cameras (“chip on tip” cameras) providing an unparalleled 4K high-definition magnified view. This fine flexible camera is placed through the nose and guided directly over the larynx and the swallowing apparatus.

An important component of endoscopy is video-assisted stroboscopy. This enables a super slow-motion assessment of the way the vocal cord surfaces vibrate against each other. Without this, minute and subtle changes on the surface of the vocal cords will be missed; examples include small scars or deep, otherwise hidden cysts.

If swallowing is affected, the flexible endoscope may be used to perform a detailed swallow assessment of the passage of food and fluid through the larynx and throat. This specialist examination is called flexible endoscopic evaluation of swallow (FEES). This will be video recorded to document the effectiveness of your swallow. FEES can be used to provide you with feedback to help improve swallow function with the assistance of a speech swallow therapist.

Further tests that may be needed include: 

• a dynamic X-ray study which records the swallowing of radio-dense dye (video swallow or modified barium swallow)

• CT scan of the larynx, neck, and chest

• MRI scan

Voice disorders can’t always be prevented, but there are things you can do to help look after your voice, including: 

• staying hydrated  

• avoiding shouting

• avoiding unnecessary throat clearing 

• reducing intake of alcohol, caffeine

• reducing exposure to smoke and dust

• seeking prompt help for throat or sinus infections 

• managing any symptoms of gastrointestinal reflux 

• practicing good vocal hygiene – use vocal warm-ups if you use your voice regularly, and make sure you plan rests for your voice

Voice disorders are often harmless, but there are some complications to be aware of, including:

• difficulty breathing 

• difficulty swallowing

• increased risk of choking 

• social isolation 

In severe cases, there's a risk of pneumonia from food entering the windpipe (aspiration), which can be life-threatening.

Treatment options will depend on the specific underlying condition of the voice disorder, but optimal treatment of a voice disorder commonly follows a three-pronged approach.

Medical interventions 

Many conditions may be managed successfully by prescription and over-the-counter medicines that are designed to reduce infection, inflammation, and exacerbating conditions such as gastroesophageal reflux and post-nasal drip (from nasal and sinus conditions). 

Surgical interventions 

The exact surgical procedure will be tailored to the particular condition, but will usually involve a short general anaesthetic, suspension laryngoscopy (a technique where the device used to allow access to the larynx is held in place by a support rather than the surgeon) and ventilation without the need for a tube. This gives the surgeon unimpeded, two-handed access to the voice box structures without the need for any external incisions.

The surgical team offering laryngological treatment at Welbeck have over 60 years of experience between them. This critical expertise ensures the delicate structures that comprise the larynx are respected, in order to be able to cleanly and precisely remove the diseased section, with minimal injury to surrounding healthy tissue. Inappropriate surgical treatment risks worsening the voice postoperatively through the formation of potentially irreversible scarring. 

Our group is skilled in the use of fine dissecting instruments and lasers to cleanly excise pathological lesions. We have equipped our theatre with a wide array of microsurgical instruments and the latest lasers, including carbon dioxide and KTP laser technology, to help facilitate clean dissection.

Other treatments we offer may include: 

• fine suture techniques

• biological filler

• botulinum toxin injection

Behavioural interventions

Behavioural interventions such as speech and swallow therapy are a very important component in the restoration of a voice disorder and should be performed together with any medical or surgical treatment. Patients suffering from hoarseness often develop compensatory vocalising behaviours and tension in the muscles that surround the larynx. This dysfunction may persist and make the hoarseness worse, even after the trigger has gone. We work with highly experienced speech therapists who are experts in managing all aspects of voice and swallow rehabilitation.

At Welbeck, our ENT specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.

Get in touch today to book an appointment.