One of the most beautiful instruments and means of artistic expression is the human voice. Whether it be opera, pop, stage, or oration, the voice conveys emotion, thought, and beauty. However, as with most parts of the body, the voice box, or larynx, can be prone to injury. Most singers and professional voice users have had, or will have, a problem with the use of their voice. Hoarseness, raspiness, change in quality, range restriction, breathiness, throat clearing, breaks, roughness, difficulty with the passagio, prolonged warm-ups, and a poor post-performance recovery are all signs of a problem with the voice box. Early diagnosis is the key to prompt correction and prevention of future long term and potentially disabling conditions. Identifying those voice professionals with problems will help save careers, maintain quality, and most importantly, preserve enjoyment and satisfaction often derived from the voice.
Symptoms
- Loss of range
- Throat discomfort
- Raspiness
- Breathiness
- Throat clearing
- Voice breaks
- Pitch problems
- Less power
- Vocal fatigue
- Poor recovery
- Long warm-ups
Causes
Laryngeal:
- polyp, nodule, cyst
- vocal fold paralysis
- granuloma
- laryngopharyngeal reflux (LPR)
- muscle tension/strain
- neurological disorders
- aging voice
- laryngeal cancer
Non-Laryngeal:
- chronic sinusitis
- asthma
- allergy
- lung disease
Diagnosis
A diagnosis can often be made simply by listening to your patient. If your patient is hoarse and does not improve despite 1-2 weeks of treatment or more than one treatment regimen, visualization of the larynx is a must. Stroboscopy is the gold standard for visualizing and diagnosing disorders of the larynx. Not only is the image highly magnified, the stroboscopic effect helps to slow down the vibration of the vocal folds to ensure a proper diagnosis. Solid white light with flexible fiberoptic laryngoscopy alone is often insufficient.
Early diagnosis and treatment almost always leads to an excellent voice outcome for professional voice users having vocal difficulties.
Treatment
Medical therapy aimed at laryngopharyngeal reflux, laryngitis, laryngeal swelling, and other diseases is often the first line of treatment, typically in conjunction with voice therapy. For lesions of the vocal folds that do not respond to conservative approaches, surgery has seen significant advances in the last decade. Microflap surgery with microscopic removal of abnormal tissue often preserves the normal vibration of the vocal folds. New KTP laser treatments can remove abnormal blood vessels that occur from recurrent micro-trauma of the vocal folds.
Voice therapy is typically scheduled once a week for 6-8 weeks with a trained speech-language pathologist(SLP). SLPs with a background in classical singing can address both the speaking and the singing voice.
Possible therapy activities that will reduce hoarseness due to hyperfunction include:
- vocal function exercises
- resonant voice therapy
- physical manipulation of the larynx
- progressive relaxation
- easy onset of voicing
- identification and elimination of vocal abuses