Voice & Swallowing Disorders

Nodules, Polyps, and Cysts

Vocal cord nodules are also known as “Singer’s Nodes.” They appear on both sides of the vocal cords, typically at the midpoint, and directly face each other. Like other calluses, these lesions often diminish or disappear when overuse of the area is stopped.

A vocal cord polyp typically occurs only on one side of the vocal cord and can occur in a variety of shapes and sizes. Depending upon the nature of the polyp, it can cause a wide range of voice disturbances.

A vocal cord cyst is a firm mass of tissue contained within a membrane. As with vocal cord polyps and nodules, the size and location of vocal cord cysts affect the degree of disruption of vocal cord vibration and subsequently the severity of hoarseness or other voice problem. Surgery followed by voice therapy is the most commonly recommended treatment for vocal cord cysts that significantly alter and/or limit voice.

A reactive vocal cord lesion is a mass located opposite an existing vocal cord lesion, such as a vocal cord cyst or polyp. This type of lesion is thought to develop from trauma or repeated injury caused by the lesion on the opposite vocal cord. A reactive vocal cord lesion will usually decrease or disappear with voice rest and therapy.

Changes in vocal quality and persistent hoarseness are typically the first warning signs of a vocal cord lesion. When a vocal cord lesion is present, symptoms may increase or decrease in degree, but will persist and do not go away on their own.

Hoarseness

Hoarseness is the abnormal change in the quality of voice. The voice may sound breathy, raspy, strained, or show changes in volume or pitch. Voice changes are related to alterations in the vocal folds of the voice box. While breathing, the vocal folds remain apart. When speaking or singing, they come together and, as air leaves the lungs, they vibrate, producing sound. Changes in the structure of vocal folds hinder vibration, altering voice quality, volume, and pitch.

Causes of hoarseness include: Acute laryngitis, vocal abuse and misuse, benign vocal cord lesions (nodules, polyps, and cysts,) vocal hemorrhage, GERD/LPR, smoking, neurological disorders, vocal cord paralysis, and cancers of the airway and throat.

Otolaryngologists will obtain a thorough history of a patient’s hoarseness and general health. They will then evaluate the voice and do a complete ear, nose, and throat exam. This includes examination of the vocal folds by laryngoscopy. Laryngoscopy may be suggested by the otolaryngologist at any time during an evaluation for hoarseness, but if it persists beyond three weeks it should be evaluated and that evaluation should occur within a maximum of 3 months. The evaluation should be immediate if there is concern about a serious underlying cause is suspected.

Our specialists at C/V ENT Surgical Group which serves the greater Los Angeles and Thousand Oaks areas, will often utilize various scopes and likely video stroboscopy to determine the cause of your voice disorder and then plan a proper treatment course.

Laryngeal Surgery

Benign or malignant lesions can develop on the vocal cords. Benign non-cancerous growths on the vocal cords are most often caused by voice misuse or overuse, which causes trauma to the vocal cords. These lesions (or “bumps”) on the vocal cord(s) alter vocal cord vibration and lead to hoarseness. The most common vocal cord lesions are nodules, polyps, and cysts. Vocal nodules (also known as singer’s nodules) are similar to “calluses” of the vocal cords. They occur on both vocal cords opposite each other at the point of maximal wear and tear, and are usually treated with voice therapy to eliminate the vocal trauma that is causing them.

Contrary to common myth, vocal nodules are highly treatable and intervention leads to improvement in most cases. Vocal cord polyps cysts and granulomas are the other common benign lesions. These are sometimes related to voice misuse or overuse, but can also occur in people who don’t use their voice improperly possibly due to laryngopharyngeal reflux (LPR) or after a severe viral illness. These types of problems typically require microsurgical treatment for cure, with voice therapy employed in a combined treatment approach in some cases.

Our specialists at C/V ENT Surgical Group which serves the greater Los Angeles and Thousand Oaks areas, will often utilize various scopes and likely video stroboscopy to determine the cause of your voice disorder and then plan a proper treatment course.

If this treatment involves surgery then they will schedule your for a micro suspension direct laryngoscopy which is an outpatient procedure performed at a surgery center. In this short procedure a microscope and fine microsurgical instruments are utilized to treat your laryngeal problem. Most patients are able to leave within one to two hours following the procedure.

GERD and LPR

Gastroesophageal reflux disease, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus. In some cases, reflux can be silent, with no heartburn.

During gastroesophageal reflux, the contents of the stomach and upper digestive tract may reflux all the way up the esophagus, and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR). Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, throat clearing, voice changes ,or foreign body sensation. Many patients with LPR do not experience heartburn.

For proper diagnosis and treatment, our doctors at C/V Surical Group will perform a thorough examination usually including examination of the throat and pharynx with a special scope (laryngoscopy.)

Lifestyle changes a large part of the treatment of LPR. These include:

• Avoid eating and drinking two to three hours prior to bedtime
• Do not drink alcohol
• Eat small meals and slowly
• Limit caffeine, carbonated drinks, chocolate, tomato, citrus fruits, fatty and fried foods, and spicy foods.
• Weight loss
• Quit smoking
• Wear loose clothing

Swallowing Trouble

Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The process of swallowing has four stages:

• Oral preparation stage: Food or liquid is manipulated and chewed in preparation for swallowing.
• Oral stage: The tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
• Pharyngeal stage: Begins when food or liquid is quickly passed through the pharynx and into the esophagus.
• Esophageal stage: The food or liquid passes through the esophagus and into the stomach.

Dysphagia has a number of causes. Any interruption in the swallowing process can cause difficulties. Eating slowly and chewing thoroughly can help reduce problems with swallowing. Dysphagia may be due to poor teeth, ill fitting dentures, common cold, or gastroesophageal reflux. Other causes include hypertension; diabetes; thyroid disease; stroke; progressive neurologic disorder; medications; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or prior surgery or radiation therapy in the head, neck, or esophageal areas.

When dysphagia is persistent and the cause is not apparent, our surgeons at C/V Surgical Group will discuss the history of your problem and examine your mouth and throat. Often a flexible laryngoscope is placed through the nose with visualization of the back of the tongue, throat, and larynx.