The Management of Voice Abnormalities
The treatment can be broadly divided into voice therapy, surgery and medication. They are not used exclusively and for patients undergoing surgery, most will require voice therapy. Treatment will be discussed fully during the consultation.
Voice therapy examines the way in which a patient is producing voice and how they are looking after the structures that are used to produce it. Therapy provides a variety of techniques that can teach individuals to develop voice habits that will preserve a healthy voice. The therapist provides education and exercises for the voice. The number of sessions required will depend on the type and severity of the problem.
Therapy is often the only treatment needed although is also used in conjunction with surgery.
Surgery to the larynx is performed under general anaesthesia (the patient is completely asleep). Delicate instruments are controlled through a rigid tube which is placed through the mouth and into the throat (a laryngoscope). The larynx is visualised using an operating microscope, allowing the surgeon to see the vocal cords in great detail and perform precise surgical manoeuvres.
LASER surgery is used for some conditions and is performed using the microscope in a similar way to conventional surgery.
When a vocal cord has been paralysed, surgery may be required to change the position of the cord. This is achieved either by injecting a substance next to the cord or by placing material on the outside of the cord through the neck to push the cord inwards.
The surgery is usually performed as a day case.
Medication is commonly used to treat voice abnormalities. These may be directed at the larynx itself or indirectly at the nose and sinuses and chest. Infections of the sinuses, throat, larynx and chest may require treatment with antibiotics or antifungal medication and patient’s who suffer with asthma should have this controlled as well as possible.
Steroids are sometimes used to reduce swelling of the vocal cords.
A common condition in the adult population is acid reflux. Acid is produced in the stomach in order to control digestion. It can escape into the oesophagus or gullet (oesophageal reflux) or into the throat (laryngo-pharyngeal reflux). Acid can cause or exacerbate inflammation of the larynx. It is worse at night when the patient is lying down and it is associated with being overweight, smoking, drinking alcohol and having an acidic or spicy diet particularly if the patient eats late in the evening. As well as lifestyle modification there are very good drugs available to treat this condition. Occasionally it can be associated with an infection in the stomach. Patients may require referral to a gastroenterologist.