This is a truly great time in which we live. People are living longer and longer lives, and technological advances have allowed us to do so with an ever increasing quality of life. We have prosthetic joints to keep us mobile, hearing devices to overcome the most profound hearing loss, surgery to repair sight deficits, and plastic surgery to keep us looking youthful. Until recently however, we have had little to offer to those patients with significant loss of voice. Even now, all too often, I meet patients who have been told that their voice loss was just due to “old age,” and there was nothing that could be done.
Our voice is one of our most defining characteristics. It allows us to communicate with loved ones near and far. Inflection helps us to express our emotions to others. Many people also rely on their voice for their livelihood. Those who use their voice professionally make up over 30% of the workforce and include singers, actors, teachers, medical professionals, lawyers, and salespeople just to name a few. For most of us, loss of our voice (even for a very short time) can be a devastating event.
Diagnosis and treatment of voice disorders requires several key elements. The first is a physician with interest and expertise in the field of voice. Laryngologists are Ear, Nose, and Throat Surgeons who have spent an additional year of training specifically focusing on the diagnosis and management of disorders of the voice, airway, and throat. The next key element is the ability to closely examine both the structure and the function of the vocal cords. Voice specialists use high definition video endoscopes along with a technique called stroboscopy. This allows the examiner (and the patient) to see the finest details of the vocal cords, as well as their individual vibrations, which are the critical component to sound production.
The final, and perhaps most critical, component is that the patient needs to see a physician to be evaluated. Many patients delay seeking treatment for a variety of reasons. Some just think that losing one’s voice with age is normal or hope that the problem will go away. All too often I see patients who have delayed seeking treatment for years because of fear that they have a cancer in their throat. More often than not, that isn’t the case. But even if it is, catching a cancer at the early stage when it first affects our voice almost certainly means it is readily curable with an excellent voice outcome. This may not be the case if the problem is ignored. The majority of hoarseness, however, comes from much more common causes such as inflammation due to infections, overuse of the voice, or, occasionally, acid reflux. We also see plenty of non-cancerous masses due to viral infections or the trauma of everyday voice use. Probably the most common cause of hoarseness that I see is simply mechanical; due to people changing the way they are using the very delicate muscles of the voice box without ever realizing that they are doing it.
Whatever the cause, the first step towards treating a voice problem is establishing an accurate diagnosis with the aid of the latest imaging and voice analysis technology. Your Laryngologist will then discuss a treatment strategy for any medical or surgical therapies that may be recommended. They will likely work closely with a Speech and Language Pathologist for treatment of any mechanical issues through a course of Voice Therapy. A positive outcome for restoration of the patient’s voice is the team’s ultimate goal.
