Structural voice disorders are abnormalities in the vocal tract that affect voice production. They occur due to anatomical or physiological changes in the vocal folds or surrounding structures. Some common causes of structural voice disorders include:
What are the vocal folds?
The vocal folds, also known as vocal cords, are two folds of mucous membrane that extend across the larynx. They are located above the trachea (windpipe). When you breathe, the vocal folds are open to allow air to pass into and out of the lungs. When you speak, the vocal folds come together and vibrate, creating sound.
What causes structural voice disorders?
There are several types of abnormalities that can affect the vocal folds and cause structural voice problems:
Vocal fold paralysis
Vocal fold paralysis occurs when one or both vocal folds do not move properly. This is usually caused by nerve damage related to surgery, stroke, tumors, or other neurological conditions. With vocal fold paralysis, the affected fold remains in a fixed or paralyzed position.
Vocal fold scar
Scarring of the vocal folds can occur after trauma, surgery, intubation, or radiation treatment. Vocal fold scars disrupt the normal pliability and vibration of the folds during phonation.
Vocal fold cysts or nodules
Cysts are fluid-filled growths that form on the vocal folds. Nodules are callous-like growths. Both cysts and nodules develop most commonly in people who use their voices excessively or improperly.
Laryngeal papillomatosis
This condition causes wart-like growths to form on the larynx, vocal folds, and respiratory tract. It is caused by human papillomavirus (HPV).
Muscle tension dysphonia
This occurs when the laryngeal and neck muscles are excessively or improperly tensed during speech. This disrupts proper vocal fold vibration.
What are the symptoms of structural voice disorders?
Symptoms vary depending on the specific disorder but may include:
- Hoarse, breathy, or raspy voice
- Voice fatigue or loss of voice during use
- Reduced vocal pitch and loudness
- Inability to control vocal pitch and loudness
- Voice breaks
- Wet-sounding or gurgly voice
- Throat pain or discomfort
- Coughing
- Sensation of a lump in the throat
- Difficulty swallowing
How are structural voice disorders diagnosed?
Diagnosing a structural voice problem involves a review of medical history and a physical exam of the head and neck. The otolaryngologist will visually examine the vocal folds with specialized equipment. This may include:
- Laryngoscopy – Examination of the larynx using a small mirror or a thin, flexible endoscopic camera.
- Stroboscopy – Laryngoscopy with a stroboscopic light. This allows the vocal fold vibration to be viewed in slow motion.
Other tests may also be recommended such as:
- Imaging studies – CT scan or MRI to identify tumors, nerve problems, or muscle tension.
- Laryngeal electromyography – Measures electric currents in laryngeal muscles.
- Acoustic and aerodynamic voice tests – Measures voice characteristics.
- Biopsy – Removal of small tissue sample for analysis.
How are structural voice disorders treated?
Treatment depends on the specific cause and nature of the voice disorder. Some options may include:
- Surgery – To remove growths, release scar tissue, or correct anatomical issues.
- Medications – Corticosteroids to reduce inflammation and swelling.
- Voice therapy – With a speech-language pathologist to modify vocal behaviors.
- Vocal hygiene – Resting the voice, staying hydrated, avoiding irritants.
- Procedural treatments – Injection augmentation, lasers, radiation for some conditions.
Many cases of structural voice disorders can be successfully managed with proper treatment and vocal rehabilitation. However, some causes may be chronic or difficult to resolve completely. People with their jobs or daily life impacted by a voice disorder should seek evaluation by an otolaryngologist who specializes in voice care.
What are some examples of structural voice disorders?
Here are some specific examples of common structural voice problems:
Vocal polyps
Vocal polyps are benign, fluid-filled growths on the vocal folds typically caused by vocal misuse or overuse. They appear as sessile or pedunculated lesions and can impair vocal fold vibration.
Intubation-related granulomas
Prolonged intubation can cause injury and chronic inflammation of the larynx, resulting in granulation tissue forming on the vocal folds. This is seen in some critically ill patients after ventilator use.
Muscle tension dysphonia
Excessive contraction or tension in the laryngeal and cervical muscles disrupts normal vocal fold movement and phonation. This is associated with stressful voice use or psychological factors.
Vocal fold bowing
The edges of the vocal folds can become concave or bowed inward, usually due to scarring. This prevents full closure of the folds during vibration and leads to a breathy, raspy voice.
Sulcus vocalis
Sulcus vocalis is a groove or depression along the edge of the vocal folds caused by chronic tissue damage. It creates gaps that impair normal mucosal wave propagation during phonation.
Laryngeal papillomatosis
Squamous papillomas due to HPV infection cause wart-like lesions on the larynx. This creates hoarseness but can become extensive and obstruct the airway in severe cases.
Vocal fold paralysis
Damage to the recurrent laryngeal nerve leads to reduced mobility of the paralyzed vocal fold. This alters voice production and may allow food/liquid to enter the airway.
Vocal fold atrophy
Disuse atrophy of the vocalis muscle causes thinning of the fold edges. This creates gaps between the folds and breathy, weak voice production.
What professions are affected by structural voice disorders?
People in professions with high vocal demands are at increased risk of structural voice problems. These occupations include:
- Teachers
- Singers
- Actors
- TV and radio hosts
- Salespeople
- Politicians
- Counselors/therapists
- Call center workers
- Clergy
- Attorneys
- Aerobics instructors
- Cheerleaders
Heavy occupational voice use can contribute to disorders like vocal fold nodules, polyps, and muscle tension dysphonia. Proper vocal training, technique, and vocal hygiene practices are important for these professions to prevent chronic voice problems.
What is the impact of structural voice disorders?
Structural voice disorders can significantly impact quality of life and lead to:
- Reduced verbal communication abilities
- Difficulty speaking loudly or being heard
- Voice changes that reduce confidence
- Social isolation or relationship strain
- Embarrassment about vocal sound
- Negative perceptions from others
- Reduced job performance
- Missed work/school due to lost voice
- Depression or anxiety
For professional voice users like teachers, singers, or public speakers, the effects on occupations and finances can be severe. Seeking proper diagnosis and management of structural voice problems is important to minimize long-term impacts on quality of life.
Are structural voice disorders preventable?
Some causes of structural voice disorders cannot be prevented, such as vocal fold paralysis due to stroke or surgery. However, certain habits and practices can reduce risk:
- Avoid vocal overuse/misuse
- Stay hydrated
- Limit alcohol/caffeine
- Stop smoking
- Reduce exposure to pollutants/allergens/reflux
- Treat sinus infections promptly
- Learn proper vocal techniques
- Consider voice therapy if at high vocal risk
- Get regular vocal health check-ups
For people undergoing neck/chest surgery or intubation, steps should be taken to reduce trauma and irritation to the larynx. Proper prevention and vocal health habits can help reduce risk of chronic voice disorders.
What is the prognosis for structural voice disorders?
The prognosis depends greatly on the specific voice disorder:
| Disorder | Prognosis |
|---|---|
| Vocal nodules | Good with voice therapy |
| Vocal polyps | Good with surgical removal |
| Muscle tension dysphonia | Good with voice therapy |
| Papillomatosis | Variable, depends on severity |
| Vocal fold paralysis | Variable, little improvement likely |
| Vocal fold scarring | Poor, often a chronic problem |
With benign growths like nodules or polyps, prognosis is generally good after removal and vocal rehabilitation. Nerve paralysis and vocal fold scarring have poorer outcomes and may cause lifelong hoarseness.
For optimal results, it is important to follow treatment recommendations, attend regular follow-ups, and modify vocal behaviors after diagnosis of a structural voice disorder.
Who treats structural voice disorders?
A team approach by multiple specialists is often required to effectively treat structural voice disorders:
- Otolaryngologist (ENT) – Diagnoses vocal fold issues and performs surgical treatments.
- Speech-language pathologist – Provides voice therapy and rehabilitation.
- Pulmonologist – Assesses respiratory function related to phonation.
- Gastroenterologist – Evaluates issues like reflux that affect the voice.
- Neurologist – Consults on neurological causes like vocal fold paralysis.
- Psychologist/counselor – Helps with emotional impact of voice disorders.
The otolaryngologist typically acts as the coordinator and lead provider. They will assemble the appropriate team based on the results of the voice evaluation.
What questions should I ask my doctor about voice disorders?
Some examples of questions to ask your doctor when getting evaluated for a voice disorder include:
- What do you think is causing my voice symptoms?
- Will I need any tests to confirm the diagnosis?
- Could this permanently affect my voice if untreated?
- What are my treatment options?
- Will surgery or voice therapy be necessary?
- What changes do I need to make to my vocal behaviors?
- How can I prevent this from occurring again?
- Do you have experience treating other patients with similar issues?
- Should I see a specialist like an otolaryngologist or speech pathologist?
- Could my medications or other health conditions contribute to this?
Don’t hesitate to discuss all of your concerns thoroughly with your doctor. It is also alright to seek a second opinion if you are unsure about the diagnosis or treatment plan.
Conclusion
Structural voice disorders affect the anatomy of the vocal folds and larynx, disrupting normal voice production. Causes include growths, paralysis, scarring, infections, and muscle tension abnormalities. Symptoms are often gradual in onset and include hoarseness, vocal fatigue, loss of control, and pain. Diagnosis involves visualization of the vocal folds and increasingly specialized treatments are available, though some disorders can still be challenging. Many cases, however, can be significantly improved with proper medical care and voice rehabilitation. Increased awareness and preventative vocal health practices can help reduce risk in people who rely on their voices for their careers.