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Voice Disorders and Laryngology

The voice is produced by two delicate folds of tissue vibrating several hundred times a second. Very small changes to those folds — a nodule, a polyp, inflammation, or a nerve that is not working — can alter the voice out of all proportion to their size.

For professional voice users in particular — teachers, singers, lawyers, call-centre staff, clergy — a voice problem is an occupational problem. Dr Ellinas was trained and run dedicated specialist voice clinics during his fellowship training in the United Kingdom.

CONDITIONS COMMONLY SEEN

  • Persistent hoarseness (dysphonia) of any cause
  • Vocal cord nodules, polyps and cysts
  • Vocal cord palsy — a vocal cord that has stopped moving, often causing a weak, breathy voice and sometimes difficulty swallowing
  • Laryngopharyngeal reflux — throat clearing, a sensation of a lump in the throat, chronic cough and morning hoarseness
  • Muscle tension dysphonia and voice strain
  • Laryngeal Web — a band of scar tissue between the vocal cords causing a weak voice and, in more severe cases, noisy or difficult breathing
  • Leukoplakia and other precancerous changes of the vocal cords
  • Laryngeal cancer
  • Chronic cough and globus (persistent lump-in-the-throat sensation)
  • Voice problems following intubation or thyroid surgery

ASSESSMENT

The core investigation is direct visualisation of the vocal cords. Flexible upper airway endoscopy, performed in clinic through the nose, allows the larynx to be examined while you speak.

Assessment also covers voice use patterns, occupational demands, reflux symptoms and any relevant medical history.

TREATMENT

Many voice disorders improve without surgery. Treatment may involve voice therapy with a speech and language therapist, management of reflux, adjustment of vocal technique and workload, or treatment of an underlying medical cause.

Where surgery is indicated:

  • Microlaryngoscopy and microlaryngeal surgery — precision surgery on the vocal cords performed under general anaesthetic using an operating microscope and an operating endoscope, with no external incision, to remove nodules, polyps, cysts or suspicious lesions
  • Coblation-assisted laryngeal surgery — Coblation is used in the management of laryngeal webs, allowing the scar band between the vocal cords to be divided precisely with minimal thermal injury to the surrounding tissue and a reduced tendency for the web to re-form
  • Biopsy of laryngeal lesions where cancer must be excluded
  • Procedures for vocal cord palsy to improve voice strength and swallowing safety

AN IMPORTANT WARNING

Hoarseness lasting longer than three weeks in an adult should always be assessed by an ENT specialist, particularly in current or former smokers. Most causes are benign, but persistent hoarseness is the earliest and often the only symptom of laryngeal cancer and early diagnosis substantially changes the outcome.

Request an appointment: +357 24 840840