The human voice is truly a marvel, immeasurably enriching our lives. Hoarseness, or loss of vocal function, cripples our communication efforts and compromises our quality of life. Advances in medicine are based on discoveries that shatter old truths or shed light on novel diseases. In the field of Otolaryngology, this has led to the improved diagnosis and treatment of the hoarse patient.
Common causes of hoarseness include acute viral laryngitis, laryngopharyngeal reflux, allergic rhinitis, sinusitis, and local trauma related to vocal abuse (overusing or misusing the voice). Occasionally, persistent or worsening hoarseness can indicate a more grave disease like head and neck cancer. A less common cause of hoarseness, which is frequently difficult to diagnose or misdiagnosed, is spasmodic dysphonia.
One of the most commonly diagnosed causes of hoarseness is laryngopharyngeal reflux (LPR).
LPR is also sometimes referred to as “silent reflux” or used interchangeably with gastroesophageal reflux disease (GERD). In this disease process, acidic reflux from the stomach travels up through the esophagus into the throat and often causes local irritation and inflammation in the larynx. This may be clinically evident on a flexible fiberoptic laryngeal examination in the office. The symptoms most commonly seen with LPR include globus sensation, or the feeling of something stuck in the throat, frequent throat clearing, cough and hoarseness. Frequently patients will not have many of the symptoms commonly seen in GERD, such as heartburn, stomach indigestion or sour taste in the mouth. Treatment is centered around medication, and lifestyle and dietary modifications to reduce reflux.
A less common cause of hoarseness is spasmodic dysphonia. This neurologic disorder can cause crippling, persistent hoarseness that often goes undiagnosed for years. Patients complain of a strangled voice and voice breaks that are uncontrollable. They may undergo years of voice therapy without improvement. Spasmodic dysphonia is a treatable laryngeal focal dystonia. When these patients are treated with EMG-guided botulinum toxin injections into the vocal fold, they have a resolution of their symptoms for two to three months. Repeat injections help improve these patients’ vocal quality of life. This simple, in- office procedure remains the mainstay of treatment for spasmodic dysphonia. The most difficult barrier for these patients is often the diagnosis and referral to an otolaryngologist.
Lastly, many patients seek evaluation for persistent hoarseness in order to diagnose or rule out a diagnosis of head and neck cancer. Laryngeal cancer in particular may present with persistent hoarseness as a very early sign. This type of cancer is most commonly seen in the setting of current or past tobacco use, but can also be seen in non-smokers. Generally, laryngeal examination in the office allows the Otolaryngologist adequate visualization to determine if there are any suspicious lesions that may require biopsy.
As a general rule, hoarseness which is persistent or worsening over a period of weeks to months should be evaluated by an Otolaryngologist. Albany ENT & Allergy Services Center for Voice is pleased to provide our patients with the latest technology in flexible laryngeal examinations with crystal clear distal chip camera technology, as well as videostroboscopy to allow for precise evaluation of the delicate movements of the vocal folds. Additionally, we are delighted to offer laryngeal electromyography (EMG) to assist in precise application of botulinum toxin into the laryngeal muscles for the treatment of spasmodic dysphonia in an in-office setting.
The Center for Voice is proud to offer our patients a comprehensive approach to the evaluation and treatment of voice disorders through regular collaboration with our Speech and Language Pathologist, Susan Hare. Working closely together, the Voice Center team can tailor treatment to each individual’s vocal requirements and goals, whether it be participating in a conversation at lunch with friends, or performing in front of a crowd of hundreds