Voice and swallowing disorders

When the structures in your throat don’t function as they should, you may have difficulty using your voice or swallowing. Ear, nose and throat (ENT) doctors at Atrium Health Floyd and Harbin Clinic are skilled in diagnosing and treating these problems. They work with speech-language pathologists and other specialists, such as gastroenterologists, neurologists and oncologists, to provide personalized care for you.

What are voice and swallowing disorders?

Voice disorders affect the quality, pitch and volume of your voice. Swallowing disorders interfere with your ability to move food from your mouth into your esophagus without going down your windpipe (trachea). Both involve complex coordination between nerves, muscles and other tissues in the voice box (larynx) and back of your throat (oropharynx).

Types of voice and swallowing disorders

Many disorders can affect voice and swallowing. Some common types include:

• Laryngeal cancer: A mass of rapidly growing cells in the voice box that can spread to other areas of the body
• Laryngeal papillomatosis: Fast-growing, noncancerous tumors caused by the HPV virus that can occur in the voice box, on vocal cords or in the airways from the windpipe to the lungs
• Laryngotracheal stenosis: Narrowing of the airway, which can occur in the voice box or windpipe
• Laryngitis: Inflammation of the voice box that can happen suddenly (acute) or persist for a long time (chronic)
• Laryngopharyngeal reflux disease (LRD): Backflow of stomach acid (acid reflux) up through your esophagus to your throat
• Professional voice disorders: Problems using your voice for singing, acting or professional speaking
• Spasmodic dysphonia: Spasms in the muscles of the vocal folds (vocal cords) that make speaking difficult
• Vocal cord lesions: Noncancerous growths on your vocal cords, including polyps, nodules and cysts
• Vocal fold paralysis: Immobility of one or both vocal cords that prevents them from functioning properly
• Dysphagia: Difficulty swallowing
• Zenker’s diverticulum: A pouch that develops in the back of your throat that can trap food and interfere with swallowing

Causes of voice and swallowing disorders

Voice and swallowing disorders can be caused by a wide range of diseases, events and other factors, such as:

• Aging
• Cancer in the head, neck, larynx, esophagus and lungs
• Congenital anomalies present at birth
• Injuries from trauma and surgery for another condition
• Inflammatory diseases
• Infections
• Overuse of your voice
• Neurological diseases such as stroke, multiple sclerosis and Parkinson’s disease
• Smoking

Symptoms of voice and swallowing disorders

Symptoms of voice disorders include:

• Chronic cough
• Hoarseness
• Difficulty speaking, raising your voice or changing the pitch
• Noisy breathing (stridor)
• Shortness of breath

Symptoms of swallowing disorders include:

• Choking or coughing while eating
• Difficulty swallowing
• Frequent throat clearing
• Lung infections, such as pneumonia
• Weight loss

Voice and swallowing disorders diagnosis

ENT doctors and speech-language pathologists often work together to diagnose voice and swallowing disorders. Their first step is to review your medical history and symptoms. They’ll evaluate your voice or swallowing and may run one or more tests, such as:

• Laryngoscopy: A type of endoscopy that involves passing a thin, flexible tube with a camera (laryngoscope) through your throat to view your voice box and upper esophagus
• Laryngeal electromyography: Measures electrical impulses in your vocal cords
• Videostroboscopy: Allows your provider to view the vibrations of your vocal cords in slow motion
• Voice recording and analysis: Provides a comprehensive assessment of your recorded voice, including acoustic parameters and breathing patterns
• Fiberoptic endoscopic evaluation of swallowing: Uses an endoscope to look inside your throat while you swallow
• Videofluoroscopic swallow study: Takes X-ray videos of your head and neck while you swallow foods and liquids mixed with a barium contrast agent

Voice and swallowing disorders treatment

Treatment depends on the type of disorder and your needs and preferences. Therapy is often recommended as a first step and may be the only treatment you need. In voice therapy, you may learn exercises to strengthen your voice or ways to change the mechanics of speaking. Swallowing therapy helps improve muscle tone and coordination so that you can swallow better.

Medication injections into your vocal cords are a treatment for certain conditions. For example, botulinum toxin (Botox®) injections can help reduce laryngeal spasms. For vocal fold paralysis, doctors inject a bulking agent to move a paralyzed vocal cord closer to the center of the windpipe.

In some cases, surgery may be your best option. Our ENT doctors are skilled surgeons and offer a range of procedures. Whenever possible, they perform minimally invasive surgery using an endoscope and small instruments. Some advanced types of surgery we offer include:

• Balloon dilation of the airway: Expands narrowed sections of the voice box or windpipe to allow better breathing
• Cricopharyngeal myotomy: Opens a tight sphincter (muscular ring) in your upper esophagus to improve swallowing
• Laser treatment: Removes vocal cord lesions
• Medialization laryngoplasty: Places an implant next to a paralyzed vocal cord to move it closer to the healthy vocal cord