Voice and Swallowing Disorders

The cricopharyngeal muscle (CPM) separates the esophagus and throat. Unlike most muscles, the CPM stays flexed and tightly closed until it receives a nerve signal to relax. This protects the throat and windpipe from food or liquid coming back up and entering the lungs.

If the CPM malfunctions or is impaired, you can have difficulty swallowing. Symptoms of CPM dysfunction may include coughing when eating or drinking, choking episodes, increased effort to swallow food or liquids, fear of eating or a sensation of food sticking in your throat.

CPM dysfunction may occur because of the normal aging process or changes in the muscle or neural signaling pathways. Muscle enlargement (called hypertrophy), scarring of the muscle (called fibrosis) from radiation or trauma, stroke and reflux can all damage the CPM.

Dysarthria is a speech disorder caused by an injury to the nervous system. It happens when it’s hard to control the muscles used for speech or when those muscles are weak. Conditions that affect the nervous system or cause facial paralysis commonly cause dysarthria. Certain medications may also cause dysarthria.

Dysphagia means you have difficulty swallowing. Dysphagia isn’t a diagnosis but the symptom. Many factors can contribute to dysphagia, including acid reflux, throat infections, nerve diseases such as Parkinson’s disease, ALS or multiple sclerosis, medication side effects, tumors or vocal fold weakness or paralysis.

Symptoms of dysphagia may include drooling, feeling like you have a lump in your throat, changing voice, losing weight, developing lung infections, coughing up blood or coughing or choking on food or drink.

Dysphonia is a voice disorder. It causes involuntary spasms or contractions of the vocal cords, interrupting speech and affecting the quality of a person’s voice. Depending on the type of dysphonia, the voice may sound broken, strained or breathless. The 2 most common types of dysphonia are adductor type, where the vocal cords close too tightly during certain sounds, and abductor type, where the vocal cords spasm open during certain sounds.

Hoarseness, which is a form of dysphonia, is an abnormal change in the quality of your voice, making it sound raspy, strained, breathy, weak, inconsistent or shaky, and it often makes it harder for you to talk. Hoarseness is usually caused by a problem in the vocal cords that produce sound. Your vocal cords are separated when you breathe but when you make sound, they come together and vibrate as air leaves your lungs. Anything that alters the vibration or closure of the vocal cords will result in hoarseness.

See an ear, nose and throat specialist if you have symptoms including hoarseness that last more than 4 weeks, difficulty breathing, pain when speaking or severe changes in your voice lasting more than a few days.

Causes of hoarseness may include acute laryngitis, vocal cord lesions, reflux, smoking, vocal cord atrophy or neurological diseases or disorders.

Laryngeal cancer occurs when malignant (cancer) cells form in the tissues of the larynx, or voice box. Most laryngeal cancers form in the squamous cells – the thin, flat cells in the lining of the larynx.

Signs of laryngeal cancer may include difficulty swallowing, worsening or persistent hoarseness, difficulty breathing, pain in the ear, a lump in the neck or coughing up blood. Laryngeal cancer is most commonly associated with smoking. Other risk factors include human papilloma virus and acid reflux.

Laryngeal cleft is a rare type of birth defect. Babies born with laryngeal cleft have a defect in the separation between the voice box and the esophagus. This allows food and drink to enter the windpipe and travel to their lungs instead of their stomach.

Injuries to the larynx may be caused by motor vehicle accidents or athletic injuries and account for less than 1% of all traumatic injuries. A fracture of the larynx is a break of the thyroid or cricoid cartilage.

Scarring of the larynx can be caused by breathing tubes placed during critical illness and causing raw surfaces on the vocal cords or radiation therapy for larynx cancer, as well as overuse of the vocal cords.

Laryngeal voice disorders are conditions that affect the ability of the larynx to work properly, causing problems with speech and creating other sounds.

Laryngitis is inflammation or swelling of the voice box, or larynx. Your vocal cords work by opening and closing smoothly, but when they are inflamed, they distort the sounds that pass through them. This causes your voice to sound weak or hoarse.

You may be more prone to laryngitis if you overuse your voice, are frequently exposed to tobacco smoke, are a heavy drinker or have a respiratory infection such as bronchitis or sinusitis.

Laryngomalacia is a congenital condition in babies that causes a partial blockage of the voice box because the tissue above the vocal cords is softer than usual. This results in noisy breathing, but in most cases will go away on its own. Laryngomalacia is uncommon in adults.

Laryngopharyngeal reflux is also called silent reflux because it does not include heartburn as a symptom. It occurs when stomach acid moves back up through the esophagus into the throat. Symptoms can include cough, throat clearing, hoarseness and a sensation of having a lump in your throat.

Excessive muscle tension in your larynx, neck, jaw, tongue or chest can cause swallowing issues.

Recurrent respiratory papillomatosis (RRP) is an uncommon condition caused by the human papilloma virus (HPV). With RRP, viral, noncancerous warts called papillomas develop on the surfaces of the respiratory tract. These papillomas can make breathing difficult.

Reinke's edema, or polypoid corditis, occurs when there’s swelling or a buildup of fluid in the vocal cords. Symptoms include hoarseness and breathing difficulties when it is severe.

Sulcus vocalis is a groove in the vocal cord folds. There are 3 different types. It causes a weak or breathy voice.

A vocal fold granuloma is a noncancerous growth on vocal folds. It is often caused by voice overuse or strain, acid reflux or temporary breathing tube insertion. The primary symptom is hoarseness or feeling like it is difficult to talk. It’s also common to feel like you have something in your throat with a vocal fold granuloma.

Similar to sulcus vocalis, scarring on the vocal cords reduces their ability to vibrate. That leads to hoarseness, a breathy voice and increased voice fatigue. The scar tissue may be due to overuse of the voice, aging or excessive screaming or yelling. Treatments can include therapy and sometimes surgery. However, even with treatment, there is generally not a return to full function.

Nodules, polyps and cysts are all growths that can occur on the vocal cords. They can be cancerous or benign. Nodules are similar to a callus on the skin and are most common among people who speak and sing more than normal. They develop over time. Polyps are similar but can appear after a single episode of overuse. Some polyps, like Reinke’s edema, are associated with other activities, such as smoking. Cysts are less common. These growths have a fluid-filled or semisoft center.

Your vocal cords move through the contraction of various muscles controlled by your brain and a specific set of nerves. Vocal cord paralysis can result from abnormal function of the nerves that control your voice box muscles (laryngeal muscles). Paralysis is a complete absence of vocal cord movement, caused by a complete loss of nerve input. This can be due to a malfunction of the recurrent laryngeal nerve (RLN) or the superior laryngeal nerve (SLN).

Vocal cord paralysis can happen at any age and come from different causes. In most cases there is no specific cause, but some theorize it could be from a common cold virus that leads to nerve inflammation. Other causes include injury during surgery, breathing tube insertion, tumors growing around the nerves, autoimmune disease or neurological conditions like a stroke.

A Zenker’s diverticulum (ZD) is a rare condition where an outpouching occurs where your throat meets your esophagus, the swallowing pipe that leads into your stomach. When this happens, a pouch forms and mucous, food and/or liquid can become stuck instead of going down your esophagus and into your stomach like normal. This is commonly caused by increased tension in the muscle at the top of your esophagus (called the cricopharyngeus muscle).

Symptoms include difficulty swallowing, regurgitating or vomiting food, aspirating food or saliva, noisy swallowing, bad breath, choking, coughing, hoarseness and weight loss. ZD is usually treated with surgery.

This test measures irregularities in sound produced by the movement of vocal folds.

Vocal cord movement is measured through a noninvasive device that is strapped around the neck.

Small needle electrodes are inserted into voice box muscles to evaluate the health of the muscles and nerves.

Air is pushed through a small, flexible tube into the esophagus (the tube that connects the throat to the stomach) to determine its ability to generate sound.

A small probe is placed through the nose and into the stomach. The tube is connected to a computer that displays readings on muscle contractions.

A flexible tube with a light at one end and a camera at the other is inserted into the nose and into the middle of the throat. Pictures of the throat and voice box are taken as the patient swallows liquid and food.

This is performed as an add-on to the FEES test. Air pulses are delivered through the tube to evaluate swallowing ability and sensation.

A flexible tube with a light at one end and a camera at the other is inserted into the nose to allow doctors to view the vocal folds.

A catheter is placed through the nose into the throat to videotape the swallowing motion and to measure muscle contraction, strength and coordination of swallowing muscles.

A tiny mirror is placed at the back of the throat so doctors can inspect vocal folds.

A thin probe is placed through the nose into the throat to measure acid levels.

An in-clinic test where a thin tube with a camera is placed through the nose to throat and esophagus so the physician can view and assess swallowing problems.

As the patient swallows liquid or foods, X-rays are taken of the mouth, throat and esophagus. These show whether food and liquid are passing efficiently from the mouth through the throat and into the esophagus.

This procedure uses high-speed flashes of light to produce images of vocal folds in slow motion. Physicians and speech therapists study the detailed images to form accurate treatment plans for patients with voice disorders.

We can evaluate the voice and develop a treatment plan for professional actors, singers, voice talent and other patients. Our speech pathologists also provide voice therapy.