Frequently Asked Questions
Answers to some of our most frequently asked questions...
Question: My voice is hoarse and I feel like I have a lump in my throat. I have a lot of mucous and clear my throat constantly. My primary care doctor told me I have reflux, but I don't have heartburn or indigestion. Any ideas?
Answer:Hoarseness or voice change, the sensation of a lump in the throat, excessive throat mucous or post-nasal drip, chronic throat clearing, and cough are all symptoms consistent with acid reflux into the larynx, also called laryngopharyngeal reflux (LPR). I would recommend that you see an otolaryngologist (Ear, Nose, and Throat physician, or ENT) who will visualize your larynx and vocal cords with either a mirror or a flexible endoscope that is inserted painlessly through the nose. Redness or swelling of the larynx and vocal cords, along with your symptoms and medical history, may indicate LPR. Treatment for LPR often includes a combination of diet and lifestyle modifications and medication. The medications most often prescribed for LPR are proton pump inhibitors such as Prevacid, Nexium, Prilosec, Aciphex, etc. These medications are most effective when taken 30 - 60 minutes before a substantial meal (usually dinner). It may take as long as six months of continuous medication and lifestyle modifications for symptoms to begin to resolve. You may also want to request a referral to a speech-language pathologist for a voice evaluation and treatment. Voice therapy will address associated vocal problems and facilitate the healing process. For more information on LPR, please visit our webpage related to this topic at http://www.gbmc.org/voice/refluxchanges.cfm.
Question: My ENT told me I have vocal cord nodules. What does that mean and what should I do? My voice is really hoarse!
Answer: Vocal cord nodules are bilateral benign growths on the vocal cords that are usually thought to be the result of voice overuse or misuse. The first line of treatment is usually voice therapy with a speech-language pathologist. Voice therapy can very often successfully reduce or eliminate nodules, although large, fibrous, or more chronic nodules may require surgical removal to improve the voice. Even in cases of surgical removal, pre- and post-operative voice therapy is strongly encouraged to address the initial behavioral causes of the vocal cord nodules so that they do not re-develop and so that vocal quality successfully returns to normal.
Question: I am having surgery on my vocal cords. What can I do after surgery to protect my voice and how long until I can talk again?
Answer: Physicians vary greatly in their post-surgical recommendations. Here at the Milton J. Dance Head and Neck Rehabilitation Center, we recommend one week of strict vocal rest, meaning absolutely no talking or whispering. During this time, you should also avoid coughing or throat clearing... if you absolutely must, use a breathy cough or throat clear. Avoid alcohol and keep well hydrated by drinking at least 64 ounces of fluids per day. Do not gargle with mouthwash; if you feel a need to gargle, use warm salt water. After your week of voice rest is up, begin by talking quietly - absolutely no screaming or yelling! Continue to use only a breathy cough or throat clear and only when absolutely necessary. Limit milk products, as they tend to increase mucous so that you feel a need to clear your throat. Voice therapy with a speech pathologist can be very helpful in facilitating post-surgical healing.
Question: A few weeks ago, I went to a baseball game and did a lot of cheering and screaming. I lost my voice the next day! My voice returned, but since then it has been really raspy and breathy, in fact, sometimes I have no voice at all. My ENT told me that I have a polyp on my vocal cord. What is a polyp? Could this be the result of too much yelling? Does the polyp have to be surgically removed or will voice therapy help?
Answer: A vocal cord polyp is a benign, fluid-filled lesion that is often thought to be the result of a period of acute voice abuse, such as you've described. Many ENTs will recommend surgical removal of a vocal cord polyp because a polyp generally does not resolve with voice therapy alone. Ideally, individuals who opt for surgical removal of a vocal cord polyp should receive pre- and post-operative voice therapy. Pre-operative voice therapy is helpful in establishing a comprehensive vocal hygiene program to encourage optimal post-surgical recovery, including education as to post-surgical vocal guidelines. Post-surgical voice therapy typically involves vocal exercises designed to encourage healing, improve vocal quality, and prevent future lesions from occurring.
Question: A few months ago I had a bad cold and lost my voice. It hasn’t come back since and it’s very weak and soft. People say they can’t hear me, especially when I’m in a crowd. It’s very frustrating and is affecting my job. I went to an ENT and she told me I have a paralyzed vocal cord. She told me I have to wait a year for my voice to come back. Isn't there anything I can do in the meantime?
Answer: What must first be determined is whether your vocal cord is simply weak (paresis), or paralyzed. Often, decreased vocal cord movement following an upper respiratory infection is simply a paresis, although it can appear paralyzed on laryngeal examination. The best way to determine whether you have vocal cord paresis (weakness) or paralysis is through a test called laryngeal electromyography (LEMG). This test is performed by an otolaryngologist (ENT) and a neurologist. LEMG provides information as to whether or not recovery of vocal cord movement is expected. If results show that recovery is expected, I would recommend that you ask your physician for a referral to a speech pathologist. Voice therapy often facilitates the return of vocal function. A temporary option is the injection of a substance (e.g., Cymetra, Radiance, etc.) into your vocal cord, improving closure for a better voice. If the LEMG reveals permanent injury to your laryngeal nerve without signs of potential for recovery, a surgical procedure known as medialization thyroplasty may be recommended. Medialization thyroplasty is a surgical procedure in which an implant is inserted into the paralyzed vocal cord to achieve optimum closure for voicing. As post-surgical improvement varies, expected outcomes should be discussed with your surgeon.
Question: My ENT told me I have a nodule on my right vocal cord. He recommended voice therapy with a speech pathologist, but my voice hasn’t gotten any better and my doctor said the nodule is still there. Should I continue with therapy?
Answer: Vocal cord nodules are benign lesions that occur bilaterally (on both vocal cords). Vocal cord nodules are often successfully treated via voice therapy with a speech pathologist. However, there are other benign vocal cord lesions that can resemble a vocal cord nodule, such as a cyst or polyp. Cysts or polyps do often occur unilaterally (on one vocal cord) and do not generally respond to voice therapy.
The best diagnostic test to look at these types of lesions is called a video laryngeal stroboscopic examination. This exam provides a magnified view of the larynx with clear visualization of the vocal cord edges, allowing the doctor to differentially diagnose the lesion. If the diagnosis is a laryngeal cyst or polyp, then surgical removal is recommended for voice improvement. Post-operative voice therapy is often helpful during the healing process.
Question: My voice has been hoarse for about 6 months and it hasn't seemed to get any better. I smoked heavily for many years but recently quit. People keep asking me if I have a cold, but I don't. I also have shooting pain in my right ear. I've been to the doctor who gave me antibiotics, but nothing changed. What should I do to make my voice better?
Answer: Persistent hoarseness in the absence of a respiratory infection could indicate some type of vocal cord pathology that needs to be evaluated by an Ear, Nose, and Throat doctor (ENT). An ENT will examine your larynx using either nasoendoscopy and/or videostroboscopy. As your history of smoking places you at an increased risk of laryngeal cancer, it is recommended that you seek an evaluation at your earliest convenience.
Question: I recently saw an ENT about my voice, which has been hoarse for a long time. My voice also tires out by the end of each day and my throat often starts to hurt. Sometimes, I lose my voice altogether. My ENT told me that I have muscle tension dysphonia. What does this mean and what should I do about it?
Answer: Muscle Tension Dysphonia, or MTD, is a condition in which there is excessive muscle tension in the larynx during voicing. MTD is often associated with generalized stress or bodily tension. MTD is most often thought to be compensatory in nature, that is, a response to an underlying condition. MTD can be sucessfully addressed with voice therapy, but often requires concomitant treatment of the underlying condition for full resolution. There are no surgical treatments for MTD. Length of time required for recovery is completely unique to each patient... there are no general expectations. Your best bet is to seek voice therapy with a speech-language pathologist.
Question: Recently I had heart surgery and had a tube in my throat for more than a week. When the tube was finally removed, I could barely make a sound. It's been two months since then, and my voice is a little better but is still really hoarse. An ENT looked at my vocal cords with a scope and told me I had vocal cord granulomas. She recommended surgery to remove them. Is this the best way to go?
Answer: A vocal cord granuloma is an area of thickened, irregular tissue on the vocal cord(s) caused by irritation. Many granulomas form following prolonged intubation or when someone requires a ventilator for breathing. Other causes of vocal cord granuloma include reflux of stomach acid into the larynx and persistent vocal misuse. If the granulomas are very large in size, surgical removal is most often recommended as the first line of treatment. This often resolves the problem in the case of a intubation-related granuloma.
If your doctor feels that there is an element of vocal misuse contributing to the problem, he or she may recommend voice therapy with a speech pathologist. Because there is a high rate of recurrence in the case of granuloma, treatment is usually comprehensive in order to address several of the factors known to increase the risk of recurrence, such as ongoing reflux treatment and change in vocal behaviors.
