The larynx, or voice box, is a hollow organ near the top of the throat that holds the vocal cords, which give people their voice. It's a delicate instrument, and it needs to be treated with care.
Overuse or illness can seriously impair a person's ability to speak, and even temporarily take it away altogether. Such problems can be devastating to people who use their voice professionally - politicians, teachers, actors, singers, and broadcasters, for example - but they also can wreak havoc on anyone who suddenly is reduced to speaking in whispers.
‘As with any muscle in the body, prolonged or improper use can cause injuries to the vocal cord muscles.’
That's where doctors such as Inna Husain come in. She's a laryngologist - a specialist in voice disorders and diseases of the larynx - at Rush University Medical Center, and one of only a few in Chicago.
Like other moving parts in your body, vocal cords in the throat have muscle fibers in them. As with any muscle in the body, prolonged or improper use can cause injuries to these vocal cord muscles. Whether it comes from yelling in a bar while watching a championship game or giving too many speeches on a campaign trail, the damage can result in laryngitis, an inflammation or swelling of the larynx that temporarily can cause a partial or even complete loss of the voice.
"If you're an athlete - for example, a runner - you're more likely to hurt your knee or another muscle group that you use while running," Husain says. "People who use their voice professionally are more likely to strain or injure their vocal cords. Conversely, people whose work does not require them to speak much are less likely to stress their voices."
You don't have to be a voice professional to injure your vocal cords, though. Laryngitis also can be caused by illness, as when the vocal cords swell after a cold or virus.
In Aakansha Maheshwari's case, uncontrolled acid reflux may have been the reason for her laryngitis. Maheshwari knew she was on the phone a lot to conduct business as a textile designer, but she had no idea her simple sore throat was something she needed to address with a medical professional.
"I thought it was just a sore throat, until two days later when I couldn't speak at all," Maheshwari says. "I thought it may have been sinus trouble, but I saw a specialist and learned it wasn't related to my sinuses."
Maheshwari sought out Husain and learned she had a benign epithelial lesion (similar to polyp or nodule) on her vocal cords. Uncontrolled reflux can cause irritation and poor laryngeal hygiene techniques, such as throat clearing, which can be the cause of a lesion.
Maheshwari first tried to solve the problem with speech therapy exercises, which helped but still left her voice so scratchy that she was embarrassed by it and avoided social gatherings. "The speech therapy helped me to decrease the size of the lesion on my vocal cords, but it wasn't until I had surgery to remove it that I really noticed a difference," she says.
Surgery for most lesions is performed as an outpatient procedure. While the patient is under general anesthesia, the surgeon reaches the larynx by passing instruments through the mouth, including a laryngoscope (a slender metal scope), along with a microscope for a magnified view of the vocal cords, and tiny (microsurgical) instruments to remove the lesion.
The surgery on Maheshwari confirmed that voice therapy had reduced the size of her lesion. Instead of two to three weeks of voice rest without talking, Maheshwari only needed a week of complete voice rest due to her vigilance. "My surgery was in January, and in February, everything was back to normal," she says.
Full-blown laryngitis isn't the only reason to seek out medical help for voice problems. Prolonged hoarseness also can be a sign that it's time to see a doctor. A change in voice that is not related to a cold could be due to scar tissue or nodules. Scarring or phono traumatic lesions (nodules and polyps) can develop on vocal cords and may require medical attention.
"Nodules are not cancer; but the longer they are left there, the more scarring and changes in the voice you'll have, and the harder it may be to treat," says Husain. "As with any condition, coming in sooner is better. Most people don't know that there is a medical reason behind a change in voice, and a medical professional can best advise them."
A simple well visit check allows Husain to catch many potential problems. In particular, she recommends such appointments for voice students prior to a performance.
"It's best to be evaluated to make sure it's safe, since some may unknowingly have large blood vessels on the surface of the vocal cords, which have more of a chance of rupturing and causing a hemorrhage because of the tension," she says.
Prominent blood vessels on the surface of the vocal cords can be treated by a laser to prevent hemorrhages. If a blood vessel ruptures on the vocal cords, voice rest would be necessary until the body can reabsorb the blood and allow time to heal. After the vocal cords have healed, the laser treatment would be needed to address the source of bleeding to prevent recurrent hemorrhages.
Because vocal fold mucosal vibration directly causes changes in the voice, stroboscopes can be used in advance to see how the vocal cords are vibrating and customize care, depending on a person's situation and demands.
"Some changes in the vocal cords can be precancerous. We are now seeing more papilloma laryngeal lesions or warts in the voice box in both children and adults," Husain warns. Fortunately, a simple outpatient laser treatment can shrink the wart, even those on blood vessels, such as papilloma warts, or hemorrhagic polyps.
Given the difficulties voice problems cause, the more serious conditions they may indicate, and the availability of outpatient treatment, Husain recommends keeping a vigilant ear. "If you hear and feel something different, it's best to get it examined," she says. "In these cases, it's easier to treat these conditions and potential scarring the sooner you see a professional."