Voice and Swallowing Disorders

The Sound of Your Voice

Not a day goes by when you don't rely on your voice.

That vital sound originates in the larynx in the neck, also known as your voice box. The voice box contains two folds of tissue — your vocal cords. In order for speech to sound normal, your vocal cords need to touch together smoothly as air passes over.

If something interferes with the movement of your vocal cords, you can have problems with your voice. Your ability to communicate — at work, home, or wherever you are — can be severely impacted.

The ENT doctors at El Camino Health are experts at diagnosing and treating voice disorders.

Signs and Symptoms of a Voice Disorder

If something is wrong with your voice, it may sound:

• Quivery
• Hoarse, rough or harsh
• Strained or weak
• Whispery or breathy
• Too high or low in pitch

Other symptoms of a voice disorder include:

• Tension or pain while speaking
• A lump in your throat while swallowing
• Pain when touching the outside of your throat
• No ability to speak at all

What Interferes with the Function of Your Vocal Cords?

When your vocal cords are not working properly, there can be many reasons, including:

• Growths on the vocal cords (cysts, wart-like lumps called papilloma, nodules, polyps, blisters)
• Inflammation and swelling of the vocal cords — due to surgery, respiratory illness, allergies, gastroesophageal reflux disease (GERD), medicines, smoking, alcohol abuse or exposure to certain chemicals
• Nerve problems — stemming from disease or surgery
• Hormone disorders
• Vocal abuse that strains the vocal cords — too much shouting, talking or coughing

Potential Voice Disorders

If you have these conditions that interfere with the vocal cords, you may develop voice disorders such as:

• Laryngitis - When your vocal cords swell, your voice sounds hoarse. Sometimes, you can’t even talk. This condition — laryngitis — may be caused by a virus in the upper respiratory tract, chronic cough, inhalers used for asthma or gastroesophageal reflux disease (GERD).
• Vocal Cord Paresis or Paralysis - Sometimes the vocal cords can become paralyzed or partly paralyzed (paresis). As a result, your voice may sound weak or breathy. Or, you may have noisy, difficult breathing. Causes of vocal cord paralysis include a viral infection and nerve injury during surgery, stroke or cancer. The paralysis may heal or become permanent. To help improve the quality of your voice, doctors may recommend surgery or voice therapy.
• Spasmodic Dysphonia. - This condition happens when the vocal cords twitch suddenly, or spasm, due to nerve problems. When you talk, your voice may sound quivery, jerky, hoarse or have a groaning quality. Some people may not be able to speak at all. To treat spasmodic dysphonia, doctors may recommend speech therapy or injections of botulinum toxin to the vocal cords.

Diagnosis and Treatment for Voice Disorders

If you experience changes in your voice — and the symptoms don't go away in a few weeks — consult your doctor. To diagnose voice disorders, our specialists may use laryngoscopy (a test that allows doctors to see your throat), X-rays, MRI and other tests that show how the vocal cords vibrate during speech.

Depending on the cause of your voice disorder, treatment may include:

• Lifestyle changes (resting your voice, exercises, hydrating with fluids)
• Speech Therapy
• Surgery
• Injections
• Medicine

When Swallowing Is Difficult

Most of us don't think twice about swallowing. When we eat food and drink liquids, swallowing happens naturally. The food passes through the throat and into the esophagus — the tube that carries our food and drink to the stomach.

But for some people, swallowing is not so simple. They have dysphagia — difficulty swallowing. And sometimes they also experience pain while swallowing.

Difficulty swallowing can happen at any age, but it's most common among people who are elderly.

The ear, nose and throat doctors at El Camino Health can diagnose and treat all your swallowing disorders.

Symptoms of Swallowing Disorders (Dysphagia)

When you have difficulty swallowing, you may experience:

• Drooling
• A sensation that food or pills get caught in the back of the throat
• Coughing or choking
• A lump in the throat
• Weight loss
• Voice changes
• Lung infections
• Coughing up blood

Causes of Swallowing Disorders

If you're not swallowing properly, the problem could be caused by many factors, including:

• Acid reflux or gastroesophageal reflux disease (GERD)
• Throat infections
• Muscle weakness
• Diseases of the nervous system
• Food getting caught in the throat
• Abnormalities of the swallowing mechanism
• Vocal cord paralysis
• Cancer of the head or neck

Diagnosis of Swallowing Disorders

To diagnose swallowing disorders, your doctor will first examine you and then perform tests to look at your throat and esophagus. Techniques may include:

• laryngoscope - This small, flexible tube allows doctors to look at your tongue, throat and voice box. Doctors may give you food or liquid during this test to watch as you swallow.
• Upper GI Endoscopy - A flexible tube with a camera is inserted into your throat and pushed through the esophagus, stomach and small intestine.
• Videofluoroscopic Swallow Study - During this test, doctors use videotaped X-rays to see what happens to your food and drink during the swallowing process.
• Manometry - Doctors assess how well the esophagus is working by placing a thin tube down the esophagus and into the stomach. It measures the pressure of the muscle contractions as you swallow.

Treatment for Swallowing Disorders

If you're not swallowing properly, you may have trouble eating and drinking enough to stay healthy. Treatment will depend on the cause of your swallowing disorder.

Doctors may recommend:

• Muscle exercises to strengthen weak facial muscles or improve coordination
• Learning to eat with head turned a certain way
• Avoiding certain foods
• Preparing food and drink in a certain way to make swallowing easier and safer
• Procedure to stretch the esophagus
• Surgery to remove a blockage
• Surgery to place a feeding tube in the stomach

Depending on your unique needs, our ENT doctors may recommend treatment from other specialists at El Camino Health, too. We offer a wide range of rehabilitation services for voice, speech and swallowing disorders.