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Hoarseness is the most common symptom of pathology in the larynx (voicebox). Usually the cause of hoarseness can be determined through examination of the larynx by indirect or direct means. It is most important to determine whether there is a lesion in the larynx that might be cancerous (malignant), but more often the cause of hoarseness is a benign lesion on one or both vocal cords (such as a polyp or nodule) or more diffuse inflammation of the larynx. Examination of the vocal cords and lower throat is performed using a mirror (indirect laryngoscopy), a fiberoptic instrument (flexible fiberoptic endoscopy or rigid endoscopy), and sometimes a special lighting system (stroboscopy).
Some patients suffer from paralysis of one of their vocal cords which can leave them hoarse or at risk for aspiration. A common treatment for this disorder, called thyroplasty, involves pushing the paralyzed vocal cord closer toward the normal vocal cord using a silicone elastomer implant. In this procedure, a window is cut in the thyroid cartilage and a silastic prosthesis is inserted. This pushes the paralyzed vocal fold inward, allows contact with the opposite vocal fold, and improves voice production. The procedure is performed on an outpatient basis and is conducted under local anesthesia so that the patient can provide auditory feedback to ensure correct positioning of the prosthesis. The thyroplasty is sometimes done in conjunction with another procedure called an arytenoid adduction. In this later procedure, small cartilages within the larynx to which the vocal cords are attached are rotated to bring the paralyzed vocal cord closer to the normal cord. Whether the thyroplasty is conducted alone or in conjunction with arytenoid adduction is determined from careful pre-operative and intra-operative evaluations. Injections of Teflon or collagen into the paralyzed cord can also be used. However, there are several drawbacks to this procedure which have limited its use. These include irreversibility, altered vocal cord consistency, migration of the teflon to other structures within the neck, and scar formation. For all these reasons, this procedure is no longer the preferred treatment of vocal cord paralysis.
Bowing and deficient vocal fold tissue, which can result from prior laryngeal surgery, trauma, intubation or atrophy, can also be treated with thyroplasty. In this case, the thyroplasty may be done bilaterally rather than unilaterally as in the case of a paralyzed vocal cord. Injections of collagen into the vocal cords can also be used in conjunction with the thyroplasty to help normalize the voice.
Speech and other movement disorders can be treated with a combination of speech therapy and surgery or botulinum toxin injections. Spasmodic dysphonia is a classic representative from this group of disorders. |