Vocal Issues Due to Anatomic Abnormalities
Most vocalists live in fear of a diagnosis of “nodes.” But the truth is, there are many anatomic abnormalities that can result in hoarseness, and they usually come on slowly and with concerted “effort” (i.e. you have long term symptoms that you try to push through or ignore). The good news is that almost all are completely treatable and preventable. Here are some common anatomic abnormalities that result in hoarseness:
- Vocal cord edema – is swelling from overuse. It is treated with short term vocal rest, anti-inflammatories, steroids, and vocal retraining.
- Nodules – start out as bruising of the mid-vocal cords from misuse or pushing too hard to create sound. Over time (many months to years) the bruises can scar and develop into calluses. Treatment is voice therapy to stop misuse and is curative without surgery.
- Pseudocyst – is a pocket of mucous trapped in a cyst that occurs instead of a polyp or as polyp is resolving. It usually only minimally affects the voice and can be treated with voice therapy, rest, anti-inflammatories, steroids, or, rarely, surgery.
- Polyp – is a solid structure with the consistency of the inside of a grape that forms on one vocal cord as a result of an unfortunate incident, such as coughing really hard, choking, or screaming. Very small polyps can resolve with voice therapy, anti-inflammatories and steroids. Larger polyps usually require surgical removal.
- Smoker’s (Reinke’s) edema – is a polypoid change in the vocal cords that affects the whole cord and results in hoarseness and a deepening of the voice. The main treatment is smoking cessation. Surgery is helpful for very large polyps, but does not result in a normal voice with continued smoking.
- Vocal hemorrhage – occurs when a prominent blood vessel in one or more vocal cords ruptures, allowing the blood to disseminate throughout the vocal cord. If left untreated, the residual blood causes inflammation and scarring of the cord. This scarring prevents the vocal cord from vibrating normally (also called a sulcus). Immediate steroids and voice rest is the best treatment and usually results in complete resolution. Repeated hemorrhage is treated with laser.
- Vocal cord paralysis – is when one or both vocal cords do not move normally. It can be congenital or happen suddenly, with a virus or cold, after neck or heart surgery, or from a neck or lung tumor. Treatment is voice therapy and sometimes surgery to move one vocal cord closer to the other.