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Voice & Swallowing

Voice problems occur with a change in the voice, often described as hoarseness, roughness, or a raspy quality. People with voice problems often complain about or notice changes in pitch, loss of voice, loss of endurance, and sometimes a sharp or dull pain associated with voice use. Other voice problems may accompany a change in singing ability that is most notable in the upper singing range. A more serious problem is indicated by spitting up blood or when blood is present in the mucus.

Voice changes sometimes follow an upper respiratory infection lasting up to two weeks. Typically the upper respiratory infection or cold causes swelling of the vocal cords and changes their vibration resulting in an abnormal voice. Reduced voice use (voice rest) typically improves the voice after an upper respiratory infection, cold, or bronchitis. If voice does not return to its normal characteristics and capabilities within two to four weeks after a cold, a medical evaluation by an ear, nose, and throat specialist is recommended. A throat examination after a change in the voice lasting longer than one month is especially important for smokers. (Note: A change in voice is one of the first and most important symptoms of throat cancer. Early detection significantly increases the effectiveness of treatment.)

Pacific ENT provides the following services:

Throat image

Voice and Swallowing Conditions

Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux Disease

“Heartburn on the throat”. Stomach acid may backflow to the throat, causing irritation of the voice box. This irritation is more prominent near the posterior (back) of the voice box, near the esophagus. Symptoms of this disorder include hoarseness, swallowing problems, a foreign body sensation, frequent throat clearing and sore throat. Link to GERD/LPR in our website.


Change in voice quality and persistent hoarseness are often the first warning signs of vocal cord lesion. Other symptoms can include:

  • Vocal fatigue
  • Unreliable voice
  • Delayed voice initiation
  • Low, gravelly voice
  • Low pitch
  • Voice breaks in first passages of sentences
  • Airy or breathy voice
  • Inability to sing in high, soft voice
  • Increased effort to speak or sing
  • Hoarse and rough voice quality
  • Frequent throat clearing
  • Extra force needed for voice
  • Voice “hard to find”

What can I do to prevent and treat mild hoarseness?

  • If you smoke, quit.
  • Avoid agents that dehydrate the body, such as alcohol and caffeine.
  • Avoid secondhand smoke.
  • Drink plenty of water.
  • Humidify your home.
  • Watch your diet–avoid spicy foods.
  • Try not to use your voice too long or too loudly.
  • Use a microphone if possible in situations where you need to project your voice.
  • Seek professional voice training.
  • Avoid speaking or singing when your voice is injured or hoarse
Vocal Cord Leukoplakia
Vocal Cord Polyps
Vocal Cord Stenosis
Vocal Cord Cancer vs Normal

Vocal Folds or Vocal Cords

The vocal cords are composed of paired infolded bands stretched across the larynx (voice box). They vibrate, affecting the flow of air being expelled from the lung, resulting in various sounds.

The vocal cords are open when you breath in (inhalation), closed when holding one’s breath, and vibrating for speech or singing, opening and closing 440 times per second. They are white because of scant blood circulation.


Laryngitis is a swelling of the vocal cords usually caused by an infection. The most common cause is a viral infection such as a “cold”. Overusing the voice, such as yelling at a sports event or singing loudly may also cause laryngitis. Swelling of the vocal cords cause them to vibrate differently, making the voice sound hoarse. Resting the voice and drinking plenty of liquids is the best treatment for this condition. Overusing you voice when you have laryngitis may result in nodules, polyps or cysts.

Vocal Cord Nodules & Polyps

Vocal cord nodules and polyps are noncancerous growths on the vocal cords that affect the voice.

The vocal cords, located in the voice box in the middle of the neck, are two tough, fibrous bands that vibrate to produce sound. They are covered with a layer of tissue that is similar to skin. With use, this layer thickens. With heavy use, the thickening may localize, producing a nodule. Unlike skin, heavy usage over a short time may also produce polyps. A polyp is a soft, smooth lump containing mostly blood and blood vessels. A nodule is similar to a polyp, but tends to be firmer.

Vocal fold cysts are collections of fluid in sac-like formations on the vocal cords.

Cysts can deteriorate the quality of your voice. They may occur after an upper respiratory infection combined with vocal overuse. A ruptured cyst may result in a scar. Females are more likely than males to develop vocal fold cysts and the menstrual cycle may alter the size of the cyst. The cysts usually appear on one side of the vocal cord but may cause swelling on the opposite side due to irritation.

Initial treatment of the cysts involves vocal training and speech therapy along with medical interventions to decrease irritation of the cyst. In many cases, these will alleviate problems from the cyst. In other cases, the cyst grows larger necessitating surgery to remove the cyst. Vocal professionals may also require surgery if the minimal steps do not improve the voice quality enough to allow continued performance with the voice.

Vocal Cord Nodules &Vocal Cord Paralysis

Inability of one or both vocal folds (vocal cords) to move. The paralysis is usually due to damage to the nerves going to the vocal cords (viral infection, surgery or trauma) or due to damage to the brain, such as a result of a stroke.

Signs and symptoms include:

Voice changes: Hoarseness (croaky or rough voice); breathy voice (a lot of air with the voice); effortful phonation (extra effort on speaking); air wasting (excessive air pressure required to produce usual conversational voice); and diplophonia (voice sounds like a “gargle”).

Airway problems: Shortness of breath with exertion, noisy breathing (stridor), and ineffective or pour cough.

Swallowing problems: Choking or coughing when swallowing food, drink, or even saliva, and food sticking in throat.

Many patients with vocal cord paralysis will have return or improvement of the vocal cord function within several months of onset. Speech therapy may be recommended. Surgery may include repositioning of the paralyzed vocal cord closer to the normal vocal cord. There are many techniques available to reposition the vocal cord.

Vocal Cord (Throat) Cancer

The first symptom of throat cancer is usually a change in voice quality that persists for more than 2-4 weeks. The voice often becomes hoarse, rough or raspy. Individuals who smoke are at the greatest risk of developing throat cancer. Early diagnosis allows for more successfully treatment, with a cure rate greater than 90 percent. Therefore, it is important that if you smoke, that you be examined if you have persistent hoarseness or change in the voice for longer than 2-4 weeks.

Treatment options include surgery, radiation therapy, and/or chemotherapy.

Vocal Cord Images

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