When voice problems affect your job and when to seek help

Humans are unique amongst the animal kingdom in that they possess the ability to communicate through their speaking and singing voices. In professions like singing, teaching, law and customer care, where you need your voice for your living, the voice’s absence can mean loss of earnings or even the end of a career. The larynx contains the vocal folds which open to let you breathe and close to vibrate to make the sounds of your voice. We have all experienced voice loss or hoarse voice (dysphonia) when we have had laryngitis in association with a ‘cold’ or ‘flu’. Otherwise, dysphonia is usually due to something (a lesion) on the vocal folds impairing normal vibration or weakness of a nerve supplying the larynx.

Symptoms associated with dysphonia

Having a problem with your vocal cords most commonly results in hoarseness, loss of voice, discomfort on speaking and poor control of pitch and loudness. Hoarse voice for more than three weeks, especially if associated with pain, swallowing or breathing problems needs urgent attention.

Persistent problem? Seek professional advice

Persistent voice problems should always be assessed by a laryngologist (an ENT surgeon with an interest in voice). Examination of the larynx is usually painless and can be performed in a clinic with a small camera that inserts either in the mouth or the nose. If you use your voice excessively or shout frequently you can end up with vocal nodules. These are swellings always in the middle of both vocal folds, due to voice trauma. Treatment is resting the voice and guidance from a speech therapist who will help improve your vocal technique.

Smokers should be vigilant when it comes to voice problems

Anyone can develop a voice problem, but some people are more prone to problems than others. Professions that use the voice a lot, such as teachers and singers, have a greater chance of developing problems with the voice. If you talk loudly or shout a lot your chances increase, and aging can also increase the risk of problems. If you have been a smoker then dysphonia for more than two or three weeks should always be assessed by a laryngologist. One has to be concerned about small precancerous or cancerous lesions on the folds. Laryngeal cancers can also be associated with pain or present with a lump in the neck. Quite often small cancers can be eliminated using a laser but sometimes radiotherapy treatment may be indicated. With small laryngeal cancers, cure rates are very high. Radiation therapy uses high-energy x-rays, gamma rays, or particles to kill cancer cells.

Laryngoscopy is a medical procedure that is used to obtain a view of the vocal cords and the glottis. Laryngoscopy is most commonly performed in clinic by an ENT specialist using local anaesthesia and a flexible nasal endoscope. This helps to look for laryngeal problems. Direct laryngoscopy or microlaryngoscopy is performed under a short general anaesthesia and allows for surgery on the vocal cords, using a laser if indicated.

If you notice changes with your voice, or if you have persistent voice problems, it’s worthwhile making an appointment with a specialist laryngologist.