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Voice Disorders

Normal Voice

The vocal cords (vocal folds) are composed of pliable shelves of tissue that are stretched horizontally across the voice box (larynx). The larynx is located in the neck, at the top of the windpipe (trachea). As air is pushed through the partially closed vocal folds, the outer covering of the vocal folds, known as the mucosa, vibrate.

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Aging Voice

The larynx and vocal folds age along with the rest of the body. The muscles of the vocal fold lose bulk (atrophy) as a result of aging, as do other muscles of the body. In addition, much like tissue elsewhere in the body, the vocal folds lose their flexibility and become stiffer and less pliable over time.

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Cancer

Laryngeal Cancer is the uncontrollable growth of malignant tissue in the larynx. While the cancer initially grows on the surface of the larynx, it can spread into deeper tissues, outside of the larynx, the neck, and into other parts of the body. Smoking is the main cause of Laryngeal Cancer.

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Cyst

A vocal fold Cyst is a collection of fluid, usually mucus, contained within a membrane. The Cyst is often located near the surface of the vocal fold underneath the mucosa. Although it is not entirely clear how Cysts form, many believe that they result from mucous glands that have become blocked.

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Granuloma

A Granuloma is a growth that results from the body’s response to chronic irritation or trauma. Granulomas are non-cancerous (benign) and are commonly seen in the back portion of the vocal fold. These growths may form on one side or both sides of the larynx, and may grow into very large sizes, occasionally causing obstruction of normal breathing.

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Hemorrhage

Physical stresses caused by voicing behaviors such as shouting, throat-clearing, and coughing may lead to the rupture of the tiny blood vessels in the vocal fold resulting in bleeding (Hemorrhage) into the outer layer of the vocal fold. The proper vibration of the vocal fold is altered due to the blood in the outer layer.

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Laryngitis

Laryngitis refers to inflammation of the voice box (larynx). There are many possible causes of Laryngitis. The more common sources of inflammation are infection, misuse of voice (shouting or screaming), and acid reflux. Inflammation causes tissues of the larynx to swell, and if this swelling affects the vocal folds, it will lead to hoarseness. Laryngitis usually results in hoarseness.

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Nodules

Vocal fold Nodules are symmetric, non-cancerous growths which occur on both vocal folds. Nodules result from vocal misuse and are mostly seen in young women and pre-adolescent boys. Nodules are always bilateral and appear directly apposing each other. With recurrent vocal misuse, calluses form on the surface of vocal folds due to the continuous impact of vocal folds with each other.

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Papilloma

Papilloma is a warty growth caused by the Human Papilloma Virus. Human Papilloma Virus is the name of a group of viruses that includes more than 100 different types (strains). Different strains of the virus cause similar warty growths in various parts of the body including the skin and genitals. These growths are referred to as Papillomas (also known as warts).

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Polyp

Vocal folds Polyps are non-cancerous growths that have a variety of appearances. Vocal fold irritation from misuse of the voice and smoking contribute to their formation. They are typically located at the mid portion of the vocal fold, may be single or multiple, involve one cord or both and may be big or small. Polyps may be hanging by a thin stalk (pedunculated) or have a wide base (sessile).

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Reflux

The term Reflux means “a backward or return flow,” and it usually refers to the backward flow of the stomach contents into the esophagus or throat. When eating, food reaches the stomach by traveling down a muscular tube called the esophagus, a passageway that leads from the throat to the stomach. Once food reaches the stomach, the stomach adds acid and pepsin so that the food can be digested.

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Reinke’s Edema

Reinke’s Edema is the swelling of the entire outer layer of the vocal fold (superficial lamina propria or Reinke’s layer). It is also commonly referred to as Polypoid Corditis. Reinke’s Edema occurs exclusively in smokers, and is thought to be caused by the heat of inhaled cigarette smoke.

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Spasmodic Dysphonia

Spasmodic Dysphonia is a neurologic disease that causes involuntary movements of the vocal folds. The cause of Spasmodic Dysphonia is unknown. Spasmodic Dysphonia is not hereditary and the symptoms often begin in persons in their 30s and 40s.

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Sulcus Vocalis

Sulcus Vocalis is a thinning or absence of the outer layer of the vocal fold. The word “sulcus” means “furrow” or “cleft” in Latin, and describes the appearance of the divot seen in the vocal fold in this disorder. This change in the vocal fold results in alteration of the vibration of the vocal fold, thus causing hoarseness.

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Tremor

Vocal Fold Tremor or Benign Essential Tremor is a neurologic disease that involves abnormal muscle contraction. The involuntary movements of the muscles result in a tremor or shake. Benign Essential Tremor causes the affected body part to shake while a person is attempting to perform an activity using that body part.

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Vocal Fold Paralysis

Vocal Fold Paralysis results in the inability of the vocal fold to move. It is caused by damage to the nerve that innervates the vocal fold. The recurrent laryngeal nerve travels from the brain down the neck and into the chest before turning upwards back to the larynx.

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Vocal Fold Scar

Vocal Fold Scar refers to damage to the vocal fold, thus limiting and altering the vibration of the outer layer. This change in vibration of the vocal fold leads to a hoarse voice. Scarring is usually caused by surgery, trauma, radiation therapy or diseases of the larynx.

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