Laryngology is a subspecialty within otolaryngology (ear, nose and throat) that deals with injuries and illnesses of the larynx, often called the voice box. It sits in the front of the neck and contains the vocal cords. The larynx is responsible for swallowing and sound production, and is also the entrance to the windpipe, hence it plays a critical role to the airway.
A laryngologist is a surgeon with a special interest in airway, voice and swallowing disorders involving the throat and the voice box.
Common Conditions That Can Affect the Larynx
There are many conditions which can affect the larynx, including:
- Non-cancerous (Benign) vocal cord lesions
- Precancerous or cancerous lesions
- Inflammatory or infectious conditions
- Autoimmune conditions
- Neurologic conditions
- Airway conditions
- Vocal cord motion abnormalities
Other factors that can affect the larynx
The vocal cords can also be affected due to surgical procedures such as thyroid, cardiac, spine, thoracic and vascular surgeries. Placement of a breathing tube during hospitalization or anaesthesia can also sometimes be related to problems in the voice box.
There are several benign vocal cord conditions caused by vocal abuse, overuse and misuse. Several disorders of the larynx can be caused by injury or strain to the vocal cords through excessive talking, coughing, throat clearing, smoking, singing, screaming, or speaking too low or too loudly.
Eventually the frequent vocal misuse and abuse can cause changes in vocal function and result in hoarseness. (Hoarseness which lasts longer than 2-4 weeks without explanation should always be evaluated by an otolaryngologist.)
Disorders caused by misuse, abuse or overuse of the voice include:
- Laryngitis: Swelling or inflammation of the vocal cords.
- Vocal cord nodules: These benign, small, callus-like, inflammatory lesions on the vocal cords. Nodules are some of the most common noncancerous vocal lesions. Professional singers and individuals who have a lot of vocal demands such as teachers and salespersons are at a greater risk for development of these lesions.
- Vocal cord polyps: These are vocal lesions which are typically inflammatory in nature or post traumatic (caused by an injury). They result from persistent coughing or a vocal cord injury from heavy vocal demand. Individuals who smoke have a tendency to develop polyp-like changes on the vocal cords.
- Vocal cord haemorrhage: This is a sudden loss of voice, usually due to shouting, screaming or other strenuous vocal tasks. One or more of the blood vessels on the surface of the vocal cord can rupture, and as a result fill the soft tissues of the vocal cord with blood. This is usually treated with voice rest until the haemorrhage resolves.
- Professional voice disorders: Anyone who uses their voice for work is a professional voice user. This includes teachers, singers, counsellors, sales representative, and customer service people among others.
- Spasmodic dysphonia: This is a neurologic condition of the larynx that involves the involuntary tightening (muscle contraction) of specific muscles with the larynx or the vocal cords. This results in a voice that is strangled, strained or intermittently breathy.
- Laryngeal papillomatosis: This is a chronic viral infection in which benign, wart-like tumours grow inside the vocal cords or larynx, or the respiratory tract leading from the nose into the lungs. The lesions, which are caused by the human papilloma virus (HPV), can grow very quickly and frequently reappear despite sustained treatment. This can cause breathing problems if the patient’s airway is blocked or more frequently, hoarseness if the lesions occur on the vocal folds. Laryngeal papillomatosis can affect infants, children and adults.
- Vocal cord paralysis or vocal cord hypomobility: This condition occurs when one or both of the vocal cords in the voice box do not open or close properly. Vocal cords enable individuals to talk when air held in the lungs is released and passes through the cords enabling them to vibrate and make sounds. In addition to affecting speech, vocal cord paralysis can cause a feeling of phlegm in the throat, coughing, difficulty swallowing, and shortness of breath while talking. Although the main symptom tends to be a weak or breathy voice, symptoms of vocal cord paralysis can be more than that.
- Vocal cord motion disorders: These can be caused by surgery to the thyroid gland, thoracic surgery, vascular surgery, traumatic or prolonged placement of a breathing tube or a viral infection.
- Laryngopharyngeal reflux (LPR): This condition is also known as acid reflux disease, heartburn, or gastroesophageal reflux disease (GERD). Gastroesophageal reflux is a burning sensation in the chest that can occur after eating, stretching, bending, exercising and lying down. GERD occurs when the contents of the stomach come back up into the oesophagus. This may happen when the lower oesophageal sphincter (LES) valve – which controls the passage of food from the oesophagus to the stomach – fails to close correctly. This condition has classic heartburn symptoms. Reflux can affect the larynx as well as cause more atypical symptoms such as hoarseness, coughing, inflammation and sore throat. In such cases, it is referred to as laryngopharyngeal reflux (LPR). LPR may be associated with frequent throat clearing, coughing, excess phlegm and mucus, and the sensation of a lump in the throat.
- Laryngeal cancer: Though many growths that affect the voice box are non-cancerous, cancerous tumours can also grow in the voice box. The inner walls of the voice box are lined with cells called squamous cells. Almost all laryngeal cancers begin in these cells and are known as squamous cell carcinomas. If not caught early, laryngeal cancer can spread (metastasize) to nearby lymph nodes in the neck. Smokers are at higher risk for cancer of the larynx. If caught early, this condition is treatable.
- Laryngeal stenosis: This is the narrowing of the vocal cord airway, either from scarring or bilateral cord immobility that can cause issues with breathing. It can be caused by a number of conditions, such as autoimmune or inflammatory disorders including traumatic injuries from prolonged intubation, polyangiitis with granulomatosis, iatrogenic conditions (caused by medical treatment) such as thyroid surgery, cancerous conditions, progressive neurologic degenerative conditions or rare viral infections.
- Dysphagia: Individuals with this condition have difficulty with swallowing. Some people with dysphagia may be unable to swallow liquids, solid foods or even saliva. This often leads to the patient becoming malnourished, since he/she is unable to take enough nutrients. Dysphagia can also lead to serious infections when poor swallowing causes food to get trapped outside the oesophagus or in the lungs. Dysphagia occurs when the larynx does not close tightly during swallowing and when the throat (pharynx) does not move food to the oesophagus in an effective or coordinated way. Dysphagia is often seen in patients who have suffered strokes, but it can also occur after radiation treatments for head and neck cancer or after neck surgery. It can also be a significant component of progressive neurologic conditions.
Diagnosing Diseases of the Larynx
Diseases of the larynx are usually diagnosed by an otolaryngologist or a laryngologist. He/she will first perform a physical examination which includes a mirror or scope exam so as to visualize the throat and the larynx. Depending on the symptoms, other tests may be needed. These include, biopsies, imaging studies or an additional endoscopic examination.
If the doctor suspects vocal cord paralysis, he/she first confirms this with a scope examination. In some situations, the doctor can also order a laryngeal electromyography (LEMG). This test is for measuring the nerve input to the laryngeal muscles, and it can also help diagnose and predict if the patient will recover vocal cord function.
Treatment of Diseases of the Larynx
Treatments for conditions affecting the larynx vary depending on the diagnosis. Treatment for conditions caused by vocal abuse, overuse or misuse may be as simple as resting the voice. Singing or voice therapy might also be recommended. This is usually performed by a speech-language pathologist.
Surgery, chemotherapy, radiation therapy, or a combination of these treatments may be used to treat laryngeal cancer. Surgery may also be required to treat polyps, nodules or cysts. Treatment for conditions of the vocal cords or larynx are highly individual, depending on age, condition and profession.
Prevention of Diseases of the Larynx
Cutting back on drinking alcohol or quitting smoking can help in preventing laryngeal cancer. Taking proper care not to strain the voice through misuse or excessive use can prevent conditions such as nodules and polyps. This is especially important for singers, teachers or lawyers who spend most of their time using their voice. Taking your time to rest your voice, controlling irritating factors reflux or allergy and maintaining physical fitness can help in preventing these conditions.
Most conditions affecting the larynx are treatable especially if medical attention is sought early.
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