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Speech is our main mode of communication. However, like most things, we often take it for granted and do not realise how important our voice is until we lose it.

Common Causes of Vocal Cord Damage
  1. Misuse and Abuse
    1. Excessive shouting, talking and singing
  2. Acid Reflux
    1. Occurs when our acidic stomach contents flow up into our throat and irritates it, causing inflammation
    2. Other symptoms include constant throat-clearing, cough and hoarseness
  3. Smoking & Alcohol
    1. Toxins from cigarettes cause vocal cords to swell and become inflamed
    2. Alcohol leads to an increased incidence of acid reflux
    3. The incidence of vocal cord cancer increases 30x in someone who both smokes and drinks
  4. Nasal Allergies & Sinus Infections
    1. These are often associated with post-nasal drip
    2. This irritates the throat and leads to frequent coughing and throat-clearing, which can cause vocal trauma

Apart from hoarseness, other common vocal cord diseases include:

  1. Vocal Nodules
    1. Most common vocal injury, often associated with vocal misuse and abuse
    2. Usually respond to voice therapy
  2. Vocal Polyps
    1. Common vocal injury, often associated with vocal misuse and abuse
    2. Do not typically resolve fully with voice therapy, and usually require surgery
    3. However, post-op recovery is fast with often excellent outcomes
  3. Vocal Cord Cysts
    1. Usually arise from vocal overuse or poor vocal hygiene
    2. Vocal cysts will impair the vibration of the vocal cord and cause hoarseness
    3. Usually need to be removed surgically
  4. Vocal Granuloma
    1. Associated with cough and throat-clearing, often with acid reflux as well
    2. Usually treated with medication but may require surgery if it enlarges to affect the voice and breathing
  5. Vocal Haemorrhage
    1. Often associated with violent coughing and shouting
    2. Increased risk in women due to hormones in the menstrual cycle (progesterone)
    3. Increased risk in people on blood thinners and some painkillers
    4. Presents with a sudden loss of voice and is an emergency that requires immediate treatment
  6. Acute Laryngitis
    1. Voice loss due to a vocal cord inflammation from a virus infection
  7. Reinke’s Edema
    1. A collection of fluid in our vocal cords
    2. Associated with long term voice abuse, misuse and cigarette smoking
    3. May occur in people with low thyroid hormones and in acid reflux
    4. May require surgery to drain the fluid
  8. Vocal Cord Paralysis
    1. Associated with cancer in the head and neck, and previous surgery to the thyroid gland and cervical spine
    2. Treatment may include the injection of a temporary filler into the vocal cords or external medialization
  9. Vocal Cord Cancer
    1. More common in heavy smokers and drinkers
    2. If detected early, the cancer can be treated either with laser excision or radiotherapy with excellent results
Evaluation & Diagnosis

The vocal cords are examined through a videostrobolaryngoscopy (VSL), an equipment that allows the voice specialist to see the vocal cords in great detail, even down to examining its vibratory characteristics.

Vocal Cord Surgery

If surgery is deemed to be necessary, the timing must be right as well. A period of medical optimization before surgery is recommended if there is concomitant reflux disease or post nasal drip.

Most surgeries on the vocal cords are performed as a day surgery procedure. After surgery, voice rest is usually advised for two weeks. Whispering is absolutely prohibited.

Post-voice surgery instructions

Know Your ENT Specialist
Dr Paul Mok
Senior Consultant ENT Surgeon
MBBS, FRCS (Glasgow), FAMS (ORL)

Dr Paul Mok Kan Hwei is a certified specialist in Otolaryngology, Head and Neck Surgery (ENT) and has had a distinguished career in public service for the past 23 years.

He cares for patients with a wide variety of ENT conditions including managing patients with nasal allergies, sinus infections, ear problems and swellings in the head and neck region. His special areas of interests are in Voice, Swallowing and managing patients with Obstructive Sleep Apnea.