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Laryngology

What is laryngology?

Laryngology is a branch of medicine that deals with illnesses and injuries of the larynx, often called the voice box. Laryngology also deals with voice disorders and treatments. The larynx sits in the neck and houses the vocal cords. The larynx is vital in the body's production of sound.

What does a laryngologist do?

A laryngologist is a doctor with a special interest in voice disorders and diseases of the larynx. Laryngology is a subspecialty of otolaryngology, which refers to the treatment of the ears, nose, and throat. Otolaryngologists and laryngologists are often referred to as ENT (ear, nose, and throat) doctors.

What are some of the diseases that affect the larynx?

Some of the most common diseases to affect the larynx are:

Disorders caused by vocal abuse, misuse, and overuse: Several disorders of the larynx can be caused by strain or injury to the vocal cords through excessive talking, throat clearing, coughing, smoking, screaming, singing, or speaking too loudly or too low. Eventually, frequent vocal abuse and misuse can cause permanent changes in vocal function and possibly the loss of voice. Disorders caused by abuse, misuse, or overuse include:

Laryngitis:

An inflammation or swelling of the vocal cords.

Vocal cord nodules:

Small, benign growths on the vocal cords. Nodules are among the most common vocal disorders. Professional singers and people who have a lot of vocal demands are often affected by nodules.

Vocal cord polyps:

A condition similar to a vocal nodule, but softer and more blister-like. Heavy smokers often experience this condition and they are often caused by an injury to the vocal folds.

Vocal cord hemorrhage:

A sudden loss of voice, usually due to screaming, shouting, or other strenuous vocal tasks. In a hemorrhage, one or more of the blood vessels on the surface of the vocal cord rupture and the soft tissues of the vocal cord fill with blood. It is treated with voice rest until the hemorrhage resolves.

Professional voice disorders:

Many people who use their voices for a living may experience either temporary or, on occasion, more long-lasting problems with their voices. These include singers, public speakers, and other people who rely on their voices for their work. Persistence of such symptoms should prompt a visit to a laryngologist.

Spasmodic dysphonia:

People with this condition experience involuntary movements of one or more muscles of the larynx. This can cause difficulty in speech, or make it sound as if the patient's voice is intermittently tight, strangled, or breathy.

Laryngeal papillomatosis:

This is a disease in which benign, wart-like tumors grow inside the larynx or vocal cords, or the respiratory tract leading from the nose into the lungs. The lesions, which are caused by the human papilloma virus (HPV), may grow very quickly and frequently recur despite careful treatment. This may cause breathing problems if the patient's airway is blocked or, more frequently, hoarseness if they are on the vocal folds. Laryngeal papillomatosis can affect adults, children, and infants, with many cases occurring in children, usually before age three.

Vocal cord paralysis:

This condition occurs when one or both of the vocal cords in the larynx do not open or close properly. Vocal cords enable people to talk when air held in the lungs is released and passes through the cords, causing them to vibrate and make sounds. In addition to affecting speech, vocal cord paralysis can cause coughing and difficulty swallowing, as food or liquids may slip into the trachea (windpipe) and lungs. Although the main symptom tends to be a breathy and weak voice, symptoms of vocal cord paralysis can be more significant. The disorder can be caused by head trauma, neurologic conditions such as Parkinson's disease, a stroke, neck injury, prior neck or chest surgery, cancer, or a viral infection.

Laryngopharyngeal reflux disease (LPRD):

This condition is also called heartburn, acid reflux disease, or gastro-esophageal reflux disease (GERD). Gastro-esophageal reflux is a burning sensation in the chest that may occur after eating, bending, stretching, exercising, and lying down. GERD occurs when the contents of the stomach travel back up into the esophagus. This can happen when the lower esophageal sphincter (LES) valve, which controls the passage of food from the esophagus to the stomach, fails to close correctly. Reflux can affect the larynx and cause symptoms such as coughing, hoarseness, inflammation, and sore throat. In such cases it is referred to as laryngopharyngeal reflux disease. LPRD is thought to be one of the potential causes of laryngeal cancer but more commonly may be associated with frequent coughing, throat clearing, excess mucus and phlegm, and the sensation of a lump in the throat.

Laryngeal cancer:

Though many growths that affect the larynx are non-cancerous, cancerous tumors can also grow in the larynx. The inner walls of the larynx are lined with cells called squamous cells. Almost all laryngeal cancers begin in these cells and are called squamous cell carcinomas. If not caught early, laryngeal cancer can spread (metastasize) to nearby lymph nodes in the neck. Smokers are at higher risk than non-smokers for cancer of the larynx. The risk is even higher for smokers who drink alcohol. Fortunately, if caught early, laryngeal cancer is very treatable. Constant hoarseness while speaking is an early symptom of this type of cancer, and hoarseness that lasts longer than two weeks should prompt a visit to the otolaryngologist.

Laryngeal stenosis:

This condition is a narrowing of the airway that can cause problems with breathing. It can be caused by infection, neck injury, or prior intubation (placement of a breathing tube). Stenosis is much more common in autoimmune diseases, such as Wegener's Granulomatosis.

Dysphagia:

People with this condition have difficulty with swallowing. Some people with dysphagia may be unable to swallow solid foods, liquids, or even saliva. This can lead to the patient becoming malnourished, since he or she is unable to take in enough calories. Dysphagia can also lead to serious infections when poor swallowing causes food to get trapped in the lungs or outside the esophagus. Dysphagia happens when the larynx does not close tightly during swallowing and when the pharynx or throat does not move food to the esophagus in a coordinated or effective way. Dysphagia is often seen in patients who have suffered strokes but can also occur following neck surgery or after radiation treatments for head and neck cancer.

If you notice symptoms that you think could fit any of these conditions, consult your doctor immediately.

What are the causes of diseases of the larynx?

Conditions that affect the larynx have many causes. These include vocal abuse or overuse, which may cause vocal cord nodules, polyps, or laryngitis. Smoking and drinking can cause laryngeal cancer. Traumas or neurological conditions may cause vocal cord paralysis as well as swallowing difficulties (dysphagia).

How are diseases of the larynx diagnosed?

Diseases of the larynx are usually diagnosed by a laryngologist or otolaryngologist. He or she will first perform a physical examination which includes a scope exam to visualize the larynx and throat. Depending on your symptoms, other tests will probably be needed. These include X-rays, a biopsy (if cancer is suspected), or an additional endoscopic examination. If your doctor suspects you have vocal cord paralysis, he or she will first confirm the diagnosis with a scope exam. In some situations, they may also order a laryngeal electromyography (LEMG). This test measures the nerve input to the laryngeal muscles and can provide diagnostic and prognostic information regarding recovery of vocal fold function.

To diagnose disorders of vocal misuse such as polyps, cysts, or nodules, a laryngologist will also examine the vocal cords with a scope. Other tests that may be done to diagnose problems with the larynx include CT scans and MRIs.

How are diseases of the larynx treated?

Treatments for conditions that affect the larynx vary depending on your diagnosis. Treatment for conditions caused by vocal abuse, misuse, or overuse may be as simple as resting the voice. Voice or singing therapy might also be recommended. This is performed by a speech-language pathologist.

Surgery, radiation therapy, chemotherapy, or a combination of these treatments may be used to treat laryngeal cancer. Surgery may also be required to treat nodules, polyps, or cysts.

Treatment for conditions of the larynx and vocal cords are highly individual, depending on your condition, age, and profession. Your doctor will take all of these into account to create a personal treatment plan.

What can be done to prevent diseases of the larynx?

Quitting smoking and cutting back on drinking alcohol can help prevent laryngeal cancer.

Taking proper care not to strain the voice through excessive use or misuse can prevent conditions such as polyps and nodules. This is especially important for singers or people such as teachers or lawyers, who spend much of their day speaking. Taking time to rest your voice, maintain physical fitness, and control irritating factors such as allergy or reflux can help a good deal in preventing these conditions.

It is important to note that most conditions affecting the larynx are treatable if you seek medical attention when you first notice your symptoms. Failing to do so may mean permanent damage to the larynx and voice.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 11/8/2013…#14520

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.