What is laryngology?
When you have an issue with your larynx — often called the voice box — you might be referred to a laryngologist. Laryngology is a subspecialty within the ear, nose and throat department (otolaryngology). Healthcare providers who work in the field of laryngology are specifically trained to care for conditions that affect your larynx.
Your voice box (larynx) sits in the front of your neck. It holds your vocal cords and is responsible for sound production and swallowing. It’s also the entrance to the windpipe and plays a critical role in your airway.
What does a laryngologist do?
A laryngologist is a surgeon with a special interest in voice, airway, and swallowing disorders involving the voice box and the throat.
What are some of the diseases that affect the larynx?
There are many conditions that can affect the larynx, including:
- Benign (non-cancerous) vocal cord lesions.
- Cancerous or precancerous lesions.
- Infectious or inflammatory conditions.
- Autoimmune conditions.
- Neurologic conditions.
- Airway conditions.
- Vocal cord motion abnormalities.
What other factors can affect the larynx?
There are other factors that can also affect the larynx. These can include surgical procedures like thyroid, cardiac, thoracic, spine and vascular surgery. You can also experience a problem with the larynx from the placement of a breathing tube during anesthesia or hospitalization.
Some benign vocal cord conditions can be caused by vocal abuse, misuse and overuse. There are several disorders of the larynx that can be caused by strain or injury to the vocal cords through things like:
- Excessive talking.
- Throat clearing.
- Speaking too loudly or even too quietly.
Eventually, frequent vocal abuse and misuse can cause changes in vocal function and result in hoarseness. If you experience hoarseness that lasts longer than two to four weeks without explanation, you should see an ear, nose and throat provider (otolaryngologist).
Some disorders that can be caused by abuse, misuse or overuse of your voice include:
- Laryngitis: This condition is an inflammation (swelling) of the vocal cords.
- Vocal cord nodules: In this condition, small, benign, callus-like, inflammatory lesions (growths) form on your focal cords. Nodules are among the most common non-cancerous vocal lesions. Professional singers and people who have a lot of vocal demands (teachers, lawyers or people that work in sales) are often at the greatest risk of developing vocal cord nodules.
- Vocal cord polyps: These vocal cord lesions are typically caused by an injury (post-traumatic) or inflammatory in nature. They result from a vocal cord injury from heavy vocal cord demand or persistent coughing. People who smoke also have a tendency to develop polyp-like changes to the vocal cords.
- ·Vocal cord hemorrhage: In this condition, you might experience a sudden loss of your voice. This can happen because of screaming, shouting or other strenuous vocal tasks. In a hemorrhage, one of more of the blood vessels on the surface of the vocal cord ruptures and the soft tissues of the vocal cord fills with blood. It’s treated by resting your voice until the hemorrhage resolves.
- Professional voice disorders: While this title implies that a person must be a professional speaker or singer, anyone who uses their voice for work is really a professional voice user. Professions that are at especially high risk include teachers, counselors, customer service representatives and sales representatives.
- Spasmodic dysphonia: This is a rare neurologic condition of the larynx that involves the involuntary muscle contraction (tightening) of specific muscles within the vocal cords or larynx. This results in your voice sounding strained, strangled or intermittently breathy.
- Laryngeal papillomatosis: This is a chronic (long-lasting) viral infection 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 reappear despite sustained treatment. This may cause breathing problems if your airway is blocked or, more frequently, hoarseness if the lesions are on the vocal folds. Laryngeal papillomatosis can affect adults, children and infants.
- Vocal cord paralysis or vocal cord hypomobility: This condition happens when one or both of the vocal cords in the larynx do not open or close properly. Vocal cords enable you to talk when air held in your 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, a feeling of phlegm in the throat, difficulty swallowing and shortness of breath while talking. Although the main symptom tends to be a breathy and weak voice, symptoms of vocal cord paralysis can be more significant.
- Vocal cord motion disorders: These disorders can be caused by surgery to the thyroid gland, vascular surgery, thoracic surgery, spine surgery, prolonged or traumatic placement of a breathing tube, or a viral infection.
- Laryngopharyngeal reflux (LPR): This condition is also called heartburn, acid reflux disease, or gastroesophageal reflux disease (GERD). Gastroesophageal reflux is a burning sensation in the chest that may occur after eating, bending, stretching, exercising and lying down. GERD happens 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. This condition has more classic heartburn symptoms. Reflux can affect the larynx and cause more atypical symptoms such as coughing, hoarseness, inflammation and sore throat. In these cases, it’s referred to as laryngopharyngeal reflux (LPR). LPR 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 metastasize (spread) 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.
- Laryngeal stenosis: This condition is a narrowing of the vocal cord airway, either from scarring or two-sided (bilateral) vocal cord immobility (inability to move) that can cause problems with breathing. It can be caused by a number of conditions, including autoimmune or inflammatory disorders such as polyangiitis with granulomatosis, traumatic injuries from prolonged intubation, iatrogenic conditions — these are conditions caused by medical treatment, such as thyroid surgery — malignant (cancerous) conditions, progressive neurologic degenerative conditions or rare viral infections.
- Dysphagia: If you have this condition, you might have difficulty swallowing. Some people with dysphagia may be unable to swallow solid foods, liquids or even saliva. This can cause you to become malnourished, since you can’t 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 (throat) does not move food to the esophagus in a coordinated or effective way. Dysphagia is often seen in people who have suffered strokes, but can also occur after neck surgery or after radiation treatments for head and neck cancer. Swallowing conditions can be quite complex and typically benefit from a multidisciplinary (team) approach involving otolaryngology, gastroenterology and speech pathology.
How are diseases of the larynx diagnosed?
Diseases of the larynx are usually diagnosed by a specialist — a laryngologist or otolaryngologist. Your provider will start with a physical exam of your throat and larynx. This might involve a scope (a small, flexible tube-like tool with a camera on the end) or a mirror that’s used to look inside your throat.
Depending on your symptoms, your provider might also want to do additional tests. These tests might include:
- Imaging studies.
- Endoscopic (using a scope) examinations.
If your provider thinks you might have vocal cord paralysis, a scope exam will be used to start the diagnosis. In some situations, your provider may also order a laryngeal electromyography (LEMG). This test measures the nerve input to the laryngeal muscles. It can help diagnose and predict if you’ll recover vocal fold function.
How are diseases of the larynx treated?
Your treatment options for conditions that affect the larynx can depend on your diagnosis. If your condition has been caused by vocal abuse, misuse or overuse, the treatment might be as simple as resting your voice for a small period of time. Your provider might also suggest voice or singing therapy to help you fully recover. This therapy is typically done by a speech-language pathologist.
In some cases, you might need more than rest to treat your condition. If you’ve been diagnosed with laryngeal cancer, for example, treatment options could include:
- Radiation therapy.
Your treatment plan might involve a combination of these therapies.
Treatment for conditions of the larynx and vocal cords can be very individual. The best option for you might not work for the next person. A few factors that will be considered when your provider is determining the best treatment plan for you can include:
- Your medical condition.
- Your age.
- Your profession.
Your healthcare provider will take all of these factors into account when creating your personal treatment plan. Talk to your provider about your goals and concerns about your treatment. Having an open conversation with your provider will help in the process of treating your condition.
What can be done to prevent diseases of the larynx?
There are several things that you can do to prevent diseases and other conditions of the larynx. These include:
- Eliminating harmful lifestyle habits: Quitting smoking and cutting back on the amount of alcohol you drink can help prevent laryngeal cancer.
- Not straining your voice: Taking proper care not to strain your voice through excessive use or misuse can also prevent conditions like polyps and nodules. This is especially important if you spend a lot of time speaking. Singers, teachers and lawyers are all examples of professions where you could strain your voice from frequent speaking or singing. It’s important to take time to rest your voice, maintain a healthy lifestyle with physical fitness and control any irritating factors that could harm your voice. These factors can include allergies or reflux.
Most conditions that affect the larynx are treatable if you reach out to your healthcare provider when you first notice symptoms. It’s important to contact your provider if you are experiencing anything unusual because some conditions can cause permanent damage to your larynx and voice.
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