What is Voice Clinic?
If your voice has changed or you have become hoarse, it is important that you see your ENT Consultant immediately.
The medical term dysphonia means a change in the voice, including hoarseness, and the similar term aphonia means complete loss of voice (usually reduction to a tiny whisper.)
It is absolutely essential to see your ENT doctor if you have been hoarse for longer than three weeks, particularly if you are or have been a smoker.
The problem will get better over a few days and your doctor may advise you to:
- rest your voice and use it gently and sparingly
- drink plenty of liquids, particularly water, and to avoid alcohol, tea and coffee
- stop smoking (preferably forever!)
- take simple painkillers regularly, if necessary (paracetamol or soluble aspirin)
- start or increase antacid medication if acid reflux is thought to be a factor in your case.
ENT surgeon who may specialize in throat problems a laryngologist will assess you. Here, they will have all the expertise and equipment required to examine your throat and larynx (voice box) and usually make an accurate diagnosis at this first visit. They can also decide immediately in most cases what is the best treatment for your problem.
What does the examination of my larynx (voice box) require?
With you comfortably seated, the surgeon or speech therapist will pass a small narrow, highly flexible teleSCOpe (fibreoptic endoscope) through your nose and into the back of your throat. This gives the most detailed view of your throat and larynx with its vocal folds. In almost every patient it gives an instant and accurate diagnosis. It also allows the speech therapist and surgeon to ask you to talk/sing/swallow so that they can see your larynx working. This examination in the clinic means that people do not have to be admitted to hospital (as was necessary in the past) and most people only require a small amount of local anesthetic to be placed in the nose. The
examination is NOT painful and even children and the most nervous adults can be successfully examined without distress.
After a diagnosis is made, what treatments are used for hoarseness?
Depending on the cause of your hoarseness or voice change, the following treatments may be necessary and these will be explained to you by your specialists. The majority of patients attending a voice clinic require treatment by a speech therapist. surgery is only occasionally required and is often undertaken after. or in combination with speech therapy.
- Speech therapy
Speech and language therapists in the Pakistan have a detailed university and scientific training in all the complex aspects of the human voice. The therapy is aimed to restore the best possible voice for the patient. This begins with educating all the patients in how to care for their voice (vocal hygiene) and helping the patient to understand the lifestyle factors and any stresses which have led to the hoarseness. Reduction or removal of these factors is often essential in restoring a good voice and the therapist is able to continuously monitor and measure the patient’s progress.
Voice therapy may involve additional advice about posture and body position and breathing exercises. Voice exercises may be given that are specific to each patient depending on the problem.
Occasionally direct massage to the muscles of the neck around the larynx (manual therapy) is used to relax excessive tension in this area.
This therapy requires the patients understanding and cooperation to be successful, particularly in those patients who have had problems for many months or years and where factors such as stopping smoking or alcohol abuse are very important.
Surgery is only required in the minority of patients with hoarseness or change in their voice. A list of possible procedures is discussed in the adjacent patient information section of this website entitled Hoarseness or Chan ;e in Voice.
Microlaryngoscopy (examination and operations on the larynx)
If the ENT or voice clinic examination shows a swelling or tumour in the larynx, usually on one or both of the vocal folds, then an examination and operation under a general anaesthetic may be required. This is called a microlaryngoscopy. This examination and any surgery are best undertaken once the patient has been assessed and advised what to do both before and after the surgery, includiing the immediate period after the operation and the long-term.
Microlaryngoscopy is done while the patient is comfortably asleep under full general anaesthesia. (This is explained to the patient upon admittance to the hospital.) While the general anaesthetic is being administered, the laryngologist passes special telescopes and laryngoscopes through the mouth and down the patient’s throat into the larynx. The use of these finely-tuned instruments allows a clear view of the larynx; this view can be considerably magnified by additional used of a special operating microscope, which is the reason for the name: microlaryngoscopy. This procedure also enables the laryngologist to accurately assess any swellings and disease and in many cases to completely remove these with further specialised instruments or by means of a laser. The following are some of the swellings and diseases that require may require microlaryngoscopy:
- Vocal Nodules: These common and relatively simple swellings of the vocal folds are usually diagnosed at the examination in the outpatient clinic. They do NOT usually need an operation. They will get better and disappear if the patient follows the instructions and advice of the Speech and Language Therapist. The patient should proceed to surgery on the advice of the therapist if conservative measures have not resolved the nodules, or there is any doubt as to whether they are the correct diagnosis.
- Vocal polyps: Once a polyp has formed on a vocal fold it is rare that for it to resolve itself, even if the patient follows the speech and language therapist’s advice. For this reason, polyps require removal by the laryngologist during the microlaryngoscopy. A polyp,a nd indeed any other tissue removed during microlaryngoscopy, is sent to the hospital histopathology laboratory so that it can be accurately examined by a specialist pathologist to be certain of the correct diagnosis.
- Benign cysts: papillomas. and tumours: Cysts and benign tumours are both rare (there are different types which occur in both children and adults) but usually require removal for pathology examination and to treat the hoarseness successfully.
- Malignant: tumour (cancer) of the larynx: At microlaryngoscopy, the laryngologist can take a small portion of any cancer to send it to the histopathology laboratory for exact diagnosis.This is known as a biopsy. If the cancer is small enough (usually because the patient went early to their doctor when they became hoarse) iit may be possible to remove it all at this operation.
Unfortunately if the cancer is larger it may require treatment by radiotherapy (often 4-6 weeks of treatment) or an open operation through the skin of the neck to remove part (partial laryngectomy) or all (total laryngectomy) of the larynx. It cannot be emphasised enough that patients with hoarseness for more than 3 weeks must see their doctor urgently.
Summary: How can I prevent hoarseness?
- Do not use your voice for too long or too loud. Do not scream and shout, particularly against background noise
- Use a microphone when possible if you need to project your voice so that many pe0ple can hear you, particularly if you are a professional voice user such as a teacher, lecturer, singer, actor, or in a similar profession
- Seek professional voice training
- Do not continue straining your voice when it is hoarse or injured
- If you smoke – STOP”
- Avoid things that dehydrate you such as caffeine (excessive amounts of tea/coffee) or alcohol. Drink plenty of water (particularly if you are using your voice for long periods as. for example, a teacher. singer, actor, salesperson)
- Avoid secondhand smoke