Voice and Swallowing Disorders

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IntegratedENT - Voice and Swallowing Disorders

Integrated ENT of Lone Tree offers a full range of services to cover voice and swallowing disorders, including medical, surgical, therapeutic and counseling interventions. We are dedicated to helping patients who suffer from these disorders, as well as any other disorders related to the larynx and throat, and vocal cords.

We recognize that voice and swallowing difficulties are hard to deal with personally, socially, as well as professionally, so we work hard to help patients overcome these maladies through proper diagnosis, treatment and/or rehabilitation.

Voice Disorders

A voice disorder occurs when your vocal folds become inflamed, develop growths or become paralyzed. Basically, it is any change in the voice that prevents patients from being able to do with their voice whatever it is that they need to do. This may range from a complete inability to produce speech to a subtle difference in the quality of a singer’s voice.

Causes of a Voice Disorder

Voice disorders may be the result of lifestyle choices (occupational or social vocal demands), medical problems, or a combination of the two. There are a variety of medical conditions that can lead to voice problems, and they are often gradual in onset. The most common causes of hoarseness and vocal difficulties include

  • Acute Laryngitis
  • Advanced Aging
  • Allergies 
  • Asthma
  • Benign Vocal Cord Lesions (e.g., nodules, polyps, cysts)
  • Cancers of the Head and Neck
  • Chronic Laryngitis
  • Gastroesophageal and Laryngopharyngeal Reflux Disease
  • Laryngeal Cancer
  • Laryngopharyngeal Reflux Disease (LPR)
  • Medications
  • Muscle Tension Dysphonia (MTD)
  • Parkinson’s Disease
  • Poor Speaking Technique
  • Reinke’s Edema
  • Rheumatoid Arthritis
  • Smoking
  • Spasmodic Dysphonia
  • Throat Cancer
  • Upper Respiratory Infections
  • Vocal Cord Hemorrhage
  • Vocal Cord Lesions
  • Vocal Cord Paralysis and Paresis
  • Voice Misuse and Overuse


Laryngitis is a swelling of the vocal cords usually due to an infection. A viral infection (a “cold”) of the upper respiratory tract is the most common cause of infection of the voice box. When the vocal cords swell in size, they vibrate differently, leading to hoarseness. The best treatment for this condition is to rest or reduce your voice use and stay well hydrated. Since most of these infections are caused by a virus, antibiotics are not effective. It is important to be cautious with your voice during an episode of laryngitis because the swelling of the vocal cords increases the risk for serious injuries such as blood in the vocal cords or formation of vocal cord nodules, polyp, or cysts.

Vocal Cord Lesions

Benign noncancerous growths on the vocal cords are caused by voice misuse or overuse and from trauma or injury to the vocal cords. These lesions (“bumps”) on the vocal cord(s) alter vocal cord vibration. This abnormal vibration results in hoarseness and a chronic change in one’s voice quality, including roughness, raspiness, and an increased effort to talk.

The most common vocal cord lesions include vocal nodules also known as “singer’s nodes” or “nodes” which are similar to “calluses” of the vocal cords. They typically occur on both vocal cords opposite each other. These lesions are usually treated with voice rest and speech therapy (to improve the speaking technique thus removing the trauma on the vocal cords). Vocal cord polyp(s) or cyst(s) are other common vocal cord lesions caused by misuse, overuse, or trauma to the vocal cords and frequently require surgical removal after all nonsurgical treatment options (e.g., speech therapy) have failed.

Gastroesophageal and Laryngopharyngeal Reflux Disease

Reflux (backflow of gastric contents) into the throat of stomach acid can cause a variety of symptoms in the esophagus (swallowing tube) as well as in the throat. Hoarseness (chronic or intermittent), swallowing problems, a foreign body sensation, or throat pain are common symptoms of gastric acid irritation of the throat, called laryngopharyngeal reflux disease (LPRD). LPRD is difficult to diagnose because approximately half of the patients with this disorder have no heartburn symptoms which traditionally accompany gastroesophageal reflux disease (GERD).

Your gastric acid can flow up to the throat at any time. The at-night aspect of LPRD is thought to be the hardest to diagnose because there are usually no specific symptoms while the reflux occurs. Consequently, patients will awake with throat irritation, hoarseness, and throat discomfort without knowing the cause. An examination of the throat by one of our ENT physicians will determine if stomach acid is causing irritation of the throat and voice box.

Poor Speaking Technique

Improper or poor speaking technique is caused from speaking at an abnormally or uncomfortable pitch, either too high or too low, and leads to hoarseness and a variety of other voice problems. Examples of this condition are when young adult females, in a work environment, consciously or subconsciously choose to speak at a lower than appropriate pitch and with a heavy voice. Percussive speaking, a voice too loud or focusing on the first syllable of each word, is another improper speaking technique that may result in injury or trauma to the vocal cords and muscles causing “vocal fatigue.”

Other factors leading to improper speaking technique include insufficient or improper breathing while talking, specifically breathing from the shoulders or neck area instead of from the lower chest or abdominal area. The consequence of this practice is increased tension in the throat and neck muscles, which can cause hoarseness and a variety of symptoms, especially pain and fatigue associated with talking. Voice problems can also occur from using your voice in an unnatural position, such as talking on the phone cradled to your shoulder. This requires excessive tension in the neck and laryngeal muscles, which changes the speaking technique and may result in a voice problem.

Vocal Cord Paralysis

Hoarseness and other problems can occur related to problems between the nerves and muscles within the voice box or larynx. The most common condition is a paralysis or weakness of one or both vocal cords. Involvement of both vocal cords is rare and is usually manifested by noisy breathing or difficulty getting enough air while breathing or talking. However, one vocal cord can become paralyzed or severely weakened (paresis) after a viral infection of the throat, after surgery in the neck or cheek, or for unknown reasons.

The immobile or paralyzed vocal cord typically causes a soft, breathy, weak voice due to poor vocal cord closure. Most paralyzed vocal cords will recover on their own within several months. There is a possibility that the paralysis may become permanent, which may require surgical treatment. Surgery for unilateral vocal cord paralysis involves positioning of the vocal cord to improve the vibration of the paralyzed vocal cord with the non-paralyzed vocal cord. There are a variety of surgical techniques used to reposition the vocal cord. Sometimes speech therapy may be used before or after surgical treatment of the paralyzed vocal cords or sometimes as the sole treatment. Treatment choices depend on the nature of the vocal cord paralysis as well as the patient’s voice demands.

Throat Cancer

Throat cancer is a very serious condition requiring immediate medical attention. When cancer attacks the vocal cords, the voice changes in quality, assuming the characteristics of chronic hoarseness, roughness, or raspiness. These symptoms occur at an early stage in the development of cancer. It is important to remember that prompt attention to changes in the voice facilitates early diagnosis, thus early and successful treatment of vocal cord cancer can be obtained.

Persistent hoarseness or change in the voice for longer than 2 to 4 weeks in a smoker should prompt evaluation by one of our ENT physicians to determine cancer of the larynx (voice box). Different treatment options for this cancer of the voice box include surgery, radiation therapy, and/or chemotherapy. When vocal cord cancer is found early, typically only surgery or radiation therapy is required, and the cure rate is high (greater than 90 percent).

Hoarseness or roughness in your voice is often caused by a medical problem. Contact one of our ENT physicians if you have any sustained changes to your voice.

Symptoms of Voice Disorders

Patients may experience any of the following symptoms associated with a voice disorder including

  • Breathlessness when you speak
  • Hoarseness or other change in the pitch, timbre or quality of your voice
  • Decreased speaking or singing range
  • Difficulty making the voice sufficiently loud or soft
  • Difficulty with register transitions of the speaking or singing voice
  • Increased throat clearing
  • Sensation of “something” in the throat
  • Tightness, discomfort, or a burning sensation in the throat
  • Tremor quality or abrupt starts and stops that are involuntary
  • Vocal fatigue or pain on phonation

Patients who have voice problems due to benign vocal cord lesions such as nodules, polyps, or cysts, may have issues with hoarseness, limitations in pitch, range, and volume; shortness of breath; the need to cough or clear the throat frequently; or vocal fatigue. 

Risks for Developing Voice Disorders

Professional voice users such as teachers, attorneys, salespeople, receptionists, sports coaches and participants, singers, and actors have the highest risk of developing voice disorders. This is due to the increased demand they place on their voices to do their jobs.

Diagnosing Voice Disorders

Based on your symptoms, your doctor may perform any one of the following diagnostic tests to see if you have a voice disorder:

Flexible Laryngoscope. A flexible tube containing a light and camera is inserted through your nose.

Rigid Laryngoscope. A rigid viewing tube is inserted through your mouth.

Videostroboscope. A camera is combined with a flashing light to provide a slow-motion view of your vocal cords as they move.

Treatment Options for Voice Disorders

Your ENT (ear, nose, and throat) doctor will work closely with you to understand your concerns and tailor your treatment plan to suit your needs and lifestyle. The majority of voice problems are not life-threatening and are easily treatable. Vocal disorders are usually treated with:

Allergy Treatments. For some patients, allergies create too much mucus in the throat, so allergy testing may be recommended in order to pinpoint the allergen and provide subsequent treatment.

Botox Injection. Botox is injected into your neck to decrease muscle spasms or abnormal movements that affect the vocal muscles of the larynx.

Medication. Medication can help to reduce inflammation, treat gastroesophageal reflux or prevent blood vessel regrowth. They can be taken orally, injected into the vocal cords or applied topically during surgery.

Surgery. Surgery recommendations are usually dependent on your diagnosis but may include removal of lesions (polyps, nodules, and cysts) from the vocal cords using microsurgery, carbon-dioxide laser surgery, or potassium titanyl phosphate (KTP) laser treatment.

Voice Therapy. Speech pathology specialists can teach you how to use your voice more efficiently through voice therapy, which involves vocal and physical exercises coupled with behavioral changes.

For cases where one vocal cord may stop moving (becomes paralyzed), there are two procedures that can be done to push the paralyzed vocal cord closer to the middle of the windpipe so that the vocal cords can meet and vibrate closer together. This is done to improve the voice and allows the larynx to close when you swallow.

Fat or Collagen Injection. Body fat or synthetic collagen is injected through your mouth or the skin on your neck to add bulk to the paralyzed vocal cord or to treat vocal cord weakness.

Thyroplasty. For this procedure, a small opening is created in the cartilage from the outside of your voice box (larynx), and an implant is inserted through the opening and is pushed against the paralyzed vocal cord, moving it closer to your other vocal cord.

Swallowing Disorders

Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder.

Process of Swallowing

People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces.

The process of swallowing has four related stages:

  • The first stage is the oral preparation stage, where food or liquid is manipulated and chewed in preparation for swallowing.
  • The second stage is the oral stage, where the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
  • The third stage is the pharyngeal stage which begins as food or liquid is quickly passed through the pharynx, the region of the throat which connects the mouth with the esophagus, then into the esophagus or swallowing tube.
  • In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.

Although the first and second stages have some voluntary control, stages three and four occur involuntarily, without conscious input.

Causes of Swallowing Disorders

Difficulties in swallowing may be due to a range of issues, including something as simple as poor teeth, ill-fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: hypertension; diabetes; thyroid disease; stroke; progressive neurologic disorders (e.g., Parkinson’s Disease, Multiple Sclerosis); the presence of a tracheostomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.

Swallowing difficulty can also be connected to some medications including:

  • Nitrates
  • Anticholinergic agents found in certain antidepressants and allergy medications
  • Calcium tablets
  • Calcium channel blockers
  • Aspirin
  • Iron tablets
  • Vitamin C
  • Antipsychotic
  • Tetracycline (used to treat acne)

Any interruption in the swallowing process can cause difficulties. Eating slowly and chewing thoroughly can help reduce problems with swallowing.

Symptoms of Swallowing Disorders

If you are having any of the following symptoms, you should get checked for a possible swallowing problem, including:

  • Coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing and being sucked into the lungs.
  • Discomfort in the throat or chest (when gastroesophageal reflux is present)
  • Drooling
  • Frequent choking on food
  • Feeling that food or liquid is sticking in the throat
  • Pain when swallowing
  • Recurring pneumonia (indicates that food may be going into the lungs rather than the esophagus)
  • Sensation of a foreign body or lump in the throat
  • Voice change
  • Weight loss and Inadequate nutrition (due to a prolonged or more significant problem with swallowing)

Diagnosing Swallowing Disorders

When dysphagia is persistent and the cause is not apparent, our ENT physicians will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors. Sometimes a small tube (flexible laryngoscope) is placed through the nose and the patient is then given food to eat while the scope is in place in the throat. These procedures provide visualization of the back of the tongue, throat, and larynx (voice box). These procedures are called FEES (Fiber optic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing). If necessary, an examination of the esophagus, named TransNasal Esophagoscopy (TNE), may be carried out by one of our ENT doctors. If you experience difficulty swallowing, it is important to seek treatment to avoid malnutrition and dehydration.

Other tests that may be performed include:

Cineradiography. This is an imaging test in which a camera is used to film internal body structures. During the test, you will be asked to swallow a barium preparation (liquid or other forms that light up under X-ray). An X-ray machine with videotaping capability will be used to view the barium preparation movement through the esophagus. This is often performed under the guidance of a speech pathologist, an expert in swallowing as well as speech.

Upper Endoscopy. An endoscope, a flexible narrow tube, is passed into the esophagus and projects images of the inside of the pharynx and esophagus on a screen for evaluation.

Manometry. This test measures the timing and strength of esophageal contractions and muscular valve relaxation.

Impedance and pH Test. This test can determine if acid reflux is causing a swallowing problem.

Treatment Options for Swallowing Disorders

Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is usually tailored to the particular cause of the swallowing disorder.

Gastroesophageal reflux can often be treated by changing eating and living habits in these ways:

  • Eat a bland diet with smaller, more frequent meals.
  • Eliminate tobacco, alcohol, and caffeine.
  • Reduce weight and stress.
  • Avoid food within 2 hours of bedtime.
  • Elevate the head of the bed at night.

If these don’t help, antacids between meals and at bedtime may provide relief.

Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.

Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist or a speech-language pathologist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutrition expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.

Once the cause is determined, swallowing disorders may be treated with:

  • Medication
  • Swallowing therapy
  • Surgery

Surgery is used to treat certain problems. If a narrowing exists in the throat or esophagus, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and can be performed by one of our ENT physicians.

Many diseases contribute to swallowing disorders. If you have a persistent problem swallowing, please make an appointment with one of our ENT doctors.

Swallowing Disorders Left Untreated

Some people don’t realize they have a swallowing problem and just decide to eat foods that are easier to eat or they eat more slowly. If a swallowing problem is left untreated, however, it raises your risk for choking or having large pieces of food lodge in your esophagus.

Contact Us

If you become hoarse frequently or notice a voice change for an extended period of time, please contact Integrated ENT at (303) 706-1616 for a voice disorder consultation. Likewise, if you believe you are suffering from a swallowing disorder, please contact us to set up a consultation. You may also request an appointment online.