Vocal Cord Issues: Recovery and Treatment Options for Athletes - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Madam, regarding your issue, it is best to visit an outpatient clinic for a laryngoscopy to understand your condition in detail.
It is important to take good care of your vocal cords on a daily basis by drinking plenty of water (especially while speaking), avoiding loud and forceful speaking, and steering clear of irritating foods, as well as foods that are too hot or too cold.
I have provided a reference article for you.
If you would like to see images, please visit the following websites:
┌─── ■ Dr.
Yeh's Otolaryngology Department Medical Electronic Newsletter ■ ──
2002/04/05
The leading dizziness specialist in the Zhukang area, Dr.
Yeh, a pioneer in online medical practice in Taiwan.

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※ This article will be organized and published in the 【Dr.
Yeh's Otolaryngology Website/Health Education】 electronic newsletter on the fifth of each month.
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【A Picture Speaks a Thousand Words – Understanding Hoarseness Through Laryngeal Images】
Explanation: This issue of the electronic newsletter includes 22 fascinating images related to various diseases.
However, it is difficult to grasp the nuances through this text alone, so I strongly recommend linking to my website for a visual reading.
Indeed, "A picture speaks a thousand words."
The larynx serves three major functions: providing an airway for normal breathing, acting as a watchdog to protect the airway from foreign objects (including food), and producing sound.
Changes in voice are often the first noticeable sign of potential laryngeal disease.
Clinically, there are many causes of hoarseness, ranging from simple functional voice disorders to life-threatening tumors.
Laryngeal images provide the best clues; sometimes, a picture is worth a thousand words.
Images 1-4: The top left, top right, bottom left, and bottom right show normal images of a male taking a breath and producing sound.
The basic principle of human voice production is as follows: exhaled air travels through the trachea to the larynx, vibrating the vocal cords to produce sound.
Typically, when taking a deep breath, the vocal cords open (Images 1 and 2), and during phonation, they come together, allowing air to escape through the narrow gap, producing sound (Images 3 and 4).
The vibration occurs primarily in the membranous portion of the vocal cords, while the cartilaginous part does not contribute to this vibration.
In fact, the vibration of the vocal cords is quite complex, involving both vertical and horizontal movements, with a wave-like motion on the surface of the vocal cords known as "mucosal wave." The quality of the voice is fundamentally determined by this mucosal wave and the elasticity and softness of the underlying Reinke's space.
The pitch of the voice is related to the frequency of vocal cord vibration and the length, thickness, and tension of the vibrating portion, while the volume is associated with the amplitude of vocal cord vibration.
The sound produced by vocal cord vibration is a simple frequency, which then travels through the pharynx, oral cavity, and nasal cavity, generating various frequencies, intensities, and patterns.
The combination of these different sounds is what we actually hear, referred to as "voice."
Case 1: Bilateral Vocal Cord Nodules.

Image 5 (left): Small nodules visible on both vocal cords during respiration.

Image 6 (right): Vocal cord closure image.

A young female teacher complains of hoarseness due to her profession, which requires prolonged speaking and shouting.
White nodules are observed on the anterior third of both vocal cords.
The causes of this condition are primarily: 1) prolonged voice use, and 2) incorrect phonation habits.
Initially, it may just be chronic laryngitis, but over time, thickening of the epithelium and irreversible changes in the subepithelial tissue occur, leading to the formation of vocal cord nodules.
Nodules are most likely to occur at the midpoint of the anterior two-thirds of the vocal cords due to the maximum vibration point during phonation.
Early detection and initiation of speech therapy can lead to gradual reduction or even resolution of the nodules.
If ineffective after more than a year of therapy, microlaryngeal surgery may be considered.
Case 2: Bilateral Vocal Cord Polyps.

Image 7 (left): Vocal cord polyps on both sides.

Image 8 (right): Magnified view of the polyps.

A middle-aged male, who smokes, drinks, and enjoys singing at karaoke, presents with phonotrauma.
This condition arises from vocal cord trauma, where loud shouting can easily cause microvascular rupture, leading to hematoma formation beneath the vocal cord mucosa, which eventually liquefies and forms polyps.
Sometimes, polyps and nodules can be difficult to distinguish, or they may lie between the two.
Clinically, vocal cord polyps are more common in men and are less related to speaking habits, while nodules are more common in women and are associated with habitual speaking.
Case 3: Dysphonia Due to Hypertrophy of the False Vocal Cords (Dysphonia Plica Ventricularis).

Image 9 (left): Hypertrophy of the left false vocal cord.

Image 10 (right): Magnified view.

A middle-aged male patient presents with hoarseness for several years, with hypertrophy of the left false vocal cord visible.
Patients with this condition often exhibit tension during phonation, making smooth speech difficult.
Some patients may have atrophy or underdevelopment of the true vocal cords, necessitating compensation by the false vocal cords to maintain subglottic pressure, resulting in hypertrophy and incorrect phonation.
Case 4: Glottic Web.

Image 11 (left): Glottic web on both vocal cords.

Image 12 (right): Magnified view showing adhesion at the anterior ends of the vocal cords after inhalation.

A middle-aged female patient, who sustained neck trauma in a car accident ten years ago and underwent several vocal cord surgeries, presents with hoarseness.
The anterior ends of both vocal cords show scarring due to mucosal damage and subsequent healing, resulting in web-like scar tissue.
This patient complains of hoarseness, and in severe cases, it may even affect breathing.
Case 5: Left Vocal Cord Paralysis.

Images 13, 14, 15 (from left to right): During phonation, the left vocal cord is paralyzed, and the right vocal cord moves towards the left side.

A middle-aged female patient underwent left thyroid surgery, injuring the left recurrent laryngeal nerve.
During phonation, the left vocal cord is paralyzed, and the right vocal cord moves towards the left side, resulting in significant breathy hoarseness and choking.
The laryngeal muscles are innervated by branches of the tenth cranial nerve (vagus nerve), specifically the superior laryngeal nerve and the recurrent laryngeal nerve.
Clinically, if a patient presents with persistent hoarseness (lasting more than 6-8 weeks) and unilateral vocal cord paralysis, further evaluation is necessary (including chest X-ray, and possibly CT or MRI) to rule out tumors in the neck, skull base, thyroid, or mediastinum.
In cases where no cause is found (which is often the case), it is termed idiopathic vocal cord paralysis.
Case 6: Bilateral Vocal Cord Paralysis.

Image 16 (left): Vocal cords come together during phonation, unaffected.

Image 17 (middle): During inhalation, both vocal cords are paralyzed and cannot abduct, leading to breathing difficulties.

Image 18 (right): A piston tracheostomy tube placed in the larynx.

An elderly female patient with bilateral vocal cord paralysis after thyroidectomy, a rare clinical scenario.
The cause is similar to unilateral paralysis, involving injury to the recurrent laryngeal nerve.
These patients typically have less difficulty with phonation but may experience breathing difficulties.
The patient underwent tracheostomy with a piston tube, allowing air to be inhaled through the piston during inhalation, while phonation occurs when air pressure is maintained against the piston.
Case 7: Left Mediastinal Lymphoma.

Image 19 (top left): Left vocal cord paralysis.

Image 20 (top right): During phonation, the right vocal cord moves towards the left paralyzed side.

Image 21 (bottom left): Chest X-ray shows abnormal widening of the upper left mediastinum.

Image 22 (bottom right): Chest CT scan preliminarily diagnosed as left mediastinal lymphoma.

A young female patient presents with hoarseness for several weeks and a firm, non-mobile mass measuring 2x3 cm palpable above the left clavicle, with no history of upper respiratory infections or neck surgeries.
Laryngoscopy reveals left vocal cord paralysis (Images 19 and 20), with the right arytenoid moving towards the left side during phonation.
Chest X-ray (Image 21) shows abnormal widening of the upper left mediastinum, initially suspected to be lymphoma.
Further CT examination (Image 22) supports this suspected diagnosis, and the patient is referred to thoracic surgery for treatment.

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Reply Date: 2005/06/19