ENT physicians are also trained in the field of laryngology, which now includes further training for ENT physicians to become a laryngologist.  Laryngology is a branch of ENT that specializes in the diagnosis and treatment of diseases affecting the larynx (voice box), upper airway, and swallowing disorders.

Any patient that has prolonged voice changes or hoarseness that does not improve or resolve in a routine time period, such as 1-3 months, should be evaluated by an ENT.  Hoarseness can be considered any voice change perceived by the patient, which may include other symptoms such as voice fatigue, low pitch, vocal breaks or unreliable voice, breathy voice or shortness of breath with speaking, increased effort to speak, rough voice quality, and frequent throat clearing.  

During the evaluation, a detailed history will be taken and patients will undergo examination of the larynx (voice box) with scopes to directly look at the vocal cords in the office.  This exam helps the doctor look for changes of the vocal cords, such as nodules, polyps, lesions, or weakness of the vocal cords.

Vocal cord nodules, polyps, and cysts are a group of benign (non-cancerous) lesions on the vocal cords that can lead to voice changes or hoarseness. Often these lesions arise in patients with high vocal demands or voice overuse.  Nodules are similar to calluses that form on the vocal cords, typically involving both vocal cords. These can arise in any age group, often presenting in children and adults.   Vocal cord polyps are typically unilateral or involving one vocal cord, and can vary in appearance.  Vocal cord cysts are a firm mass of tissue that like polyps are often unilateral and can affect different areas of the vocal cord.  Treatments for the above conditions range from voice therapy, lifestyle changes, and surgery. 

Professional voice encompasses any patient that requires his/her voice to complete daily work requirements or demands.  This group of patients varies widely depending on the voice use.  Professional voice includes patients who not only speak a lot during the day, such as teachers and customer service representatives, but also singers, whether for pleasure or for a job.  For professional voice patients, evaluation of the larynx (voice box) is highly encouraged if voice changes or hoarseness develops sooner rather than later, so if changes to the vocal cords are noted, these can be addressed and hopefully corrected in a timely manner.   

Vocal cord paresis (weakness) or paralysis (no movement) results in weakened motion or no motion of one or both vocal cords, which can lead to significant voice and swallowing changes.  Vocal cord paresis or paralysis can occur for a variety of reasons including surgical, trauma to the neck, prior intubation injury, tumors in the skull base, neck, and chest, and viral infections.   Patients may notice a weak or breathy voice, shortness of breath with speaking or noisy breathing. Patients may also have coughing or choking when swallowing.  Treatment options vary from speech therapy to surgery on the vocal cord with injections or implants to correct the problem. 

Neurologic changes can involve the vocal cords and lead to voice changes.  Spasmodic dysphonia (SD) and vocal tremor are two of the more common causes.  These disorders can lead to “spasms” or tremors of the vocal cords which causes interruptions in speech and changes to vocal quality.  These disorders may require treatment with a speech therapist, neurologist, or possible injections into the vocal cords themselves to help dampen the spasms or tremors.