Voice Disorders

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A chronic cough is a cough that lasts eight weeks or longer in adults or four weeks in children. While often seen as a minor annoyance, chronic cough can disrupt sleep, cause fatigue, and in severe cases, lead to vomiting, lightheadedness, or even rib fractures.

Causes and Contributing Factors:

• Upper airway irritation: Postnasal drip, allergies, or sinus issues
• Lower airway conditions: Asthma, chronic bronchitis, or other pulmonary disorders
• Gastroesophageal reflux: Acid reflux triggering irritation in the throat
• Laryngeal hypersensitivity: Increased sensitivity of the larynx and airway can cause an exaggerated cough response to otherwise minor triggers.
   

Common Triggers:

• Talking for long periods or speaking loudly
• Sudden changes in temperature or exposure to cold air
• Strong odors, smoke, or perfumes
• Eating or drinking certain foods that irritate the throat
   

For patients whose cough persists despite medical management, behavioral speech therapy is the primary treatment. Therapy is most effective when conducted in collaboration with a laryngologist (ENT specializing in voice and swallowing) to ensure comprehensive care.

Targeted Therapy Includes:

• Strategies to reduce cough frequency and intensity
• Techniques to improve airway control and coordination 
• Strengthening of respiratory and vocal support
• Identification and management of personal cough triggers and maladaptive habits, such as throat clearing or vocal strain
   

By addressing laryngeal sensitivity and implementing targeted behavioral strategies, patients can regain control over their cough, improve comfort, and protect both voice and airway health.

To understand paradoxical vocal cord dysfunction (PVCD), it is helpful to know how the vocal cords function normally. 

When you breathe in (inhale) the vocal cords open, allowing air to flow into your windpipe (trachea) and reach your lungs. However, with PVCD, the vocal cords close together, or constrict, when the person inhales. This leaves only a small opening for air to flow into the windpipe. PVCD occurs on and off. 

Patients with Paradoxical Vocal Cord Dysfunction often complain that they have trouble breathing in, feel tightness in the throat, hear noisy breathing from their throat (stridor), and sometimes have a cough or clear their throats with the episodes. 

A special type of speech therapy is a very important part of the treatment for PVCD. Special exercises increase a person’s awareness of abdominal breathing and relax the throat muscles. Speech therapy focuses on decreasing tension in the larynx by helping patients focus on exhaling rather than inhaling. Diagnosis and treatment plan is completed in collaboration with your pulmonologist and laryngologist. 

Dysphonia refers to having an abnormal voice. It is also known as hoarseness. Dysphonia has many causes. Changes to the voice can occur suddenly or gradually over time. The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely. There may be voice breaks where the voice completely stops or cuts out. There may be pitch changes, either higher or lower for the patient. The patient may have a complete loss of voice for a period of time as well. 

Sometimes the patient will complain of pain with speaking or singing and difficulty projecting the voice. Most commonly, dysphonia is caused by an abnormality with the vocal cords (also known as vocal folds) but there can be other causes from problems with airflow from the lungs or abnormalities with the structures of the throat near the vocal cords.

The overall goal for the patient with dysphonia is optimal long-term voice quality and communication function with minimal recurrence. Diagnosis and treatment should be both efficient and effective. Voice therapy is an integral component of intervention and contributes to both its efficacy and efficiency. 

Vocal cord nodules, sometimes called singer’s or screamer’s nodes, can form if you’re repeatedly misusing or overusing your voice. These callus-like growths develop in the midpoint of your vocal cords. This part of the vocal cords gets used most often when you’re using your voice. Often, nodules develop on both vocal cords. 

Vocal cord polyps, like nodules, can result from repeatedly overusing or misusing your voice. They can also form after a single episode of vocal abuse (like yelling at a sports event). Polyps can vary in size and shape, but they’re usually larger than nodules. They typically form on one vocal cord, but the friction from a single polyp rubbing against the other vocal cord may cause an additional polyp to form. 

Voice therapy teaches how to use your vocal cords so they can heal. It can also teach you how to prevent lesions or voice injuries in the future. Nodules are typically treated conservatively with voice therapy under the guidance of a speech therapist and in collaboration with your laryngologist.

In collaboration with your laryngologist, pre-operative voice therapy is helpful in establishing a comprehensive vocal hygiene program to encourage optimal post-surgical recovery, including education as to post-surgical vocal guidelines. Post-surgical voice therapy typically involves vocal exercises designed to encourage healing, improve vocal quality, and prevent future lesions from occurring. Specifically soft vocal onset (i.e. easy onset voicing practice) is encouraged as an early mode of voice production using the typical /h/ sound to initiate words and then voicing after he initial easy contact of the vocal folds. 

Presbyphonia, also known as Aging Voice disorder occurs during the aging process. It is brought on by decreased use and volume of the respiration system, as well as decreased activity in the vocal muscles. Presbylarynx is the aging of the larynx, causing stiffness of the joints and cartilages around your larynx. Lower activity of the vocal muscles, a decrease in collagen and vocal cord mucosa change (thinner for men, thicker for women). 

Using specialized voice therapy, we can target vocal cords in order to increase voice strength. Good vocal hygiene is a must. Breath support techniques will improve respiratory capacity as well as vocal volume and production. It is good practice for the speech pathologist to teach the patient how to project his voice. This improves volume without putting more effort on the vocal mechanism.