Treatment of Voice Disorders

The three main treatments for voice disorders are:

• Medical treatments
• Voice therapy
• Surgical treatments

Each type of treatment has specific indications and outcomes.

Typically, voice disorders are addressed with a combination of treatment approaches. For example, patients with voice disorders caused by backflow of stomach fluids to the voice box (reflux laryngitis) may be treated with both anti-reflux medication and voice therapy. (For more information, see Reflux Laryngitis.)

In most cases, voice function can be improved or resolved with appropriate treatment.

As with treatment of any disease, accurate identification of the voice disorder's cause is key to an effective treatment plan.

Advances in general medicine have also advanced treatment of voice disorders. For example:

• New anti-reflux medicines provide effective medical treatment for reflux laryngitis. (For more information, see Reflux Laryngitis.)
• Effective monitoring and treatment of low thyroid hormone levels help patients with voice disorders caused by hypothyroidism.
• Advances in the use of botulinum toxin, type A as an injected medicine for muscle disorders provides a key treatment option for voice disorders caused by muscle spasm (spasmodic dysphonia). (For more information, see Spasmodic Dysphonia.)

Voice therapy is an important part of treatment for many voice disorders.

• Voice therapy is designed to treat the most common underlying cause of voice disorders: voice misuse and abuse. (For more information, see Voice Therapy.)
• Voice therapy is often combined with other treatment approaches.
  • Laryngologists often recommend voice therapy as first-line treatment for voice disorders in which voice misuse or abuse has contributed to long-term irritating injury to the vocal folds, resulting in lesions (such as vocal fold nodules, cysts or polyps). When a patient's case is not complicated, voice therapy can help patients eliminate harmful voice habits through proper voice technique. Over time, voice therapy can make the lesions much smaller or go away completely. (For more information, see Vocal Fold Nodules, Polyps, Cysts, and Reactive Lesions.)
  • Voice therapy is also indicated when voice misuse or abuse results in vocal fold scarring. Although unable to remove scarring, voice therapy can prevent further worsening of vocal fold scar and/or can help patients gain some voice function with proper voice technique.
  • For patients who have had surgery to remove a vocal fold growth (cancerous or non-cancerous), voice therapy plays a key role in guiding recovery and rehabilitation of voice function. (For more information, see Voice Therapy.)

• Surgical treatments of voice disorders have improved dramatically in recent years.
• This improvement is due to dramatic changes in surgical techniques based on:
  • Better understanding of voice function (voice physiology)
  • Better understanding of the impact of voice disorders on voice function (voice pathophysiology)
  • Better surgical instrumentation
  • Better medical and voice therapies
• The main surgical approaches to voice disorders are:
  • Phonomicrosurgery: Surgical techniques that are performed with a microscope for viewing (microsurgical techniques) and are used to remove vocal fold lesions or abnormalities that hamper vocal fold vibration (For more information, see Phonomicrosurgery.)
  • Laryngeal framework surgery: Surgical manipulation of voice box framework that improves vocal fold closure, which is important for vocal fold vibration during speaking and singing
  • Injection augmentation: Surgical injection of fat or other substance to add bulk to vocal folds for better vocal fold closure (For more information, see Framework Surgery and Augmentation.)

There are three keys to any successful treatment for a voice disorder.

1. Accurate identification of cause
   • Targeting the correct treatment plan requires the accurate identification of the cause or causes of a patient's voice disorder. This is the key first step to any and all treatment plans.
   • Additionally, if more than one cause is contributing to a patient's voice disorder, all causes need to be identified for an effective treatment plan. Missing one cause may result in less than optimal results.
2. Voice physician or voice care team
   • Voice disorders are best treated by a physician who specializes in voice (laryngologist), just as a cardiac problem is best treated by a cardiologist.
3. State-of-the-art treatment strategies
   • Treatment strategies for voice disorders have been greatly improved in recent years. Patients with voice disorders should seek medical consultation for their voice problems, whether these problems are old or new.

The state of the art in phonomicrosurgery continues to evolve. The addition of high-magnification binocular microscopy, microsurgical instrumentation, and extended applications of laser technology have revolutionized the status of laryngeal and airway surgery.

Advisory Note