Laryngology

The branch of medicine referred to as Laryngology deals with illnesses and injuries of the larynx (voice box). This is a special branch of otolaryngology, that focuses on the ear, nose and throat. The larynx or voice box is located on the front of the neck and it holds the vocal cords. It’s responsible for swallowing, breathing, and voice production. The conditions affecting the larynx can range from laryngitis and vocal cord nodules to laryngeal cancer.

What is laryngology?

When you have an issue with your larynx (voice box), you might be referred to a laryngologist. Laryngology is a subspecialty of the ear, nose and throat department (otolaryngology). Medical practitioners who work in the field of laryngology are specifically trained to take care of conditions that affect your larynx.

The larynx is located in the front of your neck that holds your vocal cords and is responsible for voice production, breathing and swallowing. It’s also the gateway to the trachea (windpipe) and plays a critical role in your airway.

What does a laryngologist do?

A laryngologist is a surgeon specialized in voice, airway, and swallowing disorders involving the larynx or glottis and the throat.

Diseases that affect the larynx

There are various conditions that can affect the larynx, including:

Benign (non-cancerous) vocal cord lesions.
Cancerous or precancerous lesions.
Infectious or inflammatory conditions.
Autoimmune conditions.
Neurologic conditions.
Airway conditions.
Vocal cord motion abnormalities.

What are the other factors that can affect the larynx?

The other factors that can also affect the larynx can include surgical procedures like thyroid, thoracic, cardiac, spine and vascular surgery. A person can experience a problem with the larynx from the placement of a breathing tube during anaesthesia or hospitalization.

Some benign (noncancerous) vocal cord conditions can be caused by misuse, overuse and vocal abuse. There are various disorders of the larynx that can be caused by injury or strain to the vocal cords through things like:

Excessive talking.
Throat clearing.
Coughing.
Smoking.
Screaming.
Singing.
Speaking too loudly or even too quietly.

Consistent vocal abuse and misuse can lead to changes in vocal function and result in hoarseness eventually. If the hoarseness (abnormal voice change) lasts longer than two to four weeks without explanation, you should see an ENT specialist (otolaryngologist).

Conditions caused due to abuse, misuse or overuse of your voice can include:

Laryngitis: This condition is an inflammation (swelling) of the vocal cords from irritation, overuse or infection.

Vocal cord lesions: In this condition, small benign nodules, polyps and cysts form on your vocal cords. Nodules are one of the most common non-cancerous vocal lesions. People who have a lot of vocal demands such as professional singers, teachers, lawyers or people that work in sales are often at the greatest risk of developing vocal cord nodules.

Vocal cord polyps: These vocal cord lesions are usually caused by an inflammation or a post-traumatic injury. They result from a vocal cord injury from heavy vocal cord demand or continuous coughing. Heavy smokers are more likely to develop polyp-like changes to the vocal cords.

·Vocal cord haemorrhage: In this condition, you might experience a sudden loss of your voice that can happen because of screaming, shouting or other strenuous vocal tasks. Whenever the blood vessels on the surface of the vocal cord ruptures, the soft tissues of the vocal cord fill with blood leading to a haemorrhage. It’s treated by resting your voice until the haemorrhage is resolved.

Spasmodic dysphonia: A rare neurologic condition of the larynx that involves the involuntary muscle contraction (spasms) of specific muscles within the vocal cords or larynx, resulting in voice problems starting from trouble saying a word or two to being not able to talk at all.

Laryngeal papillomatosis: This is a chronic (long-lasting) viral infection in which benign, wart-like tumours grow inside the larynx or vocal cords, or the respiratory tract leading from the nose into the lungs. The lesions caused by the human papillomavirus (HPV), may grow very quickly and frequently reappear despite sustained treatment. This virus may cause breathing problems if your airway is blocked or, more frequently, hoarseness if the lesions are on the vocal folds. Laryngeal papillomatosis can affect adults, children and infants.

Vocal cord paralysis or vocal cord hypomobility: This condition occurs when either or both of the vocal cords in the larynx do not open or close properly. When air held in your lungs is released and passes through the cords, vocal cords vibrate and make sounds that enable you to talk. Apart from affecting speech, vocal cord paralysis can cause coughing, a feeling of phlegm in the throat, shortness of breath while talking and difficulty in swallowing. Although the main symptom happens to be a breathy and weak voice, symptoms of vocal cord paralysis can be further significant.

Laryngopharyngeal reflux (LPR): This condition is also called acid reflux disease, gastroesophageal reflux disease (GERD) or heartburn. Gastroesophageal reflux is a burning sensation in the chest that usually occurs after eating, bending, stretching, exercising and might be worse at night. GERD happens when the stomach acid frequently travels back up into the esophagus. This can happen when a valve-like muscle called the lower esophageal sphincter (LES), which controls the passage of food from the esophagus to the stomach, fails to close correctly. This condition has more classic heartburn symptoms. Reflux can affect the larynx and cause more symptoms such as coughing, hoarseness, inflammation and sore throat which is referred to as laryngopharyngeal reflux (LPR). LPR may be associated with chronic cough, throat clearing, excess mucus and phlegm, difficulty in swallowing and the sensation of a lump in the throat.

Laryngeal cancer: Though many growths that affect the larynx are not cancerous, cancerous tumors can also grow in the larynx. The inner walls of the larynx are lined with thin, flat cells called squamous cells. Almost all laryngeal cancers begin in these cells lining the larynx and are called squamous cell carcinomas. If not diagnosed early, laryngeal cancer can spread to nearby lymph nodes in the neck. Smokers are at a higher risk than non-smokers for cancer of the larynx. The risk is even higher for smokers who also consume alcohol. Fortunately, if identified early, laryngeal cancer is very treatable.

Laryngeal stenosis: This condition is a narrowing of the vocal cord airway at any level starting from the epiglottis until the trachea, either from scarring or bilateral vocal cord immobility that can cause problems with breathing. It can be caused by various conditions, including autoimmune or inflammatory diseases such as polyangiitis with granulomatosis, traumatic injuries following placement of a breathing tube, iatrogenic conditions. These are conditions caused by medical treatment, such as thyroid surgery, progressive neurologic degenerative conditions, malignant (cancerous) conditions or rare viral infections.

Dysphagia: This condition refers to a difficulty in swallowing. Some people with the condition may not be able to swallow solid foods, liquids or even saliva. This can cause them to become malnourished since enough calories are not taken in. Dysphagia can also lead to serious infections when food gets trapped in the lungs or outside the esophagus because of poor swallowing. Dysphagia happens when the larynx (voice box) does not close tightly during swallowing and when the pharynx (throat) does not move food to the esophagus in a coordinated or effective way. Dysphagia is often seen in people who have suffered strokes, can also occur after neck surgery or some cancer treatments, such as radiation.

How are diseases of the larynx treated?

The treatment options can depend on your diagnosis for conditions that affect the larynx. If the condition has been caused by vocal abuse, misuse or overuse, the treatment can be as simple as resting the voice for a small period of time.

In some cases, the person might need more than rest to treat the condition. If the person has been diagnosed with laryngeal cancer, treatment options could include, for example:

Surgery.
Radiation therapy.
Chemotherapy.

The treatment plan might involve a combination of these therapies.

Treatment for conditions of the vocal cords and larynx can vary from a person to person. The best option for one person might not work for the other person. A few factors that will be considered when your physician is determining the best treatment plan for you can include:

Your medical condition.
Your age.
Your profession.

Doctors will usually take all the factors into account and create a personal treatment plan. Talk to the doctor about the goals and concerns about the treatment. Having an open conversation with the doctor will help in the process of treating the condition.

How to prevent diseases of the larynx?

There are several things that can be done to prevent diseases and other conditions of the larynx. such as:

Avoiding harmful lifestyle habits: Quit smoking, reducing the amount of alcohol intake can help prevent laryngeal cancer.
Do not strain the voice: Taking proper care to not strain the voice through excessive use or misuse can also prevent conditions like nodules and polyps. This is especially important for the people in professions who could strain the voice from frequent speaking or singing.

It’s important to provide rest to the voice, maintain physical fitness with a healthy lifestyle and control any irritating factors that could harm the voice. These factors can include allergies or reflux. Most conditions that affect the larynx are treatable if medical attention is sought immediately when the symptoms are noticed.