Conditions & Treatments > Voice Disorders


  • Acid Reflux GERD + Video
  • Hoarseness
  • Evaluation Larynx
  • Laryngeal Function
  • Fiberoptic laryngoscopy video
  • Transnasal Esophagoscopy + Video
  • Vocal Cord Injection + Video



Acid Reflux - GERD


A common cause of hoarseness in older adults is gastroesophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Many patients with reflux-related changes of voice do not have symptoms of heartburn.

Usually, the voice is worse in the morning and usually improves during the day. These people may have a sensation of a lump in their throat, mucous sticking in their throat or an excessive desire to clear their throat.








hoarsnessHoarseness is a general term which describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal folds which are the sound producing parts of the voice box (larynx). While breathing, the vocal folds remain apart (see A). When speaking or singing, they come together (see B) , and as air leaves the lungs, they vibrate, producing sound. The more tightly the vocal folds are held and the smaller the vocal folds, the more rapidly they vibrate. More rapid vibration makes a higher voice pitch. Swelling or lumps on the vocal folds prevent them from coming together properly, which makes a change in the voice.

There are many causes of hoarseness.

Fortunately, most are not serious and tend to go away in a short period of time. The most common causes are acute laryngitis which usually occurs due to the swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.
More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singer nodes), which are callous-like growths, or may lead to polyps of the vocal folds (more extensive swelling). Vocal nodules are common in children and adults who raise their voice in work or play. Uncommonly, polyps or nodules may lead to cancer.

Hoarseness and other voice changes should be evaluated by an otolaryngologist if:

It last longer than 2 weeks

Complete loss or severe change in voice lasting longer than a few days

It is associated with:

  • Pain not from cold or flu
  • Coughing up blood (hemoptysis)
  • Difficulty swallowing (dysphagia)
  • Painful swallowing (odynaphagia)
  • A lump in the neck

Evaluation – Larynx


An otolaryngologist will obtain a thorough history of your voice issues and your general health. Occasionally a very small lighted flexible scope (flexible fiberoptic laryngoscope) may need to be passed through your nose (or in some cases, a rigid scope may be used which is placed in the back of your mouth) in order to view your vocal folds.

These procedures are not uncomfortable and are well tolerated by most patients. A local anesthetic is applied to the nasal passageways to allow for the procedure to be easily tolerated. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice may be recommended. These measure voice irregularities, how the voice sounds (acoustic content), airflow and other characteristics that are helpful in establishing a diagnosis and guiding treatment.

Function – Larynxlarynx


The larynx or “voice box” is a complex structure that consists of a number of cartilage structures, muscles, and a mucosal lining that work in conjunction to help in respiration (breathing), deglutition (swallowing) and phonation (speaking).

The key structures that allow us to speak are the vocal cords. When we speak, the vocal cords come together (adduct) and vibrate. They are also very important is protecting the lungs as they adduct when we swallow. During breathing, our vocal cords spread apart or abduct.




Fiberoptic laryngoscopy video











Transnasal esophagoscopy (TNE)

Transnasal Esophagoscopy is a test to look at your esophagus (the food tube that goes from your mouth into your stomach).  This test is done by passing a flexible viewing tube through your nose and the back of your throat into the esophagus.  We do this test to find the cause of problems with your voice or with swallowing, heartburn, and other symptoms.  Pictures might be taken or a small sample of tissue removed (biopsy).  This depends on what your doctor finds.

In-office transnasal esophagoscopy (TNE) is performed without the need for intravenous or oral anesthesia or analgesia. The new esophagoscopes are narrow enough (5.1 mm) to pass through the nose, and they provide essentially the same patient safety and comfort levels as do transnasal fiberoptic laryngoscopes. In addition, these esophagoscopes can be used to perform air insufflation and obtain biopsy specimens.



TNE is particularly useful for examining patients who have reflux disease, swallowing disorders, strictures, and other esophageal pathologies.

The benefits of TransNasal Esophagoscopy are that you get immediate results, it is less costly, and you can return to work the same day after the examination since no intreaveneous sedatives are used.

Getting Ready for TNE

  • Do not eat or drink for 4 hours before the test.  If you need to take medicine, take it with a small sip of water. 
  • Tell the nurse or doctor if you have any allergies to Lidocaine or other medicines ending with "caine".
  • Tell us before the test if you are taking blood-thinners (warfarin or Coumadin®).  You must ask your local doctor if you are able to stop the drug for a couple of days before the TNE exam.  If you do not tell us about taking these drugs, you would have an increased risk of bleeding that could be life-threatening.  Please call the ENT clinic at least 4 days before the test if you have any questions about this.
  • For 5 days before your TNE, do not take aspirin or medicines containing aspirin.  Do not take the anti-inflammatory drugs (ibuprofen, Rufen®, Advil®, Naprosyn®, Feldene®).  Acetaminophen (Tylenol®) is OK. 
  • If you have an artificial heart valve, serious heart murmur, or joint replacement, please tell us when you schedule your appointment.  You may need antibiotics to prevent infection.



Vocal cord injection


Patients with vocal cord paralysis suffer from hoarseness due to incomplete contact between the vocal cords. This condition can also be dangerous as food or secretions may enter into the lungs due to poor closure of the airway by the vocal cords.

True vocal cord injection (injection laryngoplasty) is a simple, minimally invasive procedure in which the paralyzed cord is infiltrated with biocompatible material to allow for proper contact and closure of the true vocal cords. One such material that is commonly and effectively used is Cymetra, an FDA approved product made from decellularized human donor tissue. Radiesse is another product that demonstrates promise in injection laryngoplasty and may last longer than other materials currently used.




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