Your voice box (or larynx) is located in the mid-neck area.  It is composed of a cartilage framework with intrinsic and extrinsic muscles that provide motion for both speech and swallowing.  Your vocal cords are made up of muscles with a layer of mucous membrane.  These muscles and mucous membranes will vibrate with contractions that produce sounds, or voice, that your mouth then forms into speech.  The vocal cords can vibrate up to 800 times per second.  The motion of the vocal cords is under neurologic control.

The signs and symptoms of voice disorders include:

  • Hoarseness (dysphonia)
  • Vocal fatigue
  • Weak or breathy voice
  • Loss of singing range
  • Loss of voice (aphonia)
  • Pitch breaks or abnormally high or low pitched voice
  • Strained voice
  • Vocal tremor
  • Pain while speaking or singing

Common conditions that may cause changes in your voice include:

  • Laryngitis (viral, bacterial or inflammatory)
  • Gastroesophageal reflux disease
  • Vocal cord nodules or polyps
  • Growths, tumors or cancer of the voice box
  • Paralysis of the vocal cords
  • Disorders of the thyroid
  • Sinusitis
  • Myasthenia gravis
  • Spasmodic dysphonia (involuntary movements or muscle spasms of the vocal cords)
  • Vocal fold dysfunction (the vocal cords move inward with breathing when they are supposed to move outward)

To evaluate your condition your physician will attempt to look at the vocal cords, which is often done via a flexible fiber-optic examination of the larynx.  This is a good way to identify growths, inflammation, infection, ulcerations or paralysis of the vocal cords.  Because the vocal cords vibrate so rapidly, a special examination called Videostroboscopy may be recommended.  This procedure is done in an ENT’s office.

Because there are many different underlying causes and reasons for vocal dysfunction, treatment options vary depending on the nature of the disorder.  Treatment options may be very simple such as voice rest, simple medical management, control of environmental or behavioral causative factors, or speech therapy.  More severe problems may require surgery, biopsy or other treatments.  Diagnosis is the most important initial step after which your physician will make treatment recommendations to you.

Flexible Fiberoptic Examination of the Larynx

A Flexible Fiberoptic Examination involves placing a small, flexible tube through the nose and down the throat to visualize the vocal cords.  It is a quick and painless procedure with use of just topical analgesia.  It is performed safely and effectively in the office.


Videostroboscopy is one of the most practical techniques currently available for recording and observing the motion of the vocal cords. It allows for easy examination of the vibration of the vocal cords during speaking or singing.  Videostroboscopy makes the visual images of the vibration appear to be seen in either stop action or slow motion, allowing minute abnormalities that influence the voice to be seen. From the resulting visual images, an accurate diagnosis of conditions and diseases of the vocal cords, including masses or lesions, abnormal motion, inflammation, broken blood vessels, scarring and other disorders can be made.

Videostroboscopy is a simple and painless procedure that is done in the office by an ENT doctor with just an anesthetic spray applied to your nose and throat. To help the physician view the vocal cords, a small, angled telescope is placed into your mouth or a flexible telescope may be placed through your nose. You will be asked to repeat several words and make specific sounds to make your vocal cords vibrate. This action is recorded so that it can be reviewed later. The examination is painless and lasts only a few minutes. You will be able to talk throughout the examination and view what is happening on a video monitor.  In many cases, the findings are reviewed with a speech pathologist so he/she can complement the physician in formulating the best treatment plan for you. Treatment options may include medication, vocal exercises, speech therapy and in some cases, surgery.