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Dear Dr. Spector

I was born with a hoarse voice and I was wondering if it was a problem with my vocal chords and if it can be changed. My whole life I have sounded like I have laryngitis and I am now 19 and it has not changed. I can't yell or sing and when i get the tiniest of colds I am mute. Please if you have any advice I would be grateful.

Thank you

Roxanne

Athens, PA

Dear Roxanne,

There is a good chance that you would benefit from a visit to your local ENT, especially one that has a special interest in voice problems. The fact that you have had these symptoms your entire life opens up a larger range of more uncommon vocal problems, but still far and away the most common problem is a lesion on the vocal cords themselves. Given the length of time you have had the problem, any lesion found on your cords will almost always be benign, although this would be confirmed.

During your first visit to the laryngologist, he or she will undoubtedly visualize your vocal cords, and may likely be able to give you a diagnosis and plan for improvement right on the spot. If it looks to be a polyp or cyst, you will likely be scheduled for a procedure for removal, which in some cases can be performed in the office, although many people choose to have the procedure under anesthesia for comfort. Sometimes, an office procedure called a videostroboscopy will be scheduled first to gain more information about the lesion prior to its removal, and you will likely get to see the problem yourself.

Here is an example of a common lesion of this type on a right vocal cord, photographed during the procedure for its removal:

The procedure is usually less than an hour, and often results in minimal time away from work, except for the fact that you will likely be asked to rest your voice completely for several days. Additionally, you may require speech therapy for a more rapid return to normal voice, since it sounds like you've never had one.

If the laryngologist does not see any obvious abnormalities, certain problems with your ability to control your vocal cords may be the issue, and speech therapy is usually the first intervention. This can be quite helpful in certain situations, such as with the gentleman who asked the prior question regarding his lifelong high pitched voice.

Prior to a visit to the ENT, a two week trial of complete voice rest may improve the situation completely, as is the case when someone has vocal cord nodules, which usually develop as a result of misuse of the voice, such as with prolonged loud speaking. Nodules are very similar to callouses that you may form on your hands from such activities as playing the guitar or hard work. Voice rest, however, means no speaking or whispering at all. This can be difficult, and requires planning.

Thank you for your question!

Jared E. Spector, MD

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