What is a vocal atrophy?
Vocal atrophy is the thinning of one or both vocal muscles. This may be as a normal consequence of aging or due to a nerve injury. Additionally, some people simply have thinner vocal muscles than others, giving the picture of vocal atrophy.
What does that mean?
Vocal cords consist of many layers. Aside from the lining and a jelly-like layer, there is a muscle layer. This muscle is critical for vocal cord motion. When it is activated, the vocal cords are brought to the middle so that voice can be produced. However, if the muscle is not bulky enough, the cords are not able to completely touch in the middle.
This results in a weaker voice. The loss of muscle bulk is called vocal atrophy. Atrophy may happen as a normal consequence of aging or can be due to a nerve injury. Some people have naturally thinner vocal muscles.
The most common cause of atrophy is aging. All the muscles in the body thin with aging and the vocal muscle is no exception. Additionally, anything that injures the nerve can result in atrophy. Constant nerve supply is necessary for the muscle to stay bulky. If the nerve is injured, it is unable to stimulate the muscle to stay bulky. With prolonged nerve injury, the muscle gets thin. Some causes of nerve injury include:
- Trauma (surgery of the neck or chest, stab or gunshot wounds, whiplash)
- Intubation for surgery
- Tumors of the neck or chest
In some people, a cause is never found and the muscle is just discovered to be thin.
What kind of surgery can result in nerve injury?
The most common surgeries that affect the laryngeal nerves include:
- Thyroidectomy (partial or total)
- Neck dissection
- Carotid surgery
- Spinal surgery (with a neck incision)
- Heart surgery
- Mediastinal mass (thymoma, lymph nodes, etc)
- Long surgery of any kind (due to a long period of breathing tube placement)
- Esophageal surgery
Atrophy or thin vocal cords result in their inability to touch each other during speaking or singing. There is a gap between the vocal cords that may be referred to as “glottic insufficiency.” The symptoms of this gap vary according to its size. Symptoms are:
- Vocal fatigue
- Difficulty with projection
- Reduced vocal range (usually loss of top notes)
- Effortful speech
- Breathy voice (sound of air escaping while speaking)
- Unstable or wobbly voice
- Inability to hold a note for a long time
- Pitch breaks during a long note
Vocal atrophy will appear as thin vocal muscles. This usually is seen as a deeper shadow on the sides of the vocal cords. Additionally, when the patient tries to speak, their vocal cords will not touch in the middle. There will be a gap between the vocal cords.
On stroboscopy, the cords vibrate less because they do not contact to initiate vibration.
The only way to know if your symptoms are due to atrophy is to have your vocal cords examined. This requires the use of videostroboscopy or flexible laryngoscopy by a laryngologist.
Are there possible complications of atrophy?
There are complications of atrophy, particularly when it is severe. Complications include:
- Vocal fatigue
- Difficulty with projection, unable to be heard
- Inability to sing
How can I avoid having a complication?
Early diagnosis is the key to avoiding these complications. This means coming in for evaluation as soon as you are hoarse or if you have any voice or swallowing changes after surgery.
I hear so many conflicting things about atrophy? What is the truth?
Myth: It is normal to have a wobbly voice as you age.
Truth: Atrophy is a normal process of aging, as is the resultant wobble. But it is not necessary to suffer with the symptoms of atrophy. While it is as normal as wrinkles, it is more disabling and treatable.
Myth: Atrophy requires surgery.
Truth: The best resolution does require surgery. However, the procedure is short, ambulatory, and painless and can result in significant improvement. For some patients, voice therapy alone is sufficient to treat the symptoms temporarily, until the atrophy progresses. After an evaluation, it can be determined which method is best for you.
Treatment is most effective when atrophy is detected early. The longer you wait, the more the atrophy will progress and the less likely it will be to respond to voice therapy alone.
This may seem simple, but without videostroboscopy it is much more difficult.
How do you handle vocal atrophy?
Vocal atrophy treatment depends largely on the cause. Depending on the cause, most people can benefit from one of several simple procedures to alleviate symptoms. Specialized techniques developed here at the Osborne Head and Neck Institute are used to limit the disability due to vocal atrophy.
Medications and vocal hygiene are also utilized to optimize recovery.
At the Voice Division at Osborne Head and Neck Institute (OHNI), we understand that your voice is your livelihood. We take the utmost care to prevent poor voice outcomes. Your evaluation at OHNI includes:
- A complete history
- A complete physical exam of the head and neck
- Treatment planning – this usually includes voice therapy with a skilled therapist, trained in the treatment of voice disorders
This comprehensive evaluation results in the best treatment plan for you, that will help prevent you from having future problems.
Can I just see my regular ENT doctor?
Unfortunately, few people are trained to correctly diagnose and treat voice disorders. Only a laryngologist can accurately diagnose and treat you, and help prevent you from having a worse problem.
What should I ask my doctor when I see him/her to ensure I’m getting the right treatment?
You should ask your voice physician the following questions to ensure you are getting the treatment you deserve:
1. Are you board certified in ENT?
2. Are you fellowship-trained in laryngology/professional voice?
3. Do you perform videostroboscopy?
4. Do you perform the examination on your patients?*
5. When surgery is needed, do you perform the surgery yourself or are there other doctors or doctors-in-training involved?*
6. Do you accept insurance? Are your services covered by insurance?
*Often, laryngologists are located in facilities where residents or fellows (doctors-in-training) perform a large portion of the services.
Does insurance pay for a laryngologist visit?
If the laryngologist accepts insurance, your visit is usually covered. Laryngoscopy with stroboscopy is also usually covered. It is best to ask your doctor’s office billers to clarify insurance issues.