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Voice problems

Voice is the sound produced when the air passes from the lungs to the larynx or voice box. During speaking the vocal cords close partially as the air passes through them and create vibrations and produces sound. Each person’s voice is as unique as fingerprint.

Voice disorders may result in pain or discomfort during speaking, trouble in controlling the pitch, loudness or quality of the voice. Voice disorders include vocal cord nodules and polyps, vocal cord paralysis, paradoxical vocal fold movement and spasmodic dysphonia.

  • Vocal cord nodules and polyps: Vocal cord nodules are noncancerous growths occurring on both the vocal cords and are caused due to voice strain and may be exacerbated by laryngopharyngeal reflux. Vocal cord polyps are abnormal growths appearing as a swelling or nodule on either one or both of the vocal cords.
  • Vocal cord paralysis: Vocal cord paralysis occurs when one or both the vocal cords do not open or close properly causing voice problems and difficulty in swallowing and breathing.
  • Paradoxical vocal fold movement: Paradoxical vocal fold movement refers to vocal cord dysfunction where the vocal cords do not move normally despite having normal innervation. In the case of paradoxical vocal fold movement, the vocal cords close instead of opening when breathing.
  • Spasmodic dysphonia: It is a chronic voice disorder caused by forced or strained movements of the vocal cords causing abnormal changes in the voice.


In most cases resting the vocal cords may be necessary. The goal of the treatment is to regain the normal voice. For chronic voice problems medicines, surgery, voice therapy or combination of these may be needed.

Speech problems

Phonology is referred to as study of sounds of language. Pronunciation errors are common in children when they are learning to talk. During the child’s development stage, phonological disorders can affect children’s ability to learn read or spell. Speech problems are temporary or can be overcome.

Your child should listen before it begins to speak. If not, then there may be chances of speech problems and you may have to consult your doctor. Some of the common speech problems are

  • Mispronunciation – Your child may often substitute ‘f‘or‘d’ for ‘th’, or mix up words. For example your child may say I am taking baf, instead of I am taking bath.
  • Lisping – Your child may pronounce ‘‘s ‘‘as ‘‘th’’. For an instance, sister will become thithter, seven may be pronounced as theven. During this condition, your child will push the tongue out while pronouncing these letters where as in normal children, the tongue will touch the upper teeth while speaking or pronouncing these letters.
  • Stuttering – It is the repetition of certain words, sounds, or phrases. In children it is common to stutter until the age of 7 years, but sometimes it may become a permanent speech disorder. One of the causes for stuttering is genetic predisposition.
  • Flow – This is the condition where your child is learning the new speech skills and struggles to speak the sentences.
  • Hoarseness – It is the change in the voice or sound because of laryngitis or upper respiratory tract infection.
  • Slurred speech and difficulty in speaking – It develops from nerve and muscle disorders such as multiple sclerosis and Parkinson’s disease.

Some of the common speech disorders are apraxia and dysarthria.

  • Apraxia– It is caused due to the disorder of the nervous system which affects the child’s ability to pronounce words and produce sounds. In this condition the brain does not send signals to the body parts that are involved in speech. For example your child may pronounce ‘sut’ for ‘sat’.
  • Dysarthria– It is a dysfunction or impairment of the neuromotor or neuro muscular systems

Infection of the upper respiratory tract may cause inflammation of the larynx, which leads to temporary loss of voice. Also some of the brain disorders affect the organs involved in speech and these disorders include Parkinson’s disease, cerebral palsy, nerve and muscle disorder, and Alzheimer’s disease. Speech problems may also be caused because of hearing loss, mental retardation, cancer, mutisim, deafness, vocal cord problems, and nodules or polyps. These conditions may interfere in the child’s ability to speak.


The best way to treat your child and improve the speech ability is by treating the underlying disease conditions.

Speech therapy helps to overcome the problems of stuttering and lisping. In this therapy, your child will be given speech and language test which will help the therapist to diagnose, understand, and treat the problem, read more at curry supply co. Speech therapist will try to sing some rhymes or poems and read repetitive books which will improve the vocabulary speech. Sign language is taught which supports the child to say few words to avoid frustration.

  • Speech therapy helps children who have trouble in pronouncing letters, syllables. It includes coordination exercises which enable the speech muscles to strengthen and speech therapist will guide your child showing them the proper placement of lips and tongue.
  • For stuttering there is no treatment, speech therapist will teach your child to talk in such as way that your child will feel easy and relaxes while speaking.

Other ways to overcome speech problems in your child include

  • Your child will learn how to speak by imitating you. You must speak in front of your child rather than speaking behind your child or shouting from some corner.
  • Check if your child can breathe properly through nose. If your child has allergy or cold or sinus problems, then work on nose blowing and clear the blockage by using nasal sprays which will help the child to breathe through the nose with lips together.

Swallowing disorders

Swallowing disorders or dysphagia is a condition of pain and difficulty in swallowing food, liquid or saliva. This may deprive the calorie intake and pose several complications. Swallowing act involves approximately 50 muscles and many nerves. Dysphagia occurs with the problem in structures involved in swallowing. Several conditions including other nervous system problems, gastrointestinal tract problems, physical malformations, cancers, or stroke may cause dysphagia.

Risk of dysphagia increases with age, smoking, excessive alcoholism, certain medication and dental problems. Dysphagia may be during movement of food from mouth to esophagus (food carrying pipe; oropharyngeal dysphagia) or movement of food from esophagus to stomach (esophageal dysphagia).

If a person is experiencing difficulty in swallowing, coughing while swallowing, reflux of liquid through nose, weak voice, and weight loss the condition is oropharyngeal dysphagia. Whereas if the patients is experiencing pressure sensation in mid-chest area, feel a kind of food stuck in throat or chest, chest pain, belching, severe heart burn and sore throat the condition is esophageal dysphagia.

Various approached are recommended for treatment of mouth swallowing.

  • Muscle exercises to strengthen and improve the coordination of facial muscles
  • Modification in diet – avoiding certain foods or use of thickeners
  • Treatment of underlying medical conditions
  • Surgical techniques – dilation of esophagus
  • Medications relaxing esophagus or relieving spasms, antacids and others

Tonsillitis in Children

Tonsillitis is the inflammation of the tonsils which are lymphoid tissue located at the back of the throat. The main function of the tonsils is to fight against bacteria, virus, or other germs that enter through the mouth or nose.

Most episodes of tonsillitis are caused by viruses. Only 30% are caused by bacteria.

Types of tonsillar infection

Acute tonsillitis

  • Can present with sore throat, ear pain, fever, difficulty swallowing and tender glands in the neck.

Recurrent tonsillitis

  • May present with chronic sore throat, ear pain, bad breath, and persistent tender neck glands

Peritonsillar abscess

  • Presents with severe throat pain, earache, fever, drooling, difficulty opening the mouth and change in voice (hot potato voice)

Medical treatment

  • The treatment of acute tonsillitis is largely supportive and focuses on maintaining adequate fluid intake and controlling pain and fever
  • Corticosteroids may be administered to reduce swelling and pain
  • Antibiotic therapy is recommended for acute tonsillitis. The treatment is usually with penicillin
  • For those who cannot swallow fluids or medicines, admission to hospital is required for intravenous fluids and medicines

Surgical treatment

The surgical removal of the tonsils is a safe and effective treatment for recurrent tonsillitis. It is not appropriate to operate on tonsils while they are infected unless an abscess has formed, or if the condition is chronic without remittance.

Neck Lumps

In children, lumps in the neck are commonly due to enlarged lymph nodes. Benign lumps in the neck may also be caused by abscesses, cysts or sinuses, haemangioma, and lymphangioma.

The common regions in the neck where lumps are often found are in salivary glands (under the jaw), along the sternomastoid muscle (side of the neck) and near the thyroid gland (midline).

Enlarged lymph nodes are caused due to bacterial infection or viral infections. Very rarely they can be caused by lymphoma, leukemia or cancer.

Your doctor will diagnose the condition by physical examination, and any other tests that may be indicated such as; blood tests, ultrasound or biopsy.

Head and Neck Cancer

Cancers in head and neck region include the cancers in mouth, nose, and throat. These cancers arise in the moist cells (mucosal surfaces) that line the hollow organs and cavities. Head and neck cancers are also called as squamous cell carcinomas. Head and neck cancers may arise in different areas including mouth, nose, sinuses, lips, salivary glands, throat and lymph nodes in the neck.

Head and neck cancers affect nearly 3–5% of people in U.S with higher rates in men and people aged above 50 years. Use of tobacco and alcohol are the major risk factors for head and neck cancers. Other risk factors include:

  • Exposure to sun
  • Human papilloma virus infection
  • Exposure to radiations
  • Industrial or occupational exposure to wood dust, nickel, asbestos, lead and others
  • Dust inhalation
  • Epstein-Barr virus infections
  • Certain preservatives or salted foods
  • Poor oral hygiene
  • Plummer-Vinson syndrome
  • Exposure to asbestos
  • Genetics

Oncologists diagnose the cancer by physical examination, endoscopy, X-rays, computed tomography scan, magnetic resonance imaging scan, positron emission tomography scan and biopsy.

Treatment of head and neck cancer is based on the type and location of cancer, severity or grade, and patient characteristics. Various modalities include chemotherapy, radiation treatment, surgical excision of cancers, and combination approach.  Rehabilitation procedures are recommended after the treatment.

For more information, please check Head and Neck Cancer

Throat Cancer

Cancers in the tissues of the pharynx, larynx (voice box) or tonsils are referred to as cancers of the throat. The most common risk factor for developing cancer of the throat is use of tobacco – both smoking and smokeless tobacco. Other risk factors include increased age, chronic alcoholism, chewing betel nut, human papillomavirus infection, and prolonged exposure to ultraviolet light. Throat cancer may cause a lump that does not heal, makes swallowing difficult, persistent sore throat, hoarseness or changes in voice and ear pain.

Biopsy and other tests may be performed to confirm the presence and type of cancer. Treatment options include radiation therapy or surgery. A combination of radiation and chemotherapy is often used in case of large tumors. The surgical option for throat cancers is laryngectomy, a surgery to remove all or part of the voice box. Activities such as eating, speaking or even breathing become difficult following the surgery. Therefore you may be advised for speech and swallowing therapy that helps you learn to cope with the changes in the structure of the throat.

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Robert DeFatta

Robert J.DeFatta
M.D. PhD

Facial Plastic Surgeon

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Rima Abraham

Rima A. DeFatta


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