Voice and swallowing difficulties

The larynx (voice box) is a highly specialised organ responsible for coordinating eating, drinking, voice and breathing. Diseases of the larynx or throat may have significant impact on quality of life.

Acute inflammation or laryngitis can be from a viral infection and is very common, presenting with a sore throat and changes in voice due to swelling. Bacterial infections are much less common and can occasionally cause difficulty in breathing; these require immediate emergency assessment.

Chronic laryngitis is a longer term low grade inflammation of the larynx. It may be secondary to acid indigestion or fungal infections (exacerbated by steroid asthma inhalers). Gastroesophageal reflux disease (GORD) is common and may present with swallowing problems, voice changes, the sensation of a lump in the throat, throat discomfort and heartburn. It may also not have these obvious symptoms but still affect the voice box. This is referred to as laryngopharyngeal reflux (LPR) or “silent reflux”. Treatment for inflammatory processes depend on the underlying cause but are frequently medical.

Trauma to the vocal cords (small microtears) may cause benign lesions; these may take the form of cysts, papillomas, pseudocysts, polyps or nodules. Flexible endoscopy of the larynx is a good screening tool for laryngeal conditions and subtle lesions require rigid stroboscopy to make the diagnosis. We also see professional or elite voice users where rigid stroboscopy and narrow band imaging is available. Microsurgical treatment is an appropriate treatment for many benign lesions, via microlaryngoscopy under a general anaesthetic. Complex voice conditions are best managed in conjunction with speech pathologists.

There are two nerves that supply each side of the larynx. These may be injured either temporarily or permanently by viruses, surgery or tumours in the neck or chest, causing a weak or breathy voice or difficulty in breathing. Spontaneous resolution can be seen; if not, injections to the larynx, laryngeal framework surgery or laryngeal reinnervation can help.

Laryngeal cancer may also present with hoarseness and is characterised by a persistent and progressive nature, but is very treatable. Cancers are further discussed on the Head and Neck Cancer page.


swallowing and voice