Recognizing the Many Potential Causes of Vocal Cord Damage

Since the early 1980s, more recognition has been given to the multiple factors that can cause voice disorders. Whereas diagnosis was once fairly rudimentary, relying primarily on the ears and eyes of the physician, today a number of diagnostic techniques are available to augment the senses of the physician and have lead to a more accurate and complete diagnosis and subsequent improved treatment. Despite this improvement in diagnosis, finding the correct or full etiology of a voice disorder or vocal cord damage can be challenging. Increased recognition is needed of the variety of conditions, as well as side effects of some medications, that may lead to vocal cord damage.

May Be More than Misuse or Abuse of the Voice

Although the most frequent cause of voice disorders is misuse or abuse of the voice, it is important for physicians to consider other possible causes in their workup of a patient with symptoms of vocal cord damage. Some of the main conditions that can cause vocal damage include reflux laryngitis and vomiting with bulimia, said Peak Woo, MD, Professor in the Department of Otolaryngology at Mount Sinai School of Medicine in New York, as well as previous vocal fold injury from intubation and surgery. According to information on the Voice Foundation Web site ( ), reflux laryngitis is one of the two most commonly overlooked or missed voice disorders, along with laryngeal paresis.

Reflux laryngitis is a condition caused by a backflow of stomach fluids into the voice box area, which produces irritation and swelling of the voice box. The acids and enzymes in the stomach fluids that flow back into the voice box can cause hoarseness, the need for frequent throat clearing, a sore throat, or cough, but usually do not cause heartburn. This condition may be associated with bulimia, where a person vomits frequently. However, according to Gayle Woodson, MD, Professor of Otolaryngology at Southern Illinois University School of Medicine in Springfield, Ill., unless the person aspirates while vomiting, the vomitus does not come in contact with the larynx. On the other hand, she said, people who can vomit at will generally have a greater incidence of acid reflux during the day and at night, and this is probably the single greatest cause of chronic laryngitis.

Although Dr. Woo thinks that vomiting with bulimia may be a condition associated with symptoms of vocal cord damage, he thinks it is not common. Vocal fold damage from bulimia is very unusual, he said.