Recognizing the Many Potential Causes of Vocal Cord Damage

Although stopping or changing medication is recommended if the vocal cords are adversely affected, Jonathan E. Aviv, MD, Medical Director of the Voice and Swallowing Center at the College of Physicians and Surgeons, Columbia University Medical Center in New York, suggested that this may not be necessary. According to Dr. Aviv, the solution may not be to use the drugs differently, but to use them with an anti-acid medication such as proton pump inhibitors, such as [esomeprazole, omeprazole, or rabeprazole].

Increasing Recognition and Knowledge of the Causes of Vocal Cord Damage

According to the Voice Foundation, the need for recognizing that multiple factors may be contributing to voice problems is necessary to ensure appropriate treatment. A simple formula used on their Web site may help physicians improve diagnosis of these problems: Medical + Non-Medical + Compensatory Mechanisms = Voice Disorder.

According to information on the Voice Foundation’s Web site, Interacting causes may include medical causes, nonmedical causes, and patient behaviors that compensate for voice problems. All can contribute and aggravate the voice disorder. More importantly, if all contributing factors are not addressed in the treatment plan, treatment cannot be fully effective, even if it is partially correct.

A key challenge for otolaryngologists is to recognize that voice problems may have a cause, or multiple causes, not attributable or solely attributable to what once where considered standard causes, such as misuse/abuse of the voice or smoking. According to Dr. Woo, when a patient presents with voice problems that are not attributable to an ENT condition but nevertheless has damage, a careful search for medical conditions such as reflux laryngitis, medication-related laryngitis, and thyroid or endocrine conditions should be undertaken, adding that this can usually be done by otolaryngologists with appropriate referral to pulmonary and/or gastroenterology physicians as needed.

Dr. Rosen emphasized that along with a careful review of the medications a patient is using that may have negative effects on the voice, it is necessary to recognize possible psychological conditions that may be contributing to a voice disorder. Other non-ENT related areas to evaluate when patients present with voice disorders include psychological problems, which can present as voice conditions, he said. In this case, careful evaluation of the anatomy and physiology are warranted to rule out any otolaryngologic disorder effecting the voice, followed by an evaluation by a mental health professional preferably working with the voice team.