Managing Perimenopausal and Menopausal Voice Changes

This review describes the current information related to laryngeal neuropathic disorders and the possible management options available. Voice changes may range from severe hoarseness due to choking and coughing to a mild intermittent dysphonia possibly accompanied by unusual breathing. Neither the sound of the voice nor the lack of hoarseness should suggest that the problem itself is a minor one. Laryngeal neuropathic disorders may be the outcome of inflammation, irritation, infection, or a combination of these that causes a disruption in normal sensation. When sensory mediators no longer function normally, breathing, phonation, and even swallowing changes may be affected. Clinicians must be aware of the numerous sensory related disorders in the upper airway and currently accepted methods of treatment.

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Preoperative and Postoperative Voice in Tis-T1 Glottic Cancer Treated by Endoscopic Cordectomy: An Additional Issue for Patient Counseling

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940311200903 ◽

2003 ◽

Vol 112 (9) ◽

pp. 759-763 ◽

Cited By ~ 45

Author(s):

Giorgio Peretti ◽

Maria C. Mensi ◽

Cesare Piazza ◽

Manuela Rossini ◽

Cristiano Balzanelli ◽

...

Keyword(s):

Analysis Of Covariance ◽

Glottic Cancer ◽

Type I ◽

Patient Counseling ◽

Subjective Data ◽

Type Iii ◽

Voice Changes ◽

Index Evaluation ◽

European Laryngological Society ◽

The Voice

Radiotherapy contends with endoscopic surgery for the role of treatment of choice for Tis-T1 glottic cancer. The amount of vocal cord to be surgically removed logically depends on the surface and deep extension of the neoplasm. Thus, a prerequisite for proper management includes an analysis of the voice changes after each of the progressive types of cordectomy described in the European Laryngological Society Classification. Between January 1998 and December 2000, 89 patients with glottic cancer (8 Tis, 63 T1a, 18 T1b) underwent different types of endoscopic cordectomy. Perceptual analysis (GRBAS scale); objective analyses of jitter, shimmer, and noise-to-harmonics ratio; and subjective (Voice Handicap Index) evaluation of voice were performed in 51 patients. Statistical evaluation of preoperative and postoperative objective results by analysis of covariance, as well as perceptual and subjective data, showed significant voice improvement after type I and II cordectomies, with the voice attaining nearly normal parameters. By contrast, after type III, IV, and V cordectomies, the vocal outcome was not significantly different from the preoperative pattern. It can therefore be concluded that type I and II resections, whenever indicated, are adequate procedures even for professional voice users. By contrast, accurate counseling is mandatory before type III, IV, and V cordectomies.

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Intermittent Vagal Nerve Stimulation-Associated Vocal Fold Movement Impairment

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211047459 ◽

2021 ◽

pp. 000348942110474

Author(s):

Jennifer Yan ◽

Julina Ongkasuwan ◽

Elton M. Lambert

Keyword(s):

Case Report ◽

Vocal Fold ◽

Lateral Position ◽

Tertiary Hospital ◽

Vocal Fold Paralysis ◽

Vagal Nerve ◽

Deep Penetration ◽

Endoscopic Evaluation ◽

Voice Changes ◽

Refractory Seizures

Objectives: Implanted vagal nerve stimulators (VNS) are an accepted therapy for refractory seizures. However, VNS have been shown to affect vocal fold function, leading to voice complaints of hoarseness. We present a case of intermittent VNS-related vocal fold paralysis leading to dysphonia and dysphagia with aspiration in a pediatric patient. Methods: This is a case report of a patient at a tertiary hospital evaluated in pediatric swallow and voice clinics. Patient and mother gave verbal consent to be included in this case report. Results: Indirect laryngeal stroboscopy was performed demonstrating full vocal fold mobility with VNS off and left vocal fold paralysis in lateral position and glottic gap with VNS on. Voice measures were performed demonstrating decreased phonation time, lower pitch, and decreased intensity of voice with VNS on. Flexible endoscopic evaluation of swallowing demonstrated deep penetration alone with VNS off and deep penetration with concern for aspiration with VNS on. Conclusions: While the majority of cases of vocal fold movement impairment associated with VNS have been noted to have a medialized vocal fold with VNS activation, we describe a case of intermittent vocal fold lateralization associated with VNS activation with resultant voice changes and aspiration.

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Non-reversible and wide ranging voice changes after treatment with danazol.

BMJ ◽

10.1136/bmj.287.6397.946 ◽

1983 ◽

Vol 287 (6397) ◽

pp. 946-946 ◽

Cited By ~ 17

Author(s):

P G Wardle ◽

M I Whitehead ◽

R P Mills

Keyword(s):

Voice Changes

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Laryngeal Subsite Analysis of Granulomatosis With Polyangiitis (Wegener’s)

OTO Open ◽

10.1177/2473974x211036394 ◽

2021 ◽

Vol 5 (3) ◽

pp. 2473974X2110363

Author(s):

Natasha J. Minaya ◽

Vishwanatha Rao ◽

Matthew R. Naunheim ◽

Phillip C. Song

Keyword(s):

Vocal Fold ◽

Chart Review ◽

Granulomatosis With Polyangiitis ◽

Age At Onset ◽

Retrospective Chart Review ◽

Tertiary Referral Center ◽

Voice Changes ◽

Airway Symptoms ◽

Related Quality ◽

Underlying Mechanisms

Objective To analyze specific intralaryngeal findings associated with granulomatosis with polyangiitis (GPA). Study Design Retrospective chart review. Setting Tertiary referral center. Methods A retrospective chart review was performed on all patients diagnosed with GPA who were evaluated at the laryngology division of Massachusetts Eye and Ear Infirmary between January 2006 and September 2019. Results Forty-four patients (14 male, 30 female) were evaluated for laryngeal pathology. The mean age at onset was 48 years. Nine patients (21%) were identified with only vocal fold disease, 11 (25%) with subglottic disease, and 8 (18%) with disease at the glottis and subglottis (transglottic). The remaining 16 patients (36%) had a normal airway upon examination although they presented with laryngeal symptoms. Patients with glottic disease had statistically significantly lower voice-related quality of life scores than patients with isolated subglottic stenosis. Conclusions Although laryngeal manifestations of GPA is often described as a subglottic disease presenting with respiratory symptoms, subsite analysis show that only 25% of patients had subglottic disease alone, with similar rates of glottic disease alone. Laryngeal subsites have different epithelial mucosa, function, and physiology, and understanding the specific sites of involvement will determine symptoms and enable better analysis of the underlying mechanisms of disease. Glottic disease is associated with a reduction in vocal fold motion and voice changes. Subglottic involvement presents more frequently with airway symptoms. Further research is necessary to better define the specific regions of laryngeal involvement in patients diagnosed with GPA.

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