Voice disorders may be caused by many different factors, events, physical ailments and diseases. The vast majority of voice problems are caused by factors that are not life-threatening and that are easily treatable.
Almost every disorder of the larynx may result in more than one symptom, and there is no single symptom associated with a specific disorder of the larynx. For example, hoarseness, limitations in pitch and loudness, shortness of breath or increased vocal effort may be a sign of any number of disorders of the larynx.
The severity of the voice symptoms does not necessarily correspond to the severity of the underlying disease. The only way to know what is causing your specific voice problem is to be evaluated by a laryngologist.
A common cause of voice problems is one or more benign (non-cancerous) lesions on the vocal fold. A lesion is a structural defect -- an irregular or abnormal area of tissue -- that can easily disrupt the normal functioning of the vocal folds and result in symptoms of a voice disorder. Frequently, the lesion forms a protruding bump. These are called "discrete" lesions because they can be seen to occupy a limited area of the vocal fold with relatively clearly-defined borders, as opposed to generalized ("diffuse") irritation of a larger area of the vocal fold.
During voice production, the right and left vocal fold vibrate (opening and closing against each other) to produce sound. The middle portion of the edges of the vocal folds collide together first and hardest, and whip up out of the air stream with the greatest force (similar to the middle portion of a jump rope that hits the ground first and hardest with each repeated swing and moves in the widest arc). Therefore, this mid-area of the tissue is most susceptible to irritation. That is why many of these protruding lesions often form at the edge, or vibratory margin, of the vocal fold in the middle of the vibrating vocal fold.
A lesion can form on both the right and the left vocal fold at the same time. When this happens, they look like mirror images of each other. At other times, a lesion will form at the mid-portion of one vocal fold, and then over time, irritate the opposite area on the other vocal fold during each cycle of vibration. This second lesion is called a "reactive" lesion, because it forms in reaction to the irritation of the first lesion. When this happens, the lesions do not look symmetrical. One lesion may be larger and more firm-appearing than the other. There can be a "cup and saucer" appearance to the two lesions: the protruding lesion produces a small indentation in the reactive lesion.
Discrete benign mucosal lesions are not painful. However, they can result in a less efficient voice production system, so that it takes more effort to speak. This can cause a sense of fatigue and even neck discomfort. The lesions can cause many undesirable voice changes. In an effort to clear and improve the sound of the voice, an individual may use the muscles of the throat and neck. This can increase the throat and neck discomfort.
Vocal fold mucosal lesions do not hurt and only rarely can they be "felt." However, when irregularities form on the surface of the vocal folds, the mucous often gets stuck and accumulates on the lesion. The thickened mucous can make a person feel like there is "something" in the throat, and the natural reaction is to cough or clear the voice. Unfortunately, frequent coughing and throat-clearing only contribute to the mucosal irritation and can make the lesions (and voice problem) worse. Learning how to use "safe" vocal behaviors in place of coughing and throat clearing is part of the voice therapy program.
The most common cause of discrete benign mucosal lesions is prolonged and repeated irritation (micro-trauma) to the surface tissues of the vocal folds. The source of the irritation may be excessive vocal demands ("vocal abuse"), gastric reflux, repeated upper respiratory infections, or certain medications, for example. Often, there is more than one cause, with one predominant factor and a number of lesser, contributing factors.
Based upon the latest research, how we think about discrete benign mucosal lesions is changing. It used to be that these lesions were always identified as one of three types - nodules, polyp or cyst. And it used to be that treatment for nodules was always voice therapy, and treatment for a polyp or a cyst was always surgery. It now appears that sometimes these "bumps" have characteristics of more than one type of lesion, and it is not always possible to distinguish between different benign mucosal lesions during an office examination. The best treatment depends upon a number of factors specific to the individual patient. Make sure that you are getting the most current diagnosis and treatment information for your voice.