Sound of silence (Laryngitis )

Everyone has gas, very few know how to deal with it and no one wants to discuss it Dr Gita Mathai.

Laryngitis strikes without warning like a thief in the night. Suddenly, one morning when attempting to speak, instead of a normal voice all that that can be heard is a hoarse, ineffectual, frustrating whisper.

Voice is produced in the larynx (or sound box) by the vibration of the vocal cords at a rate of 80 to 400 times per second. Any alteration in the structure of the vocal cords can change the tone and timbre of the voice or cause it to disappear completely.

Upper respiratory infections, caused by a wide range of viruses, are notorious for this. The onset of laryngitis is acute, close on the heels of a cold. It may be accompanied by a running nose, sore throat, fever and body ache. The throat itself appears red and congested. If the vocal cords are visualised, they appear swollen and red with sluggish ineffectual movements.

Some bacteria like those causing diphtheria, whooping cough or tuberculosis, too, can cause laryngitis. The onset is more acute — the fever is high and the person (unlike in viral laryngitis) not only can not speak but also appears ill.

Infective laryngitis disappears with voice rest, hydration and steam inhalation in two weeks. Antibiotics are usually not required. Any alteration in the voice that persists for more than two weeks, however, requires a thorough evaluation by an ENT surgeon. This includes a physical examination of the head and neck area and visual inspection of the vocal cords with a laryngoscope.

Sometimes, the vocal cords may appear chronically inflamed and irritated. This is may be due to constant exposure to irritating allergens in the environment. It is common in smokers and in their non-smoking family members, as they are constantly exposed to passive smoking.

Nodules may be visible on thickened vocal cords. This is common in women and children. It is a harmless condition that disappears with voice rest and 12 weeks of speech therapy. Sometimes, nodules, cysts or papillomatous growths can also be seen. Once a growth has been discovered, biopsy should be done. Although most are harmless, laryngeal cancer does occur. The incidence is higher in older men, especially if they are or were smokers. It is also high in people who chew tobacco or inhale it as snuff. In 62 per cent people, the cancer is localised and treatable with a good prognosis at the time of diagnosis.

Early evaluation, diagnosis and intervention are therefore important. The synchronised and appropriate movement of the vocal cords requires coordinated action of the muscles in the sound box. These muscles are innervated and controlled by branches of the vagus nerve. Paralysis of the vocal cord may occur if the nerve supply is interrupted. Pressure on the nerve may occur from outside due to benign or malignant tumours in the head and neck. Loss of voice due to an enlargement of the thyroid gland (goitre) is very common.

Movement disorders like Parkinson’s disease or “familial tremor” can cause uncoordinated contraction and relaxation of the muscle of the voice box. In such individuals, the voice waxes and wanes in intensity and is tremulous.

Gastro oesophageal reflux disease (GERD) is common, particularly in middle-aged obese men. The acidic contents of the stomach tend to regurgitate into the oesophagus and voice box. This produces chronic irritation of the vocal cords and a change in voice.

Some systemic diseases like diabetes, thyroid malfunction and myasthenia gravis may also cause hoarseness or a soft voice.

If you have suddenly developed hoarseness and a change in voice —

Give the voice absolute rest by not speaking at all for 48 hours
Gargle with warm salt water
Take steam inhalations                                   lyr.jpg
Take analgesics and anti histamines.

If there is no improvement after 14 days, consult a physician.

Have a thorough physical examination
Get the larynx examined by an ENT surgeon
Do blood tests to rule out systemic causes.

If you have recurrent harmless but irritating attacks of laryngitis, avoid —

Breathing foul or polluted air
Tobacco in any form — chewing, smoking or as a passive smoker
Using recreational drugs like marijuana
Alcohol consumption
Shouting at sporting events
Trying to talk at noisy places
Clearing the throat continually
Whispering loudly

Speaking is an integral part of our life and a natural developmental milestone. In some people, however, the technique is faulty. There may be loss of voice, change in its quality or recurrent nodules. Speech therapy with a qualified technician corrects maladaptive vocal habits and inculcates appropriate uses of the entire vocal mechanism. The treatment process takes 1½-2 months and eventually results in a healthy and efficient voice.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at

Source:The Telegraph (Kolkata,India)

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