Voice disorders span a broad spectrum, ranging from mild hoarseness to more serious conditions involving structural or neurological causes. Conditions such as vocal cord inflammation (laryngitis), where the voice box becomes inflamed and causes hoarseness or loss of voice, to laryngeal cancer (vocal cord cancer), are significant health concerns in India, contributing to a substantial burden of head and neck cancers.
In India, laryngeal cancer incidence data from population-based cancer registries and national surveys estimates 2.76 cases per 1,00,000. According to these studies, including those conducted by the National Cancer Registry Programme of India and report by the International Journal of Head and Neck Surgery, laryngeal cancer accounts for 3-6% of all cancers in men, with age-adjusted incidence rates ranging from 1.26 to 8.18 per 100,000 population. The 5-year survival rate for laryngeal cancer in India is approximately 28%.
Common causes often overlooked
Suhel Hasan, senior consultant, head of department of ENT, Mazumdar Shaw Medical Centre, Narayana Health, Bengaluru highlights the most common voice cord issues. Voice abuse — common among teachers, singers, public speakers, and call center workers — often leads to conditions like teacher’s nodules or screamer’s nodules. Both prolonged speaking and short bursts of shouting can injure the vocal cords.
According to Raghavi Vishnu Prasanna, consultant laryngologist, Shri VAS Clinic, SIMS Hospital, Vadapalani, any hoarseness or change in voice persisting for more than two weeks should never be ignored. “A hoarse voice could be due to causes like voice abuse or more serious conditions such as vocal cord nodules, polyps, infections, neurological conditions, or even cancer,” she notes. Dr. Hasan emphasises that chronic coughing, throat clearing, and infections can also strain the vocal cords.
Precision diagnosis, targeted treatment
Diagnosis begins with a detailed history, followed by direct visualisation of the vocal cords. With advances in technology, ENT specialists now use rigid or flexible endoscopy to examine the larynx.
The gold standard remains laryngeal endoscopy — a procedure that uses an endoscope (a thin, flexible tube with a camera) to visualise the larynx (voice box) and vocal cords or stroboscopy — a specific type of laryngoscopy that uses a flashing light (stroboscope) synchronised with the vocal fold vibration to create a slow-motion effect, allowing for detailed analysis of vocal fold movement during phonation, leading to a real-time or slow-motion assessment of vocal cord movement and mucosal wave patterns.
“Earlier, mirror laryngoscopy– where laryngeal mirror or laryngoscopy mirror, a small, curved mirror was used to visualise the larynx and pharynx during an indirect laryngoscopy. This procedure used to be a common examination performed by doctors to assess the back of the throat and vocal cords, now modern tools provide significantly better clarity and precision”, he says
Once diagnosed, treatment depends on the underlying cause. Benign conditions like cysts, nodules, or polyps can often be managed with medication, lifestyle changes, and speech therapy. In cases requiring surgery, Dr. Ahilasamy, chief ENT surgeon and HOD at Prashanth Multispecialty Hospital, Chennai, explains that procedures such as micro laryngeal surgery are performed through the mouth under general anaesthesia, typically using precision tools like the CO2 laser. This carbon dioxide laser precisely vaporises or cuts tissue, offering advantages like minimal trauma, reduced bleeding, and faster healing compared to traditional surgical methods.
For patients diagnosed with early-stage laryngeal cancer, outcomes are often excellent, with cure rates approaching 100% if caught early. Laser or robotic surgery enables precise excision while preserving vocal function. In more advanced stages, treatment may involve a combination of surgery, radiation, and chemotherapy.
Singers, public speakers and the fear of pitch loss
For professionals who rely on their voice– especially singers — even minor voice changes can be career-threatening. Dr. Hasan explains that such cases demand nuanced management. Sometimes patients are given temporary medical interventions to perform in critical events, followed by longer-term care and rehabilitation. “Many singers consult even for the slightest pitch change. We work closely with speech-language pathologists to restore vocal quality without compromising vocal health,” she says.
Understanding vocal cord paralysis
One complex and often misunderstood voice condition is vocal cord paralysis or vocal fold palsy. Dr. Prasanna outlines a range of treatments depending on the cause, duration, and voice demand of the patient. Voice therapy is usually the first step for partial paralysis or when nerve recovery is expected — such as after cardiac, spinal, or thyroid surgeries. In some cases, injection laryngoplasty is done under local anaesthesia in the clinic itself to provide temporary voice improvement.
Chronic or permanent paralysis might require static surgeries like thyroplasty or arytenoid rotation — surgical procedures to move a paralysed or weak vocal fold (cord) closer to the center of the larynx in order to improve the voice. One of the latest and promising techniques in this area is dynamic reinnervation, where the paralysed vocal fold is reinnervated using a donor nerve to restore function.
Dr. Parsanna highlights the role of lifestyle in vocal health. “We often see patients who unknowingly abuse their voice–smoking, excessive alcohol, caffeine, shouting in noisy environments, or speaking non-stop without hydration. These factors compound voice strain,” she notes. She insists on early consultation and stresses that vocal hygiene is often underestimated.
Vocal rest, steam inhalation, hydration, and reducing irritants like acid reflux and allergens can go a long way in protecting the voice.
Healing beyond surgery
Recovery doesn’t end with surgery or medical management. Dr. Ahilasamy stress the pivotal role of speech-language pathologists in long-term rehabilitation. These professionals help patients retrain their voice, improve vocal efficiency, and eliminate harmful habits.
Singers, actors, teachers, and other voice users often work with therapists regularly to maintain optimal performance. Many keep a therapist on call, treating vocal care as an ongoing part of their profession — much like an athlete would with physical therapy.
Dr. Hasan emphasises that managing voice disorders requires a multidisciplinary approach involving ENT specialists, surgeons, speech therapists, and active patient participation. Dr. Prasanna notes that more focused attention on laryngology — a subspecialty within otolaryngology dedicated to the larynx or voice box — is essential for accurate diagnosis and effective treatment.
Early attention, appropriate care, and consistent voice management can significantly improve outcomes and help restore one’s vocal identity.
Published – April 30, 2025 01:51 pm IST