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Vocal Cord Paralysis

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Scott R Gibbs, MD
Vocal Cord Paralysis

Unilateral vocal cord paralysis can cause vocal changes. This usually results in a very weak, breathy voice. Patients frequently find they are unable to project their voice, nor are they able to sustain vocalization for any length of time. This is due to the fact that the paralyzed vocal cord is not able to move as it normally would. This allows air to escape from the lungs past the vocal cords and does not allow for normal vibration of the vocal cords, and therefore, the voice sounds weak and breathy. Vocal cord paralysis can be from a variety of causes, such as viral infection, neoplasms anywhere from the skull base to the mediastinum, cardiac disease, traumatic or post-surgical injury. Rehabilitation of the voice can be best accomplished with a variety of different techniques. One technique is medialization thyroplasty, in which a synthetic prosthesis is placed through the cartilage of the voice box to move the paralyzed vocal cord to a more midline position. This allows the non-paralyzed vocal cord to be able to move over and meet the other vocal cord, which has been moved into a midline position, thereby producing better phonation. This procedure generally requires the patient to stay over one night in the hospital and then usually some period of speech therapy afterwards to maximize benefit.

Dr. Gibbs is fellowship-trained in laryngology/voice disorders.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277


Scott R. Gibbs, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Spasmodic Dysphonia

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Scott R Gibbs, MD
Spasmodic Dysphonia

Spasmodic dysphonia is a voice disorder that is thought to occur at the level of the brainstem. There are two different types:

1) The most common is adductor spasmodic dysphonia. In these patients, there is excessive closure of the vocal cords, resulting in a strained, strangled type of voice. This occurs all the time while they are speaking, but can be especially worse under times of stress, fatigue, or while using the telephone.

2) The other less common type is called abductor spasmodic dysphonia. This is characterized by frequent breathy breaks while people are speaking. Treatment of this can be accomplished in several different ways.

The most effective method currently is to use botulinum toxin to inject into the muscles, which are functioning abnormally in order to weaken them. This can bring about several months worth of benefit. Repeat therapy is usually necessary and is tailored to each individual patient.

Dr. Gibbs is fellowship-trained in laryngology/voice disorders.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277


Scott R. Gibbs, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Voice Reflux

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Scott R Gibbs, MD
Voice Reflux

A common cause of hoarseness in adults and in children is laryngopharyngeal reflux. This is more commonly found in adults and occurs when gastric acid refluxes up into the pharynx and larynx. This causes irritation of the vocal folds with some swelling of the vocal folds as well as increased production of thick mucous. Many patients complain of voice changes that are worse in the morning and get better during the day. They frequently complain of painful swallowing, which is called odynophagia, and a persistent foreign body sensation in their throat with frequent throat clearing. They also frequently complain of thick mucous. Interestingly enough, up to 60% of these patients do not complain of classic reflux symptoms, such as heartburn. In several studies, this type of reflux was found to occur more commonly during the day and consists of brief periods where the stomach acid spills over onto the vocal cords. Treatment with medications that decrease the production of stomach acid have been found to greatly improve the voice quality, difficulty swallowing and foreign body sensation, as well as decreasing throat clearing. Modification in your diet may be of benefit, specifically decreasing caffeine intake. Decreasing or quitting smoking, avoidance of large meals prior to going to bed at night, and elevation of the head of the bed can all decrease the episodes of reflux.

Dr. Gibbs is fellowship-trained in laryngology / voice disorders.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277


Scott R. Gibbs, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277

Voice Disorders

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Scott R Gibbs, MD

Hoarseness, or dysphonia, is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume or pitch. The changes in sound are usually due to disorders related to the vocal folds, which are the sound producing parts of the voice box (larynx). They come together when speaking or singing, and as air escapes the lungs they vibrate, producing sound. With increased tension and lengthening, the vocal cords vibrate more rapidly and the pitch of the voice will increase. When there is swelling or mucosal abnormalities of the vocal cords they will not come together normally nor vibrate normally, and the voice will sound abnormal. Evaluation of any patient with a voice disorder involves a thorough exam, including a laryngeal examination using fiberoptic or rigid laryngoscopy and video stroboscopy.

There are many causes of vocal cord disorders (i.e. infectious, traumatic, neoplastic, inflammatory, and functional disorders, etc.) Fortunately, most are not serious. The most common cause is a viral upper respiratory infection, which usually occurs due to swelling of the vocal folds and results in decreased vibration and lowering of the pitch. These episodes usually are short-lived (less than two weeks) and respond to supportive treatment only. Another common cause is vocal abuse, which can result in voice changes, which if continuous can lead to a more permanent dysphonia. A common example is the irritation caused by extensive voice use, such as screaming at a sporting event or rock concert. People who consistently misuse their voice may develop a disorder called muscle tension dysphonia in which they use other laryngeal muscles in voice production that are not normally used. This is often misdiagnosed and mistreated. Speech therapy can often successfully treat this. Long-term vocal abuse may result in formation of vocal cord nodules (singer’s or screamer’s nodes). This can cause a lowering of the pitch with voice breaks. Speech therapy can usually successfully treat small nodules and prevent recurrence. The larger nodules generally require both surgical removal and speech therapy.

Other causes of hoarseness include such things as acid reflux into the voice box. This causes irritation of the vocal folds. People will frequently complain of painful swallowing, persistent foreign body sensation in their throat, with frequent throat clearing and thick mucous. Up to 60% of these patients do not complain of classic reflux symptoms such as heartburn. Another common cause of hoarseness is smoking. This may simply be due to chronic irritation of the vocal cords, but also may be due to formation of vocal cord polyps or cysts. Furthermore, one must always keep in mind that any smoker with voice changes or difficulty swallowing may have developed a neoplasm and should be evaluated by an otolaryngologist.

Less commonly, there are a variety of neurologic diseases that can also affect the voice as well as swallowing and should be evaluated.

Dr. Gibbs is fellowship-trained in laryngology / voice disorders.

For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277


Scott R. Gibbs, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277