Voice and throat: diagnosis and treatment
Hoarseness that won't go away, a voice that tires early, difficulty swallowing and the feeling of a lump in the throat are all checked with the same examination: laryngoscopy (throat endoscopy). It shows whether there is damage on the vocal cords themselves, or whether the vocal cords are healthy and the way the voice is produced has gone wrong. The answer changes the whole treatment plan.
What do we treat?
- Hoarseness and voice problemsthe most common symptom and the most misunderstood. Hoarseness that lasts more than 3 weeks needs a throat examination, no matter how much it bothers you, because serious causes look exactly like this in their early stages, without any pain.
- Voice care for professionals: teachers, singers, actors and anyone who talks for many hours a day. Here the examination happens earlier and with different criteria, because a small change that would not bother anyone else can stop them from working.
- Vocal cord nodules and polyps: when the examination shows a lesion on the vocal cord, the question is whether it will go away with voice therapy or needs microsurgery. The procedure is done endoscopically, with no external incision, with the aim of preserving the delicate vibrating lining of the vocal cord.
- Swallowing problems: difficulty swallowing, coughing while eating and the feeling of a lump in the throat. Swallowing and voice share the same mechanism, so they are checked with the same examination and by the same doctor.
What does a phoniatrician do?
Phoniatrics is the medical specialty dedicated entirely to voice, speech and swallowing. In Germany it is a separate specialist title, combined with pediatric audiology, and the training takes 5 years. In Greece there are very few doctors with this specialization, which is why most patients with a voice problem end up being treated without their larynx (voice box) ever having been examined while it is working.
In practice the difference comes down to one thing. A phoniatrician does not only look for damage, but at how the voice works. Dr. Ioannis Kotrotsos holds a dual German specialist qualification and has 15 years of clinical experience in Germany, where he has been the phoniatrician of the Stuttgart State Theatre (Staatstheater Stuttgart) since 2021.
How is the voice examined?
The examination starts with your history: when your voice changed, how you use it and what makes it worse. This is followed by laryngoscopy, done through the mouth or the nose. It takes a few minutes and does not hurt. Where needed, we add stroboscopy, the examination that shows the vocal cords in slow motion as they vibrate.
We discuss the findings with you straight afterwards, at the same visit, with the images in front of you. The plan follows from there, and in most cases it does not involve surgery.
Frequently asked questions
A phoniatrician is a doctor and makes the diagnosis: examines the larynx, finds the cause and decides on treatment, including surgery when needed. A speech therapist takes on voice therapy, which means retraining the voice. The two roles complement each other and in most cases work together.
A standard endoscopy shows whether there is visible damage. Stroboscopy shows the vocal cords in slow motion as they vibrate, so whether they vibrate symmetrically and whether they close fully. Many voice problems have no visible damage at all and can only be explained this way.
An ENT doctor or a phoniatrician, at the practice. You do not need to go to hospital or prepare in any way, and the examination is completed at the same visit.
No. A large share of voice problems are functional: the vocal cords are healthy but the way the voice is produced has gone wrong, something that only shows up on stroboscopy.
When should you not wait?
The rule
3 weeks
Hoarseness that does not clear up within this time should be examined, even if it does not bother you. International guidelines allow up to 4 weeks, and we do not wait that long.
Sooner
When something else is going on as well
Persistent pain, difficulty swallowing or breathing, a lump you can feel in the neck, or hoarseness in a smoker.
Immediately
Sudden loss of voice
When your voice goes suddenly while you were straining it, without a cold or virus beforehand.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Stachler RJ et al., Clinical Practice Guideline: Hoarseness (Dysphonia) — Update, AAO-HNSF, 2018.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
