Voice Disorders and Conditions

Vocal cords produce the sound of your voice by vibration and the air passing through the cords from the lungs. Your vocal cords are located in the larynx (voice box), found in the neck at the top of the trachea (windpipe). The sound of each individual voice is determined by the size and shape of the vocal cords, along with the size and shape of the throat, nose and mouth (the resonating cavities).

The Voice Program of the Division of Otolaryngology-Head and Neck Surgery at Brigham and Women’s Hospital (BWH) provides expert and coordinated diagnosis, innovative therapies and individualized patient care for a range of disorders affecting the voice and airway, from the common to complex. Our laryngologists and speech pathologists work with a range of patients from professional voice users and performing artists to patients with complex medical and surgical conditions.

Voice Topics

Causes of Voice Disorders

Vocal cord disorders are often caused by vocal abuse or misuse, such as excessive use of the voice when singing or talking, smoking, coughing, yelling or inhaling irritants. Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps and vocal cord paralysis. Disorders can also be caused by neurological conditions—such as Parkinson’s disease—cancer or as a side effect of some surgeries and for other medical reasons. Many voice disorders can be cured with treatment when diagnosed early.

Types of Voice Disorders

Vocal Cord Paralysis

Paralyzed or partially paralyzed vocal cords (paresis) can be caused by a viral infection that affects your vocal cord nerves, an injury to a nerve during surgery, stroke or cancer. If one or both of your vocal cords are paralyzed in a nearly closed position, you may have noisy or difficult breathing. If they are paralyzed in an open position, you may have a weak, breathy voice. Although some people get better over time, for others the paralysis is permanent. The Voice Program specialists and therapists at BWH will develop a program to assess, diagnose and develop a treatment plan for your specific condition to help improve your voice.

Learn more about vocal cord disorders.

Vocal Cord Growths

Growths (or extra tissues) may form on the vocal cords and can prevent the cords from working normally. The growths can include callus-like bumps called nodules, fluid-filled sacs called cysts, or wart-like lumps called papilloma. Other growths include a small area of chronic inflammation called a granuloma, and small blisters called polyps. There may also be patches of damaged tissue called lesions, or areas of scar tissue. In some people, a band of tissue called a web can grow between the vocal cords. Growths can have many causes, including illness, injury, cancer and vocal abuse. The Voice Program specialists and therapists at BWH will develop a program to assess, diagnose and develop a treatment plan for your specific condition to address these conditions.

Learn more about vocal cord growths.

Voice Program

Led by Director, Thomas Carroll, MD, Associate Director, Jayme Dowdall, MD, and Clinical Coordinator of Voice Services, Chandler Thompson, DMA, MS, CCC-SLP, the Voice Program approaches patient care as a coordinated team. Integral to their success is a team of Voice Pathologists and allied health providers who provide necessary input to the patient and physicians during clinic visits. Patients are typically seen by both a Doctor and Voice Pathologist during every visit to provide coordinated diagnoses and decide upon innovative therapies for patients with voice, swallowing and airway conditions including chronic cough and paradoxical vocal fold motion disorder.

Voice Program Specialists Treat a Diverse Patient Population

Specialists in the Voice Program deliver expert care for a highly diverse patient population, including:

  • Performing artists such as actors and singers
  • Professional voice users such as physicians, professors, lawyers, politicians, business executives, lecturers, teachers and coaches
  • Patients undergoing procedures that require intubation or dissection along the course of the recurrent laryngeal nerve (such as cardiac surgery, carotid endarterectomy, skull-base surgery, thoracic surgery and thyroidectomy)
  • Patients with conditions requiring multidisciplinary care such as multisite airway disease and subglottic stenosis
  • Patients with neurological conditions such as spasmodic dysphonia or Parkinson’s disease
  • Patients with advanced cancer that is compromising the laryngeal functions of voicing and swallowing
  • Patients with laryngopharyngeal reflux

Voice Program: Diagnosis, Care and Treatment

  • Combined visits with otolaryngologists and speech pathologists facilitate the assessment of anatomy, medical and surgical management and voice therapy in one visit
  • Collaboration with BWH specialists in the Performing Arts Clinic, the Osher Center for Integrative Medicine and the Dyspnea Center
  • Advanced diagnostic services in close collaboration with our gastroenterology, neurology and pulmonology colleagues, in addition to traditional laryngeal diagnostic services such as stroboscopy and laryngeal function studies (acoustic and aerodynamic measurements)
  • State-of-the-art laryngeal surgery incorporating the use of lasers and injectable agents in the operating room, in addition to a wide-range of awake laryngeal procedures performed both in the office and at the bedside

Learn more about voice disorders.

Specialized Services for Performers

The specialists in the BWH Voice Program provide triage assessments and therapy for performers who have events scheduled in the near future. Designed to quickly ascertain current vocal status and provide strategies to enhance a performance in an upcoming production, recital, or other event, these sessions are often part of a longer-term course of voice therapy to address underlying vocal mechanics and medical considerations.

Our Care Team

Thomas L. Carroll, MD, Laryngologist
Dr. Carroll is a board certified Otolaryngologist at Brigham and Women’s Hospital (BWH) and an instructor in otology and laryngology at Harvard Medical School. He is the Director of the BWH Voice Program, which provides diagnoses and innovative therapies for patients with voice and airway conditions.

He received his medical degree from Wright State University School of Medicine and completed a residency in otolaryngology at the University of Colorado Denver and Health Sciences Center. Dr. Carroll completed a fellowship in laryngology and care of the professional voice at the University of Pittsburgh Medical Center Voice Center.  His interests include medical and surgical care of the professional voice (singing and speaking), early glottic cancer with an emphasis on voice preservation, Laryngopharyngeal reflux and related disorders such as chronic cough, vocal cord paralysis/paresis and office based laryngeal surgery including vocal fold augmentation and photoangiolytic laser therapy.  He is a lifetime singer with an undergraduate music degree from Oberlin College.  He currently performs with the chamber choir, the Oriana Consort, in Cambridge, MA.

Jayme R. Dowdall, MD, Laryngologist
Dr. Jayme R. Dowdall is a surgeon at Brigham and Women’s Hospital specializing in otolaryngology. She is also an instructor in otology and laryngology at Harvard Medical School.

Dr. Dowdall received her medical degree from Boston University School of Medicine. She completed an otolaryngology residency at Wayne State University and an otolaryngology fellowship at the Massachusetts Eye and Ear Infirmary. Dr. Dowdall is board certified in otolaryngology and has clinical interests in voice disorders, dysphonia, endoscopic treatment of laryngeal cancer, glottic insufficiency, vocal fold paralysis, airway stenosis and office-based laryngology procedures.

Chandler Thompson, D.M.A., M.S., CCC-SLP, Clinical Vocologist/Professional Voice Specialist
Chandler is the Coordinator of Voice Services at Brigham and Women’s Hospital, Division of Otolaryngology, where she evaluates and treats patients with voice disorders, including videostroboscopic examination of the larynx, and acoustic and aerodynamic testing.  Dr. Thompson holds three degrees in Vocal Performance, including the Doctor of Musical Arts from Michigan State University. She taught singing and related music courses at several universities before matriculating at New York Medical College, where she received a Master of Science degree in Speech-Language Pathology, winning the Clinical Excellence Award.  Prior to moving to Boston, Dr. Thompson worked in New York in private practice, at the Eugen Grabscheid Voice Center of Mount Sinai Hospital, and at Westchester Medical Center. She has been an invited presenter at the Voice Foundation symposium, and the Performing Arts Medicine Association meeting for the last 3 years. Chandler has lectured at numerous college and high school performing arts programs, vocal health seminars, and NATS and ACDA events. She has received training in:  Somatic Voicework—the LoVetri Method, levels 1-3; Compton Pronouncing English as a Second Language accent modification; Buteyko Breathing Education; Biodynamic Manual Voice Therapy; and, telepractice training for speech-language pathologists.

Lindsey L. Gordon, M.S., CCC-SLP, Clinical Voice Specialist
Lindsey is a Senior Speech Pathologist specializing in voice disorders. She graduated summa cum laude from Northeastern University with both a Bachelor of Science and a Master of Science in Speech-Language Pathology. She completed her clinical fellowship at Massachusetts Eye and Ear Infirmary and stayed on staff there for eight years, working with both voice patients and laryngectomized patients. She has also held the position of Clinical Specialist and Sales Manager with Atos Medical, Inc. In that role, she focused on products related to voice and pulmonary rehabilitation for laryngectomized patients.  She has also been an Adjunct Lecturer in the graduate program for Speech-Language Pathology at Boston University, and has supervised many graduate students. In addition, she has lectured locally and nationally on the subjects of voice and pulmonary restoration for laryngectomized patients. Mrs. Gordon is also certified in the Compton P-ESL program, LSVT, and Estill Voice 1, and received training in telepractice for speech-language pathologists.

Maxine E. Van Doren, MS, CCC-SLP, Clinical Voice Specialist
Maxine is a speech-language pathologist specializing in voice disorders with a background in theater and competitive public speaking. She graduated summa cum laude from the University of California, Los Angeles with a Bachelor of Arts in Linguistics and received her Master of Science in Speech-Language Pathology from Boston University, where she was awarded the Graduate Student Leadership Award for excellence in academia, clinical skills, and leadership. Prior to joining the voice team, she worked in a private practice gaining experience treating pediatric and adult voice, speech, and language disorders. Her clinical interests include speaking voice professional voice use, laryngospasm, paradoxical vocal fold motion disorder/vocal cord dysfunction, chronic cough, irritable larynx syndrome, and telehealth. Maxine has completed training in telepractice for speech-language pathology and is certified in the Compton P-ESL program for accent modification and Estill Voice 1. She was accepted into the 2016-2017 cohort of the American Speech-Language and Hearing Association’s Leadership Development Program.

Jennifer Winston, MS, CCC-SLP, Clinical Voice Specialist
Jennifer is a speech-language pathologist, specializing in voice disorders, with a background in singing, performing, and the visual arts. She holds a Bachelor of Fine Arts in Illustration from Parsons School of Design in New York City, and a Master of Science in Communication Disorders from Emerson College in Boston. Jennifer is an active member of the New England community of barbershop harmony singers including several award winning groups, and provides education on healthy singing and care of the voice to local amateur singing groups of all styles. She has supplemental vocal training in the Estill Voice 1 & 2, and has studied with a Bel Canto style voice teacher. Jennifer’s clinical interests include disorders of professional and amateur singing voice, disorders of speaking voice, disorders of aging voice, Laryngopharyngeal Reflux Disease (LPRD), and neurogenic voice disorders. Jennifer is also a certified provider of the Lee Silverman Voice Treatment (LSVT) method, has telepractice training for speech-language pathologists, and has had unique training in accent modification.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have a voice disorder or condition and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced otolaryngologist are important to the successful outcome for patients with ear, nose and throat disorders and conditions.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be taken care of in the operating room by otolaryngologist, anesthesiologists and nurses who specialize in surgery for patients with voice disorders and conditions. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by experienced surgical and nursing staff.

Learn more about your hospital stay, patient-centered care and returning home.

Multidisciplinary Care

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care by collaborating with colleagues who have extensive experience in diagnosing and treating ear, nose and throat disorders and conditions. In addition, patients have full access to BWH’s world-renowned academic medical community, with its diverse specialists, and state-of-the-art facilities.

Resources

Learn more about voice disorders in our health library.

Learn more about voice disorders from these sources:

Visit the Kessler Health Education Library in the Bretholtz Center to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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