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Larynx (Voice Box) Procedures
Overview
The larynx, or voice box, sits at the top of the windpipe. It produces your voice, protects the airway when you swallow and lets air pass to the lungs. When something affects the vocal cords or the airway, you may notice a hoarse or weak voice, voice fatigue, noisy breathing or a feeling of something stuck in the throat.
Hoarseness is often due to a cold, voice overuse or acid reflux, and it usually settles on its own. But a voice change that lasts more than three weeks — especially in someone who smokes or uses tobacco — should be examined, because early cancer of the voice box also causes hoarseness and is far easier to treat when found early.
Dr. Savyasachi Saxena examines the larynx with an endoscope during the consultation. When surgery is needed, microlaryngeal techniques work through the mouth to treat the vocal cords precisely, and voice rest and voice therapy are part of most treatment plans. Complex airway problems, such as narrowing of the windpipe, are evaluated and treated as well.
Your specialist
Dr. Savyasachi Saxena, MBBS, MS (ENT)
ENT & Head-Neck Surgeon · HOD, Fortis Hospital, Noida
What we treat
Conditions treated
Vocal cord nodules and polyps
Benign swellings on the vocal cords, often linked to heavy voice use by teachers, singers, call-centre staff and others who talk for long hours.
Vocal cord cysts and Reinke's oedema
Fluid-filled cysts, and a jelly-like swelling of the vocal cords that is strongly associated with smoking.
Laryngopharyngeal reflux
Stomach acid reaching the throat can cause hoarseness, throat clearing, a lump sensation and chronic cough, often without heartburn.
Vocal cord paralysis
Weakness of one or both vocal cords after surgery, a viral illness or nerve involvement, causing a breathy voice, choking on liquids or breathing difficulty.
Laryngeal papillomas and leukoplakia
Wart-like growths caused by HPV, and white patches on the vocal cords that may be precancerous and need a biopsy.
Laryngeal cancer
Most often linked to smoking and alcohol. Persistent hoarseness is a key early sign.
Airway narrowing and laryngeal webs
Narrowing of the voice box or windpipe, sometimes after a long period on a breathing tube, causing noisy breathing and breathlessness.
Foreign bodies in the airway or food passage
Swallowed or inhaled objects, such as coins, bones or food, that need prompt removal.
Signs & symptoms
Symptoms to watch for
Any of these, especially if they last or keep coming back, are worth discussing with an ENT specialist.
- A hoarse, rough, breathy or weak voice for more than three weeks
- A voice that tires quickly, or loss of vocal range
- Constant throat clearing or a feeling of a lump in the throat
- Pain in the throat or ear while speaking or swallowing
- Noisy breathing (stridor) or breathlessness
- Choking or coughing when drinking liquids
- Coughing up blood
- A lump in the neck
Diagnosis
How it's diagnosed
Tests are chosen for your symptoms — not everyone needs all of them.
- 1
Video laryngoscopy
After a numbing spray, a rigid or flexible endoscope shows the vocal cords on a screen. The recording can be compared at later visits.
- 2
Stroboscopy
May be advised to see vocal cord vibration in slow motion, which helps detect subtle lesions and plan voice treatment.
- 3
Direct laryngoscopy and biopsy
Under general anaesthesia, the larynx and upper food passage are examined closely and tissue samples are taken from any suspicious area.
- 4
CT or MRI of the neck
Assesses the extent of a growth, the degree of airway narrowing or the cause of vocal cord paralysis.
- 5
Reflux and swallowing assessment
When symptoms suggest reflux or a swallowing problem, further tests or a trial of treatment may be recommended.
Treatment
Treatment options
Treatment is tailored to the cause and severity of your problem. Where they are appropriate, non-surgical options are considered first.
- Non-surgical
Voice therapy and medical treatment
Voice rest, hydration, voice therapy, reflux treatment and stopping smoking are the first steps for many voice problems. Nodules often shrink with therapy alone.
- Surgical
Microlaryngeal surgery (MLS) and phonosurgery
Performed through the mouth under general anaesthesia using a microscope and fine instruments, to remove polyps, cysts, papillomas and other lesions while protecting the delicate layers of the vocal cords.
- Surgical
LASER surgery of the larynx
A precise LASER can be used for selected lesions, papillomas, webs and early tumours.
- Surgical
Thyroplasty
A framework procedure that repositions a paralysed vocal cord to strengthen the voice and reduce choking on liquids.
- Surgical
Airway surgery and tracheostomy
Surgery for airway narrowing and webs, and tracheostomy — a breathing opening in the windpipe — when the upper airway is blocked or longer-term breathing support is needed.
- Surgical
Laryngectomy
Partial or total removal of the voice box for cancer, planned together with oncology colleagues, with voice rehabilitation options discussed before surgery.
- Surgical
Endoscopic foreign body removal
Removal of objects lodged in the airway or food passage under direct vision.
All procedures offered
- Microlaryngeal Surgery (MLS) & Phonosurgery
- Thyroplasty
- Partial / Total Laryngectomy
- Surgery for Laryngotracheal Stenosis
- Direct Laryngoscopy & Hypopharyngoscopy
- Web Excision
- Tracheostomy
- LASER Surgery
- Foreign Body Removal from the Aero-digestive Tract
After treatment
Recovery & aftercare
- 1
After microlaryngeal surgery, a short period of voice rest followed by gradual, guided voice use helps the vocal cords heal.
- 2
Avoid shouting, whispering for long periods, throat clearing and smoking while you recover.
- 3
Drink plenty of water, use steam inhalation if advised, and take reflux medicines as prescribed.
- 4
Voice therapy after surgery helps prevent nodules or polyps from coming back.
- 5
Recovery after major airway or cancer surgery takes longer and is planned individually, including swallowing and speech rehabilitation.
Safety
Possible risks
- Sore throat, minor bleeding or a temporary change in voice
- Injury to the teeth, lips or gums from the instruments used during microlaryngeal surgery
- Scarring of the vocal cords that affects voice quality
- Recurrence of nodules, polyps or papillomas
- Major airway and cancer operations carry additional risks, which are discussed in detail before surgery
Every procedure carries some risk. Dr. Saxena explains the risks that apply to you, and the alternatives, before you decide on any treatment.
Getting help
When to see an ENT specialist
Book a consultation if
- Hoarseness lasting more than three weeks
- Voice problems affecting your work, especially if you use your voice professionally
- Persistent throat clearing, a lump sensation or chronic cough
- Choking or coughing when swallowing liquids
- Any voice change if you smoke, chew tobacco or drink alcohol regularly
Get urgent care if
- Noisy breathing (stridor), breathlessness or being unable to lie flat
- A suspected swallowed or inhaled object, especially in a child
- Coughing up blood
- Sudden severe throat pain with drooling or difficulty swallowing saliva
In an emergency, call 112 or go to the nearest hospital emergency department.
FAQs
Frequently asked questions
How long should hoarseness last before I see an ENT?
If hoarseness lasts more than three weeks — or sooner if you smoke, have pain, trouble swallowing or breathing, or cough up blood — have your larynx examined. The examination is quick and is usually done during the consultation with an endoscope.
Will I need surgery for vocal cord nodules?
Usually not at first. Most nodules are treated with voice therapy, better voice habits, hydration and reflux control. Surgery is considered only if nodules persist and keep affecting the voice after an adequate trial of therapy.
Is microlaryngeal surgery done through the neck?
No. It is performed through the mouth using a laryngoscope and microscope, so there is no cut on the neck. It is done under general anaesthesia, and the hospital stay is usually short.
Can acid reflux affect my voice?
Yes. Reflux can irritate the vocal cords and cause hoarseness, throat clearing and a lump sensation, even without heartburn. Treatment includes changes to meals and lifestyle and, when needed, medicines.
Can a person speak with a tracheostomy?
Many people can, using a speaking valve or by briefly covering the tube, depending on the reason for the tracheostomy and the type of tube. The care team teaches patients and families how to manage it safely.
Further reading
This page gives general information for patients and is not a substitute for a medical consultation. Diagnosis and treatment depend on an individual examination.