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Can soft voice and need to speak louder be due to vocal cord paresis?

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Hello,

I'm having trouble with needing to speak louder than I can manage to at work and am wondering if I could have a degree of vocal cord paresis. My voice became extremely soft when I was about 8, I think after I had whooping cough although I don't entirely remember the timeline. It's improved a little over the years (I'm now 28) but it's still very hard to be heard in a room with any background noise, and it takes quite a bit of effort / concentration to speak at a louder volume. I also can't sing high notes at all and tend to run out of breath if I need to talk for a while at a stretch (e.g., dictating, rather than a simple back and forth conversation). But I may just naturally have a soft voice - I am female so it has always been attributed to soft-spokenness and I've never seen a physician about it. I've attached a picture of my vocal cords while vocalizing that I took with an Iphone (which I understand may seem rather strange, though oddly it seems to be a bit of a trend). Would appreciate any thoughts. Thank you for your time.


Category: ENT Specialist

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Category: ENT Specialist
Dr. Sunil Jalan is online now

Expert:  Dr. Sunil Jalan replied 4 Days.

Hello,



Thank you for using Ask a Doctor Service from Doctor Spring.

I am surprised that how did you take picture of your vocal cord with iphone, because it is possible with endoscope only ??

Any way you voice box (larynx including vocal cords) looks perfectly normal. You do not have vocal cord paralysis.

You need to put efforts to speak louder. Do you have any voice change, due you have any hoarseness of voice.

You need to be examined by local ENT doctor, who can examine you and do you voice analysis if required and advise you medication if required and guide about speech therapy if required

Hope this helps. Feel free to ask if you have any further queries.



Thank you.



Regards

Dr. Sunil Jalan

MBBS, DLO,MS(ENT), DNB,DAA



Patient replied :

This is a poorly done response. I am fairly knowledgable in this area and would appreciate a better thought-out answer. I have already explained that my voice changed after an infection. And you would know the picture is possible with a brief google search - this is fairly common now. Why is it that the cords do not adduct fully? The right does not come to midline and is less bulky than the left, hence my wondering about a subtle weakness. Obviously it is not fully paralyzed - this is why I asked about paresis.


Expert:  Dr. Sunil Jalan replied 3 Days.

Hello.
I could see a phonatory gap in the picture. However, in a still picture I cannot comment about vocal cord mobility. That is why I suggested that you need to be examined by a local ENT surgeon. You would require an indirect laryngoscopic examination to test for vocal cord mobility. Only this can tell us if there is any vocal cord weakness/paralysis. Always, a diagnosis is made considering age/sex/occupation/socioeconomic status/ symptoms/ examination and then we confirm it with tests.
In a young female other causes of voice change will be more common rather than vocal cord paralysis or paresis(weakness). Viral infection can cause vocal cord paralysis or paresis but still we have to confirm it. I cannot give a definitive diagnosis based on one still picture. This is because we have to take a picture of full abduction and one with full adduction of the vocal cords. I agreed that right vocal cord is less bulky than left, but this can be a normal anatomical variation. Many people with this have a normal voice.
With vocal cord paresis or paralysis voice become hoarse and breathy. That is the reason I asked about the same. If your voice is not hoarse or breathy during course of your condition, then it is very unlikely that you have paresis or paralysis.
Rather than an assumption, the best medical management can be given after a confirmed diagnosis.
I am sorry that I put in less information in my last reply but sometimes when I feel that the patient needs a definite examination by local doctor, then extra information may confuse the patient and may cause unnecessary anxiety.
Hope this helps. Feel free to ask if you have any further queries.
Thank you.


Dr. Sunil Jalan
Category: ENT Specialist
Experience: 
DAA (Diploma in asthma and allergy) : Christian Medical College, Vellore, 2012
D.N.B (ENT), 2011
Residency - M.S. (Master post graduate degree in otorhinolaryngology),  Christian Medical College, Vellore, 2009
D.L.O. (Diploma in otorhinolaryngology) - Christian Medical College, Vellore, 2007
Medical School - M.B.B.S, S.P. Medical college, Bikaner, 2004
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