Voice disorders
What are they and what causes them?
Sound is created when your vocal cords vibrate. This vibration comes from air moving through your voice box (larynx), bringing your vocal cords closer together.
If your vocal cords become inflamed, develop growths or become paralysed, they can’t work properly, so you become hoarse and you may develop a voice disorder such as laryngitis, polyps, nodules or cysts on the vocal cords, precancerous and cancerous lesions, vocal cord paralysis or weakness.
What’s the treatment?
Rest, liquids and voice therapy The vocal cords need rest and lubrication (ie chewing gum). A speech specialist can teach you how to use your voice and how to clear your throat.
Allergy treatments If you have too much mucus in your throat an allergy specialist can identify the cause and treat it.
Stopping smoking Quitting smoking can help improve your voice and lower your cancer risk. Medications Can help reduce inflammation and treat acid reflux.
Medical procedures
Removal of lesions Polyps, nodules and cysts can be removed by microsurgery or laser treatment. Botox injections Botulinum toxin injected into your neck skin can decrease muscle spasms.
If one vocal cord becomes paralysed causing hoarseness one of two procedures can be used...
Fat or collagen injection where body fat or synthetic collagen is injected to add bulk to the paralysed vocal cord, or...
Thyroplasty where an implant is inserted through an opening made in the cartilage of your voice box pushing it against the paralysed vocal cord, moving it closer to the healthy one.
We mustn’t let the pain and shock we felt when we learned about the disastrous state of our care homes slip from the public memory, nor from the minds of politicians.
It has taken the Covid-19 pandemic to reveal how the care sector has been neglected, underfunded and allowed to decay for years.
Many staff are paid the minimum wage or less. Then with the advent of the pandemic staff got overwhelmed.
Untested residents were dying, PPE shortages were intractable and no testing equipment was available.
One of the most awful aspects of this dreadful situation was distraught relatives being unable to visit their loved ones.
Consultant geriatrician David Oliver writing in the British Medical Journal says that according to healthcare business consultancy LaingBuisson, around 410,000 people aged over 65 live in the UK’s 11,300 nursing and residential homes.
This outnumbers adult hospital beds by around three to one. Yet, despite these large numbers, the care sector has received low priority compared to the NHS and got far less attention than acute hospitals or GP surgeries. But right now care homes are taking the brunt of the pandemic. New Covid-19 regulations mean care homes can take in residents from hospitals far sooner but often with no more staff. Most years, residents suffer complications and die from acute illness such as flu. But this year there is a great number of excess deaths.
With the Covid-19 pandemic many residents have no option but to isolate in their own rooms and avoid communal areas. Teams that were already overstretched must now also carry out checks, assistance and supervision within the rooms.
There are no visiting relatives to provide reassurance. Staff are going off sick or are self-isolating because of sickness in their own families.
Government promises to care homes have been broken over and over again. They still lack appropriate PPE for their staff but they selflessly continue to care for residents they know and cherish.
It would have been very hard to test residents for Covid-19 even if tests had been available because we didn’t have the testing infrastructure set up for care homes or sufficient testing staff.
Meanwhile, many homes are accommodating far more acutely ill residents who would normally have been sent to hospital and they have little support from general practice, district nursing or geriatric medics.
As Dr Oliver says, the pandemic has brought into focus issues around funding, staffing and support for care homes we should have tackled years ago. This scandal must be sorted out.
The care sector has three times as many adult beds as hospitals