Did your laryngologist make a video? Did he explain the problem to you in a way that you understand the video? If he didn’t explain your hoarseness to your satisfaction, get a copy of the video and take it home. First, identify the vocal cords. Watch them come together on the stroboscopy portion of the exam. As they vibrate, can you identify any persistent gap between them that never closes? That should explain huskiness in your voice. Then, look for any asymmetry between them. The vibrating cords should be mirror images of each other. Any asymmetry is a potential explanation of roughness.
Look at the portion of the video when your voice sounds bad. If no recording was made at a pitch or volume that brought out your hoarseness, then the problem could well have been missed.
If you are still in the office with your laryngologist, don’t try to sound good. He will gain the most information by recording video under the conditions when your voice is sounding hoarse. If the air leak or asymmetry is not obvious, did the examiner get close to the vocal cords? When I am close to the vocal cords — even though they are less than an inch long — they often no longer fit within the video screen. That is how close a laryngologist can get. The vocal cords can more than fill the screen.
If the air leak or asymmetry is not obvious, did the examiner make a recording at high and low pitches and at loud and soft volumes? The more ways your vocal cords are tested, the more likely that an accurate explanation for hoarseness can be found. These are all ways to assess how adequate your laryngeal examination is — and how you are going to get that frog out of your throat.
What you learned
- A video recording of the vocal cords is the standard of care; without it, a transient finding may be entirely missed and the examination cannot be reviewed or verified.
- The examination must include recordings at multiple pitch and volume combinations — the problem is most visible at the exact pitch and volume where the voice sounds worst.
- Proximity matters: at close range, the vocal cords should fill the entire video screen; distant views miss fine detail and may fail to reveal the air leak or asymmetry causing hoarseness.
- Husky hoarseness = a persistent gap that never closes; rough hoarseness = asymmetry between the two cords. These should be directly visible on stroboscopy when the voice is tested under the right conditions.