From the Guidelines
For vocal cord pain, I strongly recommend starting with a comprehensive evaluation by an otolaryngologist (ENT specialist) who will likely perform laryngoscopy, the primary diagnostic test that allows direct visualization of the vocal cords, as emphasized by the most recent guidelines 1. This examination can be done using either a flexible fiberoptic scope inserted through the nose or a rigid scope placed through the mouth. The key points to consider in the evaluation of vocal cord pain include:
- Identifying abnormal voice characteristics, such as changes in pitch, loudness, or vocal effort, which can indicate underlying dysphonia 1
- Assessing the patient's history and physical examination to identify underlying causes of dysphonia and factors that modify management, such as recent surgical procedures, tobacco abuse, or professional voice use 1
- Considering the need for expedited laryngeal evaluation in cases where serious underlying causes are suspected, such as recent endotracheal intubation, presence of concomitant neck mass, or respiratory distress 1 Additional recommended tests may include:
- Videostroboscopy, which provides a slow-motion view of vocal cord vibration to assess subtle abnormalities
- Voice acoustic analysis to measure voice parameters objectively
- If reflux is suspected as a cause, a 24-hour pH monitoring test might be ordered
- In cases where structural abnormalities are suspected, imaging studies such as CT or MRI scans of the neck and throat may be necessary, but only after laryngoscopy has been performed, as recommended by the guidelines 1
- Blood tests might be performed to check for inflammatory markers or thyroid function, as thyroid disorders can affect the voice These diagnostic approaches help identify the underlying cause of vocal cord pain, which could range from vocal strain, infections, and reflux to more serious conditions like nodules, polyps, or rarely, malignancies, allowing for appropriate targeted treatment. It is essential to follow the guidelines that recommend against routine use of CT or MRI scans, antireflux medications, corticosteroids, and antibiotics without proper visualization of the larynx 1. Laryngoscopy is the primary diagnostic modality, and it should be performed, or referral to a clinician who can perform it should be made, when dysphonia fails to resolve or improve within 4 weeks or if a serious underlying cause is suspected 1.
From the Research
Recommended Tests for Vocal Cord Pain
The following tests are recommended for evaluating vocal cord pain:
- Laryngoscopy, which can be direct or indirect, to visualize the larynx and vocal cords 2, 3, 4, 5, 6
- Indirect laryngoscopy with a rigid 70-degree laryngoscope to predict difficult direct laryngoscopy 4
- Flexible laryngoscopy, which is effective in 99.6% of patients and easy to perform in 96.5% of patients 6
- BPL video laryngoscopy, which provides better vocal cord visualization and easier intubation, but takes more time for intubation 5
- McCoy blade direct laryngoscopy, which takes less time for tracheal intubation and has stable hemodynamic parameters 5
Types of Laryngoscopy
There are different types of laryngoscopy, including:
- Direct laryngoscopy, which uses a laryngoscope to directly visualize the vocal cords 2, 5
- Indirect laryngoscopy, which uses a mirror or a rigid laryngoscope to visualize the vocal cords 2, 4, 6
- Flexible laryngoscopy, which uses a flexible tube with a camera to visualize the vocal cords 6
- Video laryngoscopy, which uses a video camera to visualize the vocal cords 5
Predictors of Difficult Laryngoscopy
The following are predictors of difficult laryngoscopy: