My father has had a weakness in his voice for the last three months. It is not sore but continues to grow weaker. What could be the cause, and what are his options? He is 69 and had a defibrillator inserted about one year ago.

Jennifer

What do you mean by "weakness?" For most people, vocal weakness means low volume or breathiness. Or perhaps you mean that he cannot speak for long periods of time without losing his voice entirely. Both problems may be present simultaneously, and both suggest a problem with the larynx (voice box).

Speech is a complex process requiring normal function of the brain and nerves, lungs, trachea (windpipe), larynx, pharynx (throat), tongue, soft palate and lips. You do not say that he has problems pronouncing words, or that the sound of his speech is distorted in any way. Therefore, it sounds as though his pharynx, tongue, soft palate and lips are all working appropriately.

A "strong" voice requires appropriate lung strength. However, if lack of lung strength were your father's problem, shortness of breath would be a more prominent symptom than voice problems. A strong voice also requires that the two vocal cords come together completely when the individual speaks. The vocal cords are narrow strips of tissue that are joined together at one end, like a V. When you speak, the cords move together, so that (usually) no gap is visible, like this: ||. If a gap is present, more air than usual escapes during speech. The result is a breathy, low-volume voice, and the individual must take more frequent breaths during continuous speech -- a weak voice, in other words.

There is a lengthy list of possible causes for a gap between the cords during speech. Vocal-cord paralysis (which, itself, has a long list of possible causes), age-related "bowing" of the cords, inflammation of the cords (you guessed it -- another long list of causes) and tumors on or near the cords are only some of the possibilities.

My strong suspicion is that your father has such a gap. An ear, nose and throat specialist (ENT) could determine this very quickly by examining your father's larynx with a flexible fiberoptic telescope. This is a reasonably comfortable office procedure that can quickly establish your father's diagnosis. Treatment options will vary depending upon the exact diagnosis, so I cannot predict what the ENT will suggest to treat your father's vocal weakness. Fortunately, for most patients, excellent treatments are available.

While all ENTs are skilled in the diagnosis of voice problems, not all ENTs are created equal when it comes to surgical and medical treatment of such problems. For best results, your father should try to find an ENT who has experience in the diagnosis AND treatment of voice problems.