May 13, 2025
A weak voice can have a wide range of underlying causes, but structural issues are often the most challenging to identify and treat. The Voice Clinic at Mayo Clinic in Jacksonville, Florida, offers specialized expertise in restoring vocal ability and treating voice disorders.
"We are comfortable with the complex and underlying conditions that can cause vocal changes, known as dysphonia, and voice weakness," says Amy L. Rutt, D.O., a laryngologist at Mayo Clinic in Jacksonville, Florida. "We are specially trained and focused on treating voice, upper airway and swallowing disorders. That's our niche."
Mayo Clinic's dedicated voice team includes Dr. Rutt and two speech-language pathologists. Speech-language pathologists play a critical role in voice therapy and rehabilitation, either as a primary treatment or in combination with surgery.
The voice team also works closely with other specialists, including pulmonologists and neurologists, if an underlying lung or neurological issue is suspected. A weakened voice may have a neurological etiology, including crossover from Parkinson's disease, multiple sclerosis and amyotrophic lateral sclerosis, among many other etiologies.
Comprehensive diagnosis for dysphonia
It's common for a weak voice to be initially diagnosed as gastroesophageal reflux disease (GERD), says Dr. Rutt. Reflux can cause dysphonia. However, it is best to refer the patient to be evaluated and to undergo laryngoscopy instead of prescribing reflux medications. Referring the patient helps avoid a delayed diagnosis when a structural voice disorder is the underlying cause of vocal weakness.
The voice team in Florida evaluates the structural integrity of the upper airway, larynx and vocal cords in two ways. Dr. Rutt performs laryngoscopy with stroboscopy, which allows her to examine the fine details of the vocal fold vibration.
"I put people through several vocal tasks while looking at their vocal cords," she explains. "Sometimes the cause of the weak voice is obvious, but sometimes it is not. In those cases, I do a longer voice exam with the scope to fatigue the voice and tease out the problem."
Dr. Rutt looks for vocal cord and airway issues, such as:
- Idiopathic subglottic stenosis (iSGS), which involves a narrowing of the upper trachea for unknown causes.
- Vocal cord webs (laryngeal webs), which is when abnormal tissue bands form between vocal folds, causing breathing and voice issues.
- Vocal fold lesions that can impinge vibration, making it harder to produce sound.
- Vocal fold paralysis, which can occur following a heart attack, stroke, surgery on the upper body, or trauma to the chest or neck.
- Vocal fold scarring that can affect the vibrating layer of the vocal folds.
"There are many reasons someone may develop a weak voice, and they aren't all primary voice disorders," says Dr. Rutt.
Advanced treatment for voice disorders
Treating voice disorders is a collaborative effort. "I work closely with our speech-language pathologists," says Dr. Rutt. "In some cases, singing voice therapy or conversational voice therapy is enough. But even when surgery is indicated, our patients receive postoperative voice therapy."
Dr. Rutt's surgical expertise includes several subspecialized procedures for the full spectrum of voice disorders. She performs operations through the mouth using a laryngoscope to avoid a neck incision. For vocal fold paralysis, Dr. Rutt can administer injections or insert implants to improve the voice. Patients can undergo injections in the office or operating room.
For more-severe vocal cord issues, such as bilateral vocal cord paralysis, Dr. Rutt performs complex and specialized endoscopic procedures to help patients avoid tracheostomy. The voice team provides extensive patient education for people considering these operations.
"A tracheostomy is a major lifestyle change for the patient and their family and requires lifelong care. So, it is exciting that other treatment options are available," says Dr. Rutt. "However, patients need to know that they may have to sacrifice the strength of their voice or live with a temporary swallowing problem to avoid a tracheostomy."
Dr. Rutt and the voice team also treat a high volume of rare conditions, such as iSGS. Primarily diagnosed in white, middle-aged females, iSGS typically presents with progressive symptoms of dyspnea and dysphonia.
"People with iSGS may have stridor when breathing," she says. This rare condition may be misdiagnosed as asthma. "The trachea is narrowed, often by scar tissue and inflammation. But we know how to treat that." Treatment may include steroid injections, balloon dilation or a laser wedge excision. More-advanced cases may require complex airway procedures or airway reconstruction.
"It's very fulfilling to help somebody with iSGS find their breath and voice again," says Dr. Rutt.
Pioneering research for voice and upper airway disorders
Dr. Rutt's published research is extensive and explores an array of topics associated with voice disorders. But iSGS is an area of special interest to her.
Dr. Rutt, who collaborates with research colleagues in Rochester, Minnesota, says that Mayo Clinic is one of the centers leading iSGS research. "There's a lot of ongoing research focusing on iSGS to determine the exact cause," she says. "We know it's a fibrotic disease and that there could be a hormonal component."
Dr. Rutt's iSGS research also focuses on:
- Anxiety and depression in patients with iSGS.
- How iSGS affects sexual life.
- Outcomes achieved with steroid injections.
- Structure of the tissue associated with iSGS.
- Which iSGS procedures produce better outcomes.
"We see many people with iSGS, even though it is rare," says Dr. Rutt. "We are working hard to understand the underlying causes and impact of this condition to offer the most effective treatment and support."
For more information
Refer a patient to Mayo Clinic.