Voice Disorders

VOICE DISORDERS AFFECT YOUR ABILITY TO SPEAK CLEARLY. IT’S USUALLY THE RESULT OF OVERUSING YOUR VOICE OR PROBLEMS WITH YOUR VOICE BOX OR VOCAL CORDS. MOST PEOPLE CAN MANAGE THEIR VOICE DISORDERS WITH VOICE THERAPY, BUT SOME WILL NEED MEDICAL OR SURGICAL TREATMENT.

What are voice disorders?

Voice disorders affect your ability to speak normally. They can change the quality, pitch or loudness of your voice. A voice disorder can prevent you from communicating with others or expressing yourself. This can have a serious impact on your quality of life.

How does your voice work?

Air moves from your lungs to your windpipe (trachea) and voice box (larynx). Your vocal cords are on both sides of your larynx. They vibrate as air passes through them, which produces the sound of your voice. It’s a bit like whistling. When you force air through your lips, they vibrate slightly and produce a high-pitched sound.

What are the categories of voice disorders?

Voice disorders typically fall into one of the following categories, but they can overlap:

Functional: The structures that produce sound—your voice box, vocal cords, and lungs—are normal, but you have trouble using them. Functional disorders are often the result of not being able to use your vocal cord muscles.
Organic: There are problems with the structure of your voice box, vocal cords, or lungs. Organic disorders are usually structural (such as abnormal growths in your larynx) or neurological (another disorder that affects the nerves that control your larynx).
Psychogenic: Although rare, some voice disorders develop due to emotional stress or trauma. They may be the result of anxiety, depression, or conversion disorder.

What are the different types of voice disorders?

There are many types of voice disorders, but the most common are:

Hoarseness is when your voice sounds high-pitched or weak. It can have many causes, from viral infections to Parkinson’s disease.
Laryngitis is irritation or swelling of your voice box. It is usually temporary and the result of allergies or an upper respiratory tract infection.
Muscle tension dysphonia occurs when you put too much pressure on your vocal cords and the muscles become tense.
Spasmodic dysphonia causes spasms in your voice box muscles.
Vocal fold dysfunction (VCD) can prevent your vocal cords from opening fully, leading to breathing problems.
Vocal fold lesions are benign (non-cancerous) growths such as nodules, polyps, or cysts that can affect your voice.
Vocal cord paralysis prevents you from controlling your voice box muscles.

Who gets voice disorders?

Anyone can develop a voice disorder, but some factors increase your risk:

Age and gender: Being a woman over 50 years old.
Lifestyle: Smoking, drug addiction, or alcohol abuse can damage your lungs, larynx, and vocal cords.
Occupation: Teachers, singers, telemarketers, and others with occupations that require a lot of speaking or voice use.
Other diseases and disorders: Having Parkinson’s disease, multiple sclerosis (MS), laryngeal cancer, or laryngopharyngeal reflux (LPR).

How common are voice disorders?

Between 3% and 9% of our country’s population experiences a voice disorder at some point, but less than 1% of these people seek treatment. Teachers are by far the most at-risk population. In a study involving nearly a thousand teachers in America, voice disorders were detected in 57% of the participants.

SYMPTOMS AND CAUSES OF VOICE DISORDER

What causes voice disorders?

Overusing your voice is the most common cause of voice disorders. You may overuse your voice by shouting, singing, or talking too much.

Sometimes voice disorders are the result of a short-term (acute) illness such as a cold, allergies, or sinus infection (sinusitis). Once they heal, they usually go away within a few days or weeks.

More complex voice disorders occur when there is a problem with the structure, muscles or nerves in your voice box or vocal cords.

What are the symptoms of voice disorders?

Symptoms of voice disorders vary greatly depending on their cause. You can be heard:

Shrill or wet.
Rough, tense, raspy or muffled.
Choked or out of breath.
Too high or too low.
Too loud or too soft.
Irregular or shaky, with interruptions or gaps in the sound.

DIAGNOSIS AND TESTS

How are voice disorders diagnosed?

Your primary care provider may diagnose a voice disorder or refer you to a speech-language pathologist or laryngologist (a doctor who specializes in voice box disorders). They will perform a comprehensive physical examination and evaluate your symptoms and medical history. Your healthcare provider may ask questions about how your voice problems affect your life at home, work, or school.

Your healthcare provider will look very closely at your face, head, neck, and throat while you do speaking or breathing exercises. Report any physical symptoms you feel during these exercises. Tell them if you have pain, itching, or trouble breathing.

If you see a speech-language pathologist, that provider will likely perform detailed tests to evaluate different aspects of your voice, including tone, pitch, and volume.

Your healthcare provider may recommend imaging tests to see how well your voice box and vocal cords are working. Laryngoscopy uses a special instrument called a laryngoscope (a thin, flexible tube with a video camera attached) to examine the back of your throat. They may also perform a biopsy during this test. Your healthcare provider takes samples of the nodules, polyps, or cysts and examines them under a microscope to check for disease.

METHOD AND TREATMENT

How are voice disorders treated?

Some short-term voice disorders, such as hoarseness, can be improved by resting your voice. Avoid shouting, singing, or straining your voice for a few days. Talk as little as possible.

People with more complex voice disorders may need voice therapy. Speech-language pathologists teach techniques and exercises to regulate your voice so you can communicate more clearly. A few examples include:

Accent method: You learn to coordinate breathing and speech while relaxing the vocal cord muscles.
Auditory masking: You talk loudly while wearing headphones, which plays loud background noise and teaches you to raise your voice.
Speech training therapy: You learn to speak using speech that is relevant to you. Therapists help you with additional aspects of communication, such as hand gestures and facial expressions.

Some voice disorders require medical or surgical treatment, such as botulin toxin injections to relax tense laryngeal muscles.

PREVENTION

Can voice disorders be prevented?

Some voice disorders cannot be prevented, but you can reduce your risk by paying attention to your voice.

Avoid smoking, drugs and alcohol.
Drink plenty of water to keep your vocal cords moist.
If you have a job that requires a lot of talking, rest your voice frequently.

What is the prognosis (outlook) for people with voice disorders?

Voice disorders associated with overuse or acute illness are usually temporary and do not cause permanent damage. Most people with more complex voice disorders can overcome their voice problems with the right treatments.

What questions should I ask my doctor?

Questions you may want to ask your doctor include:

Are there any lifestyle changes I can make to improve my voice?
Can a voice disorder get worse over time?
How long will I need treatment for a voice disorder?

Voice disorders affect your ability to speak clearly. They can affect the loudness, tone or pitch of your voice. Sometimes, audio problems are caused by overuse and are resolved after resting your voice. Other times, voice problems are the result of more complex health conditions. If you notice a change in your voice that lasts longer than a few weeks, contact your doctor .