Our voice is just like our fingerprints - each person’s is unique. For many of us, our voices play a major role in our identity and how we communicate with others.
A complex series of muscle movements takes place every time we use our voice. Each of us have a larynx (commonly called a voice box) that is located at the bottom of our throat. Within the larynx are our vocal folds (or vocal cords). Everytime we use our voice, air travels from our lungs and through our vocal folds, which causes them to vibrate and create sound.
When this delicate balance of airflow and muscle movements is disturbed, we may develop a voice disorder. Many people don’t give much thought to their voice, or the incredible vocal anatomy that makes speech production possible, until they experience a problem. However, the inability to effectively use our voice can have a major impact on our quality of life, affecting our interpersonal relationships, school or work performance, and overall confidence and self-esteem.
When it comes to voice disorders, educating yourself is the best way to make informed treatment decisions. For that reason, we’ve put together this informational guide to answer common questions about voice disorders, identify signs and symptoms, explain how a voice disorder is typically evaluated, diagnosed, and treated, and more.
What is a Voice Disorder?
Voice disorders can occur when our vocal folds are unable to properly vibrate. This can happen when vocal folds become inflamed, develop nodules, polyps, or other growths, or are unable to move properly. For people with voice disorders, this can affect the pitch, volume, or quality of their voice.
What Are Common Types of Voice Disorders?
While voice disorders are a fairly broad category covering a number of conditions, we’ve included a few common ones below:
- Spasmodic Dysphonia: Spasmodic dysphonia is a chronic voice disorder that is caused by nerve problems. Instead of your vocal cords vibrating normally, they may spasm or tighten when you speak. As a result, your voice may be very inconsistent: sometimes you may not be able to produce any sounds, while other times your voice could sound completely normal. The voice of a person with spasmodic dysphonia might sound hoarse, jerky, or tight.
- Vocal Nodules and Polyps: Both vocal nodules and polyps are lesions that take place on your vocal cords. Vocal nodules are benign growths and generally result from the repetitive overuse or misuse of your voice (for this reason they’re sometimes referred to as singer’s nodules). When your voice is pushed to the limit, swelling may occur. Overtime, this swelling can become callous and enlarged. Vocal polyps are often bigger than nodules and can take the form of a swollen bump or blister. While nodules are generally caused over a period of time, polyps can happen after a single episode of vocal abuse (like screaming at a concert). Both nodules and polyps can cause similar symptoms, including hoarseness, a rough or scratchy voice, trouble breathing, and more.
- Vocal Fold Paralysis: Vocal fold paralysis can occur when one of your vocal folds, or in some cases both of them, are unable to move or vibrate properly. This can cause a variety of breathing and swallowing symptoms, including hoarseness, problems with voice pitch and volume, trouble with choking or coughing during eating, and more.
- Paradoxical Vocal Fold Movement (PVFM): As mentioned, every time you breath your vocal folds open allowing air to travel through to your lung. When children or adults experience paradoxical vocal fold movement (PVFM), these vocal folds may close part-way or fully. This can cause a series of breathing and voice problems, including coughing, breathing difficulties, throat tightness, loss of voice, or changes to your voice. It’s important to know that PVFM is often confused and misdiagnosed with asthma. While similar symptoms can present, these are in fact different conditions. Proper diagnosis is important when considering treatment.
- Chronic Coughing: While coughing occasionally is completely normal, and actually helps clear your throat and lungs to prevent infection, prolonged coughing can be highly disruptive and frustrating. Coughing is generally considered chronic if it lasts longer than 4 weeks in children and 8 weeks in adults. It can often interrupt your sleeping, day-to-day life, cause problems with your voice, and lead to headaches.
- Laryngitis: Laryngitis occurs when there is an inflammation of your larynx (or voice box). Typically, this is due to overuse, irritation, or infection of your vocal folds, which can cause them to swell and distort your sounds when air passes through them. Laryngitis can be short-lived or more chronic. While it’s often caused by a temporary viral infection, persistent hoarseness of the voice can sometimes signal a more serious medical condition.
How Common Are Voice Disorders?
Voice disorders are fairly common and can impact a broad swatch of the population. According to data compiled by the American Speech-Language-Hearing Association, an estimated 3% and 9% of the U.S. population may have a voice disorder. The prevalence of voice disorders breaks down into the following categories:
While elderly adults are most susceptible to voice disorders, they can affect people of all ages.
- Prevalence is highest in elderly adults, with estimates ranging from approximately 5% to 29%.
- In children, the reported prevalence of voice disorders ranges from approximately 1.5% to 6.0%.
Males and females can both develop voice disorders, however, the prevalence of voice disorder in females increases with age.
- Adults females are 50% higher than adult males to develop a voice disorder.
- When it comes to children, boys are significantly more likely to develop a voice disorder than girls.
Certain types of voice-intensive occupations appear to increase a person’s risk of developing a voice disorder, including teachers, manufacturing/factory workers, salespersons, and singers.
What are the Symptoms of a Voice Disorder?
Here are some common symptoms that could signal you have a voice disorder. It’s important to note that different types of voice disorders can have varying symptoms. However, if you notice any of these signs it’s important to speak with a doctor or a speech-language pathologist.
- Hoarse, rough, or raspy voice
- Weak or breathy voice
- Changes to your voice’s pitch or volume
- Raw or strained throat
- Tension or pain in your throat while speaking
- Difficulty talking or breathing
- Repeatedly clearing your throat
- The feeling of a lump in your throat when swallowing
- Pain when touching the outside of your throat
What Causes a Voice Disorder?
Anything that prevents or disrupts your vocal fold movement can cause a voice disorder. There is a wide range of possible causes that can interfere with this normal function. Some of these include:
- Vocal Abuse: Vocal abuse is any type of behavior that can strain, harm, or injure your vocal folds. This can be caused by excessive talking or screaming, inhaling irritants, smoking, coughing, or clearing your throat. Vocal abuse can often lead to the development of nodules, polyps, or other growths on your vocal folds, which can change how your voice sounds. Frequently engaging in activities that cause vocal abuse and damaging your vocal folds can have both temporary or permanent effects on your voice quality and vocal function.
- Abnormal Growths: Some people may develop extra tissue on their vocal folds that can impact their function. These growths have a variety of causes, including injury, vocal abuse, cancer, or illness. These growths can take many forms, including nodules, polyps, cysts, papillomas, lesions, and more.
- Nerve Problems: Your central nervous system controls your voice and swallowing abilities. There are several health conditions that can affect these nerves, including multiple sclerosis, Huntington disease, Parkinson disease, or Amyotrophic lateral sclerosis (also referred to as ALS or Lou Gehrig’s disease).
- Inflammation and Swelling: When your vocal cords become inflamed, they can affect your natural airflow. Inflammation and swelling of the vocal folds can be caused by surgery, respiratory illness, allergies, smoking, vocal abuse, substance abuse, and more.
- Hormones: Disorders that affect your hormones or their production can cause voice disorders, including thyroid hormones and growth hormones.
How are Voice Disorders Diagnosed?
Your doctor will often diagnose voice problems through a combination of your medical history and performing a series of examinations and diagnostic tests. In some cases, your doctor may refer you to an ear, nose, and throat specialist (sometimes referred to as an ENT or otolaryngologist).
Your doctor may start by asking you a series of questions regarding your voice problems. This information will help them determine which tests to perform. These questions can include a description of your voice problems, when they were first noticed, how long they’ve lasted, how often problems occur, if they’re made worse or precipitated by certain triggers, and other underlying factors such as whether you’re a smoker.
Your doctor may then perform a series of tests to examine your vocal folds and larynx. Voice disorders may have multiple causes, and identifying each one is necessary to ensure your care team can develop a treatment plan that’s both comprehensive and effective. However, don’t let this scare you! Just because your doctor administers multiple tests doesn’t necessarily mean your voice disorder is more severe.
Some common tests include:
- Laryngoscopy: This tool allows your doctor to examine your throat using a thin, lighted scope.
- Laryngeal Electromyography, or EMG: This test measures the electrical activity in the muscles of the throat, which can help reveal any underlying nerve problems.
- Stroboscopy: This instrument uses a light and camera to visualize how your vocal folds move and vibrate when you speak.
- Imaging tests: X-rays and MRI can help doctors identify and locate certain growths, like nodules or polyps, that may be on your vocal folds.
- Acoustic Analysis: This technique uses computer analysis to measure any irregularities in how your vocal folds produce sound.
How are Voice Disorders Treated?
Treatment for voice disorders can involve a multidisciplinary team of specialists, including your doctor, an ENT, pulmonologist, psychologist, and speech-language pathologist. Your specific treatment will depend on the root cause of your voice disorder and often include a combination of treatments. Some examples include:
- Lifestyle changes: There may be certain lifestyle changes or behavioral modifications that can help you control your voice disorder or reduce its symptoms. Common changes include lowering the volume of your voice, reducing yelling or speaking loudly, and resting your voice at regular intervals. There are also certain exercises that can help relax or relieve the tension of your vocal folds.
- Medicines: Medication can sometimes help the root cause of your voice disorder. Consult with your doctor before taking any medicines.
- Injections: Your doctor may recommend injections if you’re experiencing muscle spasms that are causing your voice disorder. There are other types of injections that can help control your vocal folds.
- Surgery: In some circumstances, your doctor may recommend surgery to remove nodules, polyps, or any other types of growth on your vocal folds.
- Voice therapy: In many cases, your doctor will recommend voice therapy from a licensed speech-language pathologist. This can be used as your primary treatment, alongside other types of treatments, or as a precursor to other medical treatments. We’ve provided more information on voice therapy below.
How Can Voice Therapy From a Speech-Language Pathologist Help?
As mentioned, many voice disorders require voice therapy from a speech-language pathologist. Speech therapists are communication experts, and many specialize in voice therapy to help treat and manage voice disorders. Speech therapists are often involved during evaluation, diagnosis, and treatment. We’ve included some ways that speech therapists can help depending on your diagnosis.
- Spasmodic Dysphonia: For individuals with spasmodic dysphonia, your speech-language pathologist can help you work on strategies to articulate sounds in certain ways that make it easier to speak. They may instruct you on methods to improve your airflow, reduce excess tension and strain when uttering sounds, or compensate for your voice disorder in more efficient ways. These voice techniques can help you take back a sense of control with your voice and ultimately improve your quality of life.
- Vocal Nodules and Polyps: Treatment often begins with voice therapy from a speech-language pathologist. Voice therapy may focus on taking care of your voice (also called voice hygiene) by helping you recognize the signs of abuse and modify your behavior. Your speech therapist will help you find ways to feel relaxed, relieve stress, and help change how your voice sounds.
- Vocal Fold Paralysis: When it comes to vocal fold paralysis, your doctor may recommend voice therapy prior to surgery or medical treatments. Your speech therapist will work with you to alter the pitch of your voice, and help increase airflow and breathing support to improve the volume of your voice.
- Paradoxical Vocal Fold Movement (PVFM): Treatment for PVFM focuses on helping to ensure your vocal folds open normally, and continue to stay open, as you breathe. A speech therapist may help you practice different exercises and strategies to relax your throat during breathing. They may teach you methods for using your throat muscles to open your airways, suppress unnecessary coughing, and other ways to control and manage your PVFM. Additionally, they will help you become aware of certain triggers that can precipitate PVFM, and teach you strategies for avoiding these.
- Chronic Coughing: Your speech therapist will teach you techniques for suppressing your urge to cough, strategies to keep your vocal folds healthy, and methods for avoiding triggers that can contribute to your cough. They may make recommendations, such as breathing through your nose rather than your mouth, or avoiding certain substances like alcohol or caffeine.
How Can Expressable Help Assess and Treat Voice Disorders
Expressable matches families with a certified speech therapist trained to effectively evaluate and treat a range of voice disorders using voice therapy. All therapy is delivered online via face-to-face video conferencing.
Your child’s age and development will influence how your speech therapist interacts with them through these video chat capabilities.
Ages 0-3: Parents work directly with their speech therapist to learn cues and at-home strategies so they can confidently practice with their child outside the session and improve their voice.
Ages 3-6: Parents attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.
Ages 7 and Up: Most children attend video sessions independently but parents are kept in the loop with updates and tips during each session.
Adults: Adults attend sessions by themselves, but are welcome to bring loved ones or family members as well.
Tips to Prevent Voice Problems
Each of these recommendations can help you maintain vocal hygiene and potentially help prevent or manage the development of a voice disorder:
- Stay hydrated by drinking the recommended six to eight glasses of water a day.
- Limit your intake of alcoholic and caffeinated drinks. These can cause you to become dehydrated, which may dry out your vocal folds and larynx.
- Use a humidifier in the winter or in dry climates.
- Common cold and allergy medications can dry out the vocal folds. Try to limit your intake when possible, and if you have voice problems, ask your doctor which medications are the safest to use.
- Avoid smoking, as this can irritate your vocal folds.
- Get plenty of rest, as fatigue can have a negative impact on your voice.
- Try not to overuse your voice when possible, and avoid speaking or singing excessively when your voice is tired or hoarse.
- Rest your voice when you are sick.
- Avoid using the extremes of your vocal range, such as screaming or whispering excessively.
- Practice good breathing techniques, including taking deep breaths in your chest.
- Avoid talking in noisy environments when you can, as this can put an unnecessary strain on your voice.
- Consider voice therapy to learn healthy tips and techniques to support good vocal quality.