Voice Disorders

Voice disorders can be caused by a variety of factors and can affect a person socially, emotionally, physically, and professionally.  A person’s voice goes through changes throughout life because of normal processes, such as puberty, but when there is a sudden or gradual change in vocal quality, a visit to the doctor may be warranted.  Some of these changes include:

  • Hoarseness
  • Breathiness
  • Rough or scratchy voice
  • Harshness
  • Pain while speaking
  • Decreased pitch range
  • Vocal fatigue with prolonged use

Often, there is an underlying medical reason for the change that is diagnosed by an ear, nose and throat specialist, or ENT.  The most common causes of voice disorders include infectious or inflammatory conditions, vocal misuse or abuse, benign or malignant growths, neuromuscular diseases, and psychogenic conditions. Sometimes several underlying causes contribute to a voice disorder.  Treatment options may involve medication, surgery, elimination of vocal abuses, vocal rest and/or retraining by a certified speech therapist or a combination of methods.

Infectious and Inflammatory Conditions

Upper respiratory infections such as the cold or flu may cause the membranes in the throat to become irritated and swollen. This may lead to hoarseness and/or a lowering of vocal pitch, a condition known as “acute viral laryngitis”.  Chronic hoarseness can occur after a bout with laryngitis if compensatory mechanisms used to reduce painful speaking have become habit.

Laryngopharyngeal reflux is a condition in which stomach acids backflow into the throat. Often, many patients do not realize they suffer from this condition and do not have the characteristic heartburn associated with reflux. Symptoms may include hoarseness, the feeling of having a lump in the throat, difficulty swallowing, chronic throat clearing or cough.

Vocal Misuse or Abuse

Approximately 40% of patients with voice disorders fall into this category.  Vocal abuse may produce vocal nodules, swelling, or hemorrhage of the vocal cords.  Some causes of vocal abuse include:

  • Allergies
  • Smoking
  • Singing
  • Coaching
  • Cheerleading
  • Excessive or loud talking
  • Caffeine and alcohol

Vocal misuse, such as muscle tension dysphonia, will often develop because of an attempt to alleviate painful speaking by altering muscle patterns used in speaking.  Excessive laryngeal muscle tension is often a sign of vocal misuse. Inadequate breath support while speaking can also lead to muscle tension dysphonia.

Benign or Malignant Growths

Vocal nodules are benign growths on the vocal cords that are caused by vocal abuse.  Soft, swollen spots develop with repeated misuse of the vocal cords. Over time, these areas develop into harder, callus-like growths.  Behavioral intervention is often effective in treating this condition.

Cancerous growths are managed and treated by a physician.

Neuromuscular Diseases

Vocal cord paralysis and paresis are most often due to trauma or cancer.  For example, the nerve to the vocal cord can be injured during thyroid surgery or there could be tumor involvement of the laryngeal nerves. Voice therapy may be started to help improve vocal cord closure.  In some cases, surgery may be used to mechanically reposition the affected vocal cord to improve voice quality and even swallowing.

Laryngeal movement disorders, such as spasmodic dysphonia, are characterized by a strained, strangled vocal quality well known to otolaryngologists and speech pathologists. Vocal fold spasms occur abruptly at irregular intervals during speech.  The voice feels as though it “gives way” during speech.  Treatment may involve the use of botox injections into one or both of the vocal cords or in nearby muscles.

Parkinsonism is both a degenerative and a movement disorder because it affects a part of the brain responsible for fine muscle movement and results in slurred speech. Parkinson disease is treated with medicines and sometimes surgery.  For speech and voice problems, the most effective treatments are intensive voice treatment, such as the Lee Silverman Voice Treatment program.

Psychogenic Conditions

Often called conversion aphonia or dysphonia, this is a condition in which a psychological problem is converted into a physical symptom.  Most patients can be treated without psychiatric intervention, however, some people benefit from evaluation and treatment by a psychiatric professional.