Our voice is a big part of our identity. How we sound affects our confidence, performance at school or work, and influences our listeners. Voice plays an integral role in communication.
For speaking, air from our lungs needs to pass through our voice box. The airflow vibrates the vocal cords or vocal folds to create speech sound. When a person has problems in the movement of the vocal folds, or breathing, they may experience a voice disorder.
If your voice sounds more hoarse, wet, raspy or high-pitched than usual, you may be experiencing a voice disorder. The inability to use our voice optimally can affect our self-image, confidence, livelihood, relationships, and the overall quality of life.
You should not ignore the signs of a voice disorder. Here is everything you need to know about the types of voice disorders, voice disorder causes, signs and symptoms, and available treatment options.
- What Is A Voice Disorder?
- What Are The Different Types Of Voice Disorders?
- Are Voice Disorders Common?
- What Are The Symptoms Of Voice Disorders?
- What Are The Causes Of A Voice Disorder?
- How Is A Voice Disorder Diagnosed?
- What Is The Treatment Of Voice Disorders?
- How Can You Prevent Voice Problems?
- How Can A Speech-Language Pathologist Help Treat Voice Disorders?
- How Can Stamurai Help With The Evaluation, Diagnosis, & Treatment Of Voice Disorders?
1. What Is A Voice Disorder?
The vocal folds come together, and as air passes through these folds, they vibrate to produce sound. Sometimes, the vocal folds do not vibrate properly. It can happen due to the inflammation of the vocal folds, development of nodules and polyps, infection of and around the vocal cords, and paralysis.
A voice disorder can affect a person's voice quality, loudness, and pitch. Sometimes, voice disorders create changes in the voice quality that are inappropriate for their age, gender, geographic location, or cultural background.
In many cases, when an individual expresses concern about the quality or pitch of their voice, even when listeners do not perceive it as different, experts consider it a voice disorder.
2. What Are The Different Types Of Voice Disorders?
Organic Voice Disorders
Voice disorders arising from physiological changes of laryngeal, respiratory, and vocal mechanisms are organic. Organic voice disorders are further classified as –
These are organic voice disorders that result from the physical changes in the voice-producing mechanisms, including –
- Changes in the vocal fold tissues, such as swelling or nodules.
- Changes to the structure of the larynx.
The organic voice disorders resulting from central or peripheral nervous system issues are neurogenic. Neurological disorders involving the larynx or vocal folds can affect the entire vocal mechanism. These may include –
- Vocal tremors
- Vocal fold paralysis
- Spasmodic dysphonia
Functional Voice Disorders
When there is no issue with the physiology of the vocal folds, yet the vocal mechanism functions inefficiently, experts refer to it as a functional voice disorder. Such a voice disorder may occur due to –
- Vocal fatigue
- Muscle tension dysphonia or aphonia
- Ventricular phonation
Psychogenic Voice Disorders
The voice quality of an individual may change due to psychological stress. Prolonged psychological stress may lead to maladaptive dysphonia or aphonia. Psychogenic voice disorders or psychogenic conversion aphonia and dysphonia are rare. Speech-language pathologists (SLPs) or speech therapists may refer you to psychologists or cognitive-behavioral therapists if they suspect psychogenic voice disorders.
3. Are Voice Disorders Common?
According to ASHA, between 1.4% and 6% of all children have voice disorders. Multiple cases of voice disorders in the pediatric population have been linked to prolonged stay and intubation in neonatal intensive care units (NICUs).
Around 41% to 73% of children with vocal dysphonia were diagnosed with vocal nodules.
1 in 13 adults in the US experience problems with their voice. However, only 10% of the affected population actively seek voice therapy for adults.
In 2017, Bainbridge et. al. showed that around 6% of the young adults between the ages of 24 and 34-years showed signs of voice disorders. There was no notable difference based on age, ethnicity/race, or education levels. Teachers were more likely to develop a voice disorder in comparison with other professionals.
Among adults, the most frequent diagnosis includes acid laryngitis, dysphonia, and vocal polyps. All seniors (over the age of 60) evaluated for voice disorders showed signs of changes of voice associated with ageing, functional dysphonia, vocal fold paralysis, reflux and inflammation, and Reinke's edema. However, a laryngeal cancer diagnosis was common among individuals between the ages of 75 and 79-years.
4. What Are The Symptoms Of Voice Disorders?
If you have a voice disorder or dysphonia, you may experience changes in your vocal quality, loudness, pitch, and vocal effort.
Some of the more prominent signs and symptoms of a voice disorder may include –
- Voice that sounds rough and raspy
- Audible ‘breathing’ or ‘air escape’ while talking
- A strained voice that sounds too tense or harsh
- Vocal quality that sounds strangled, as if you are holding your breath
- Abnormal loudness, softness, or an unsteady volume.
- Abnormal pitch that’s too high, low, or inconsistent
- A voice that is hypernasal, hyponasal, or has an abnormal resonance
- Complete loss of voice (aphonia)
- Breaks in phonation
- Extreme weakness of voice (asthenia)
- A voice that sounds gurgly or wet
- Audible creaks or pulses while speaking
- A shrill voice that sounds like a piercing or stifling a scream
- A shaky voice with inconsistent loudness and rhythmic pitch
A voice disorder may also present other signs and symptoms, such as –
- Increased vocal effort during speaking
- The quick onset of fatigue or decreased endurance with prolonged talking
- Frequent coughing and throat clearing
- Feeling breathless quicker than usual
- Excessive tenderness, pain, or tension in the throat or larynx
The signs and symptoms of voice disorders may occur one-by-one or in combination. The quality of a person's voice will depend upon the cause(s) and their severity. Sometimes, assessing the auditory quality of one's voice is not enough to determine the cause or its severity. Your speech language pathologist specializing in voice therapy may recommend further instrumental assessment for determining the cause and/or severity of your voice disorder.
5. What Are The Causes Of A Voice Disorder?
The normal voice mechanism depends on several factors working together, such as –
- The respiratory system
- The laryngeal muscle activity
- The systems responsible for balance, respiratory stamina, resonation subsystem, and phonation
- The coordination between these systems and the pharynx, nasal cavity, and oral cavity
Any physiological, neurological, or psychological issues that disrupt any above-mentioned systems can cause a voice disorder.
The organic causes include –
- Vocal nodules, cysts, and/or polyps
- Narrowing of the voice box where the vocal cords press together and scar
- Inflammation of the voice box or larynx due to laryngitis
- Recurrent respiratory papilloma
- Atrophy of the vocal muscles due to aging
- Frequent acid reflux that travels up through the food pipe and reaches the throat (larynx and pharynx)
- Injury or trauma to the larynx such as intubation, external injuries, or chemical exposure
- Repeated paralysis or weakness of nerves in the larynx
- Parkinson’s disease
- Multiple sclerosis (MS)
- Amyotrophic lateral sclerosis (ALS)
- Adductor/abductor spasmodic dysphonia
- Trauma due to yelling, excessive coughing, and strain; speaking in an extremely high or low tone
- Compression and squeezing of the ventricular folds (ventricular phonation)
- Excessive effort or overuse of the vocal mechanism leading to vocal fatigue
- Chronic stress disorder (CSD)
- Conversion reaction (conversion aphonia/dysphonia)
Someone going through hormone replacement therapy (HRT) might experience changes in their vocal quality. If you are using testosterone, you may notice a masculizing effect on your voice. It is a result of HRT. However, if it concerns you, you can talk to your gender-affirming voice trainer.
Sudden changes in other hormone levels such as thyroid, growth hormones, and estrogen may also affect your voice quality, pitch, and resonance. Speak to a speech language pathologist specializing in voice therapy if the changes in your vocal quality concern you.
Other physiological conditions may also cause symptoms similar to a voice disorder. For example, an upper respiratory tract infection may cause a person to cough repeatedly, suffer from a sore throat, and talk in a hoarse voice. Therefore, visiting a physician is necessary when you first experience the signs of voice disorder.
Prolonged smoking can contribute to voice disorders and make voice disorders worse.
6. How Is A Voice Disorder Diagnosed?
A voice disorder may have multiple causes. Sometimes, transient infections also mimic the symptoms of voice disorders. Therefore, diagnosing a voice disorder is not quick or easy. Your doctor (GP) will need your medical history and run a bunch of tests. In severe cases, your GP may refer you to an otolaryngologist or ear-nose-throat specialist (ENT).
The specialist will examine your throat, vocal folds, and larynx to explore the possible causes of a voice disorder. You will have to answer a few questions such as when you first notice the signs, what kind of trouble you experience with your voice, when your voice sounds hoarse, shrill, or raspy during the day, and how often these problems occur and if they have any triggers.
Some of the common tests your doctor may recommend are –
- Laryngeal Electromyography, or EMG
- Imaging tests
- Acoustic Analysis
7. What Are the Available Treatment Options for Voice Disorders?
The treatment for voice disorders will depend upon the cause and severity. It may also depend upon the age of the individual.
Since voice disorders typically concern multiple mechanisms, the treatment decisions involve a team of specialists from multiple disciplines, such as your doctor (GP), ENT, neurologist, pulmonologist, psychologist, and SLP specializing in voice therapy. They will work together to tailor a plan that addresses the root cause(s) of your voice problems.
The treatment typically consists of a combination of therapies, such as –
Medicines can help treat the root cause of your voice disorder. However, do not self-administer drugs for your voice disorder. Always follow your doctor's prescription.
Under rare circumstances, your team of experts may recommend surgery to remove polyps, nodules, and cysts that are worsening your vocal quality.
Sometimes muscle spasms make it difficult for a person to talk. Specific injections to relax muscles can help you control your vocal folds and reclaim your voice.
Changes In Lifestyle
If you are a heavy smoker, loud talker, or simply more talkative than the average Joe, your team of doctors may ask you to make some changes. You need to smoke less, talk softly, or talk less to give your vocal folds enough time to recuperate. Some minor changes in vocal hygiene can work miracles for your vocal quality.
There is a good chance that your doctor will recommend voice therapy from a licensed speech-language pathologist specializing in voice therapy. You can choose between seeing your therapist in-person, or attending online video sessions for voice therapy. Voice therapy can be your primary treatment choice, or it can complement other treatment options, including medicines & surgery.
8. How Can You Prevent Voice Problems?
Maintaining proper vocal hygiene is one of the prime necessities for achieving and preserving a healthy voice. Vocal hygiene includes simple and daily practices that uphold the health of your vocal cords.
Here are some ways you can enjoy a balanced, steady, and youthful voice without any vocal problems –
- Consume between 8 and 6 glasses (50 to 64-ounces) of fluid per day.
- Avoid foods and drinks that can dehydrate you. These include deep-fried food, empty calories, high-sugar-containing foods, sodas, coffee (caffeinated drinks), and alcohol.
- If you live in a dry climate, invest in a humidifier.
- If you are prone to pollen, dust, or fur allergies, take your allergy medicine regularly and minimize your exposure to allergens.
- Avoid smoking.
- In case of common cold or flu, talk to a doctor before taking any meds. Common flu medicines tend to dry out vocal folds.
- Get 8-hours of quality sleep; limit your screen time before bed.
- Avoid speaking too loudly or singing continuously when your voice feels tired.
- Take a break from talking whenever possible.
- Learn and practice deep breathing exercises.
- Avoid testing the extremes of your vocal range (screaming or whispering too much).
If none of these work and your voice problems persist, please consider talking to a doctor and an SLP. Vocal disorders are treatable and early interventions limit the damage to the vocal folds.
9. How Can An SLP Help Treat Voice Disorders?
Several voice disorders need the attention of medical professionals. An SLP is a trained and licensed health professional who can diagnose and treat various voice disorders. SLPs are involved in the assessment, diagnosis, and treatment of voice disorders in children and adults.
Here are a few ways in which your SLP can assist your voice disorder treatment –
Your SLP can teach you strategies that make it easier to articulate sounds and speak clearly. Speech therapy for voice disorders takes time, patience, and persistence. You will learn breathing techniques to improve airflow and reduce tension.
You will learn new voice therapy techniques to reduce the effects of spasmodic dysphonia. Your SLP can help you take charge of your voice.
Vocal Nodules And Polyps
The SLP will teach you all you need to know about vocal hygiene. They will help you recognize and check vocal abuse. You will learn new ways to take care of your voice, strain less, and speak with less effort.
You will also learn speech therapy exercises for vocal disorders that help you relax, relieve stress, and control how you sound.
Vocal Fold Paralysis
The specialist will recommend a custom speech therapy plan for the voice disorder after diagnosis. The SLP will help you before your surgery and medication and after the procedure to ease your vocal discomfort.
You can work with your speech therapist or SLP to modulate your pitch, resonance, and breathing. It may help you improve the loudness or softness of your voice in the long run.
Coughing repeatedly and loudly can damage your vocal folds. The SLP will teach you various types of voice therapy techniques of breathing regulation that can suppress or modify recurrent coughs.
Your SLP may teach you how to breathe deeply through your nose, recognize the triggers of chronic cough, and avoid foods & drinks that induce coughing.
Paradoxical Vocal Fold Movement (PVFM)
Your speech therapist can teach you to keep your vocal folds open effortlessly as you breathe out and speak. It may take time, but through regular speech therapy exercises, you will be able to control the opening of your vocal folds.
You will learn simple yet effective methods to relax your throat muscles and suppress recurring coughing. A licensed SLP can also tell you all about the triggers of PVFM and teach you ways to avoid them.
10. How Can Stamurai Help With The Evaluation, Diagnosis & Treatment Of Voice Disorders?
Stamurai offers various type of voice therapy via one-on-one video sessions for different types of voice disorders. Our SLP will work with you to address various symptoms of the voice disorder and other voice-related problems that you may be facing right now.
The interactions with the speech therapist will depend upon you or your child’s age and ability to use technology.
Voice Disorder Treatment: Ages 0 – 3 Years
Parents will work directly with the speech therapist to address any voice problem the child may be facing. Parents will learn new skills, voice therapy techniques, and management strategies that help their child speak with less strain and effort.
Voice Disorder Treatment: Ages 4 – 6 Years
Parents should attend the online voice therapy session with their child to learn new skills, exercises, and management techniques to reduce hoarseness, breathiness, and any other problem caused by a voice disorder. Parents can talk to the SLP directly to provide/gather feedback after each online speech therapy session for voice disorder treatment.
Voice Disorder Treatment: Ages 7-Years And Above
Children can attend video sessions alone, but parents may sit-in with them. SLPs keep the parents in the loop about the child's progress and struggles during each session.
Voice Disorder Treatment: Adults
Adults can attend the sessions with their SLP alone. However, you are welcome to bring your family members as well!