Voice Disorders

What are voice disorders?

Voice disorders affect your ability to speak normally. They may 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 through your lungs, up into your windpipe (trachea) and through your voice box (larynx). Your vocal cords are on either side of your larynx. They vibrate as air moves through them, which produces the sound of your voice. It’s a little like whistling. When you force air through your lips, they vibrate slightly and make a high-pitched sound.

What are the categories of voice disorders?

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

• Functional: The structures that produce vocal sounds — your voice box, vocal cords and lungs — are normal, but you have problems using them. Functional disorders are usually 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 on your larynx) or neurological (another disorder affects the nerves that control your larynx).
• Psychogenic: Although rare, some voice disorders develop due to emotional stress or trauma. They might 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 some of the most common include:

• Hoarseness is when your voice sounds raspy or weak. It can have lots of causes, from viral infections to Parkinson’s disease.
• Laryngitis is irritation or swelling of your voice box. It’s usually temporary and the result of allergies or an upper respiratory infection.
• Muscle tension dysphonia occurs when you put too much stress on your vocal cords and the muscles get tight.
• Spasmodic dysphonia causes spasms in your voice box muscles.
• Vocal cord dysfunction (VCD) prevents your vocal cords from opening all the way, which can lead to breathing problems.
• Vocal cord lesions are benign (noncancerous) 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 certain factors increase your risk:

• Age and sex: Being a woman (or assigned female at birth) over 50.
• Lifestyle: Smoking, drug addiction or alcohol abuse can damage your lungs, larynx and vocal cords.
• Occupation: Teachers, singers, telemarketers and other people with professions 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 the U.S. population have a voice disorder at some time, though less than 1% of these people seek treatment. Teachers are by far the most at-risk population. In one study of nearly a thousand teachers, about 57% had a voice disorder.

What causes voice disorders?

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

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

More complex voice disorders occur when there’s 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 widely depending on their cause. Your voice may sound:

• Gurgly or wet.
• Rough, strained, raspy or hoarse.
• Strangled or breathy.
• Too high or too low.
• Too loud or too soft.
• Uneven or shaky, with breaks or gaps in sound.

How are voice disorders diagnosed?

Your primary healthcare provider may diagnose a voice disorder, or they may refer you to a speech-language pathologist or laryngologist (a doctor who specializes in disorders of the voice box). They perform a thorough physical exam and evaluate your symptoms and medical history. Your healthcare provider may ask you questions about how your voice challenges are affecting your life at home, work or school.

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

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

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

How are voice disorders treated?

Some short-term voice disorders, such as hoarseness, might improve by resting your voice. Avoid shouting, singing or straining your voice for several 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 speaking while keeping vocal cord muscles relaxed.
• Auditory masking: You speak out loud while wearing headphones that play loud noise in the background, teaching you to amplify your voice.
• Conversation training therapy: You learn to speak using conversations that are 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 the tight voice box muscles.

Are voice disorders preventable?

Some voice disorders aren’t preventable, but you can reduce your risk by taking care of your voice. Be sure to:

• Avoid smoking, drugs and alcohol.
• Drink plenty of water to keep your vocal cords hydrated.
• Rest your voice frequently if you have an occupation that requires a lot of speaking.

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

Voice disorders associated with overuse or acute illnesses are usually temporary and don’t cause permanent damage. Most people with more complex voice disorders can overcome voice challenges with the right treatments.

What questions should I ask my healthcare provider?

Questions you may want to ask your healthcare provider 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?

A note from Cleveland Clinic

Voice disorders affect your ability to speak clearly. They might affect the volume, tone or pitch of your voice. Sometimes, voice problems are due to overuse and resolve once you rest 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 healthcare provider.