Voice Disorders

What are voice disorders?

Voice disorders affect your ability to speak. They may change the quality, pitch or loudness of your voice. Normally, when you speak, air moves through your lungs, up into your windpipe (trachea) and through your voice box (larynx). You have two vocal cords at the top of your windpipe inside your larynx. They’re in an open position when you breathe. They touch and vibrate as air moves through them, producing the sound of your voice.

But with a voice disorder, something interferes with this process and makes your voice sound different.

Voice disorders may be:

• Organic. There are problems with the structure of your voice box, vocal cords or lungs. Organic disorders are usually structural (like abnormal growths on your larynx).
• Neurological. A disorder affects the nerves that control your larynx.
• Functional. The structures that produce vocal sounds — your voice box, vocal cords and lungs — are normal, but you have problems using them. Usually, this happens when you have difficulty using your vocal cord muscles. Additionally, it’s possible for stress, emotion and changes to your psychological state to influence your voice.

Some voice disorders may involve more than one category. For example, you could have a vocal fold paralysis — when one vocal cord doesn’t move the way it should (neurological). In response, the other vocal cord may overcompensate for the paralyzed one, causing you to develop tension in your throat (functional). Or excessive tension (functional) in the throat could lead to the development of vocal fold nodules (organic).

A voice disorder can prevent you from communicating with others or expressing yourself. This can have a serious impact on your quality of life. But there are treatments that can help.

Types of voice disorders

There are many types of disorders that can change your voice. Some of the most common ones include:

• Laryngitis. Irritation or swelling of your vocal cords. It’s usually temporary and results from allergies or an upper respiratory infection.
• Muscle tension dysphonia. When the muscles inside and/or around your voice box get too tight. This can also involve the muscles your neck, shoulders and upper back.
• Spasmodic dysphonia (laryngeal dystonia). A neurological disorder that causes spasms in your vocal cords.
• Vocal cord lesions. Benign (noncancerous) growths — like nodules, polyps or cysts — that can affect your voice.
• Vocal cord paralysis. When your vocal cords aren’t moving as they should. This prevents you from controlling your voice box muscles.

There are also disorders of your upper airway. They don’t involve using your voice, but they do involve your larynx and vocal cords. They include:

• Inducible laryngeal obstruction (ILO), also known as paradoxical vocal fold motion disorder (PVFM) or vocal cord dysfunction
• Exercise-induced laryngeal obstruction (EILO)

If you have ILO or EILO, your vocal cords or other structures in your throat may be moving the wrong way when you breathe. This can keep you from taking in full breaths.

What are the symptoms of voice disorders?

Symptoms of voice disorders vary depending on the cause. Your voice may sound:

• Strained
• Raspy or hoarse
• Breathy or airy
• Gurgly or wet
• Weak and hard to project
• Too high or too low
• Too loud or too soft
• Uneven or shaky, with breaks or gaps in sound

Speaking may hurt or take a lot of effort. It may feel like you have a lump in your throat.

What causes voice disorders?

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

Sometimes, voice disorders are the result of a short-term (acute) illness like a cold, allergies or sinus infection (sinusitis). They cause inflammation in your throat that changes the way air flows through. Once you recover, your voice usually returns to normal 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.

Risk factors

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

• Age and sex. Being a female over 60
• Job. Teachers, singers, telemarketers and other people with professions that require a lot of speaking or voice use (in one study of nearly 1,000 teachers, more than half had a voice disorder)
• Behaviors. Drinking alcohol and smoking
• Surgery. A past surgery involving your throat (like a thyroidectomy) or using a breathing tube
• Hormonal disorders. Having diabetes, thyroid disease or polycystic ovary syndrome (PCOS)
• Other medical conditions. Having a neurological disorder, autoimmune disease, chronic acid reflux (GERD), laryngopharyngeal acid reflux (LPR), laryngeal cancer, substance use disorder or alcohol use disorder

How are voice disorders diagnosed?

Your primary healthcare provider may diagnose a voice disorder. They may refer you to a speech-language pathologist (SLP) or laryngologist (an ear, nose and throat doctor who specializes in voice box disorders). They’ll ask questions about your symptoms and medical history. Your provider may also ask about how your voice challenges are affecting your life at home, work or school.

Your provider will listen closely while you’re speaking. They’ll look closely at your face, head, neck and throat while you speak and breathe. They may ask you to use your voice to say certain phrases or hold out certain sounds with your voice and go high and low in pitch.

Report any symptoms you feel during these exercises. Tell your provider if you have pain, scratchiness or difficulty breathing.

What tests will be done to diagnose this condition?

To see how well your voice box and vocal cords are working, you may need imaging tests:

• Laryngoscopy. Uses a thin, flexible tube (scope) with a video camera attached to examine the back of your throat. Your healthcare provider may take samples from nodules, polyps or cysts and check for diseases (biopsy).
• Videostroboscopy. Uses a scope attached to a special camera that shows your vocal cords moving in slow motion when you make sounds.
• Laryngeal electromyography (LEMG). Uses an electrode to measure the nerve signals produced when you use your voice box muscles.
• An MRI or CT scan. Shows detailed images of your vocal cords and voice box that allow your provider to check for growths.

How are voice disorders treated?

Some short-term voice disorders might improve by resting your voice. Your healthcare provider may advise you to avoid shouting, singing or straining your voice for several days. They may tell you to try to talk as little as possible.

Other treatments include:

• Voice therapy. Speech-language pathologists teach techniques and exercises to help you find the most efficient way to use your voice so you can communicate more clearly. They can teach you how to care for your voice to maintain your vocal health.
• Medications. Proton pump inhibitors (PPIs) or other medications can help if LPR or GERD is causing your voice issues. Sometimes, steroids or antibiotics are necessary for certain voice problems.
• Medical procedures or surgery. You may need surgery to remove a lesion on your vocal cords. You may need botulin toxin injections to relax tight voice box muscles. For paralyzed vocal cords, your provider may inject a filler to help close the gap between your vocal cords. They may place an implant to help your vocal cords close (medialization laryngoplasty).

Are voice disorders preventable?

Although some voice disorders related to overuse are preventable, many aren’t. Still, you can reduce your risk by taking care of your voice. You can:

• Avoid smoking, recreational drugs and alcohol
• Drink plenty of water to keep your vocal cords hydrated (when you drink water, it’s absorbed by your body and helps keep your vocal cords sliding past each other with ease)
• Take steps to avoid getting sick, like washing your hands often
• Rest your voice frequently if you have a job that requires a lot of speaking
• Learn healthy limits of voice use

If you do have to talk or sing a lot, make sure your body is conditioned for it. Sudden changes in the amount of voice use without enough preparation can cause fatigue and injury.

What’s the prognosis (outlook) for people with this condition?

Voice disorders associated with overuse or acute illnesses are usually temporary and don’t cause permanent damage. If your voice disorder is more complex, it may take a bit of work to cure or manage your condition. You may need surgery or several sessions of voice therapy. But most people overcome voice challenges with treatment.

How do I take care of myself?

The best way to care for your voice is to stick to your treatment plan. But it’s important to attend to your mental health, too. Having trouble speaking can lead people to feel that they can’t express themselves freely. In children, it can cause poor self-esteem. After all, it can be incredibly frustrating and isolating to have to use a lot of effort to get your voice out.

Talk to your healthcare provider if you’re dealing with these issues. Ask them to recommend resources that can help.

When should I seek care?

Schedule a visit with your healthcare provider if you’re noticing unexplained changes in your voice that don’t get better within a few weeks. Early treatment can prevent worsening symptoms. Often, it can prevent long-term damage to your vocal cords that requires more invasive treatments, like surgery.

What questions should I ask my healthcare provider?

Questions you may want to ask include:

• What behaviors should I change to improve my voice?
• What treatments will I need, and how long will I need them?
• What healthcare providers will I need to work with?
• How likely is it that my voice issues will resolve completely?
• Can you recommend resources to help me cope with having a voice disorder?