The Definitive Guide to Voice Disorders: What You Need to Know
Leanne Sherred, M.S., CCC-SLP
Chances are you’ve had trouble with your voice at some point. Ever cheered too loudly at a concert, and your voice was hoarse or raspy for a few days afterward? How about a simple cold that left you temporarily with no voice at all? Voice problems are common, and they're often short term. However, others can last longer, be more severe, and affect your day-to-day life.
Voice is the sound produced by the vibration of your vocal folds (or vocal cords) in the larynx (voice box). You may have a voice disorder if you have a problem with pitch, volume, tone, and other qualities of your voice. These problems occur when your vocal cords don't vibrate normally.
What are symptoms of a voice disorder?
Voice disorders affect the ability to speak normally. If you have a voice disorder, your voice may:
Have a quivering sound when you speak
Sound strained or choppy
Sound rough or harsh
Be weak, whispery, or breathy
Sound too high or too low, or change in pitch
Other common signs and symptoms of voice problems include a feeling of tension or pain in your throat while speaking. You may also feel a "lump" in your throat when swallowing, or feel pain when you touch the outside of your throat.
Examples of voice disorders
Laryngitis: Laryngitis is when your vocal cords swell. Your voice may sound hoarse, or you may not be able to speak at all. There are several types of laryngitis, and treatment may depend on the cause:
Acute laryngitis is usually caused by a virus in the upper respiratory tract. Symptoms can appear suddenly but they usually last just a few weeks. Treatment is to rest the voice and drink plenty of fluids.
Chronic laryngitis is when the swelling lasts for a long time. Common causes include a chronic cough, using inhalers for asthma, and GERD.
Vocal cord paralysis: This is the result of your vocal cords becoming fully or partially paralyzed. Depending on how severe your diagnosis is, symptoms can range from having a weak, breathy voice, to difficulty breathing. Vocal cord paralysis can be caused by a variety of factors, including a viral infection that affects your vocal cord nerves or an injury to a nerve during surgery, stroke, or cancer. While some people naturally get better over time, in some cases the effects can be permanent. Surgery and voice therapy may help improve the voice.
Spasmodic dysphonia: This is a nerve problem that causes the vocal cords to spasm, making your voice sound tight, quivery, or jerky. At times, your voice may sound completely normal. Other times, you may not be able to speak at all.
Vocal nodules: Vocal nodules are often caused by vocal abuse. They are a common problem for professional singers or others who routinely push their voice to the limits. Vocal nodules can make the voice sound hoarse or low or breathy. They are noncancerous growths on the vocal cords, and are often small and callous-like, growing in pairs.
Vocal polyps: These are also noncancerous and can cause the voice to be low and breathy. Vocal polyps look and feel similar to a blister.
Causes of voice disorders
When we speak normally, our vocal cords touch together softly inside our larynx. When this is disrupted for any reason, it can cause a voice disorder.
If your vocal cords become inflamed, develop growths, or become paralyzed, they can't work properly, and you may develop a voice disorder. Voice disorders can be caused by many factors. In some cases, the cause of a voice disorder is not known. The most common voice disorder in children is the result of them being… well, children. This is referred to in the medical community as “phono trauma,” which is simply a fancy word for voice misuse. It can be caused by excessive screaming, loud sounds, inordinate throat clearing, or coughing. Additional causes of voice disorders in adults and children include:
Growths: In some cases, extra tissue may form on the vocal cords. This stops the cords from working normally. In addition to nodules, growths can also include cysts, lesions, scar tissue, or lumps called papilloma. Other growths include a small area of chronic inflammation called a granuloma, and small blisters called polyps. Growths can have many causes, including illness, injury, cancer, and vocal abuse.
Inflammation and swelling: Many things can cause inflammation and swelling of the vocal cords. These include surgery, respiratory illness or allergies, GERD (acid reflux), some medicines, exposure to certain chemicals, smoking, alcohol abuse, and vocal abuse.
Nerve problems: For adults, certain medical conditions can affect the nerves that control the vocal cords. These may include multiple sclerosis, myasthenia gravis, Parkinson's disease, amyotrophic lateral sclerosis (ALS), and Huntington's disease. Nerves can also be injured from surgery or chronic inflammation of the larynx (laryngitis).
Hormones: Voice disorders can be caused by natural hormones, including those that affect thyroid hormones, female and male hormones, and growth hormones.
Misuse of the voice: Vocal abuse is anything that harms the vocal cords, causing them to become stressed or irritated. Examples of vocal abuse include too much talking, shouting, or coughing. Smoking and constant clearing of the throat is also vocal abuse and can lead to a voice disorder.
How are voice disorders diagnosed?
If you or your child have a voice change that lasts for a few weeks, your healthcare provider may send you to see a throat specialist called an otolaryngologist (an ear, nose, and throat specialist, or ENT).
An otolaryngologist will ask you about your symptoms and may examine your vocal cords and your larynx using certain tests. They may examine your vocal cords internally using a small scope called a laryngoscope, in which the provider holds a small mirror at the back of the throat and shines a light on it. In the case of paralysis, your healthcare provider may also do a laryngeal electromyography, which measures the electrical current in the vocal cords. Other tests can include a stroboscopy, which uses a light and a video camera to see how the vocal cords are vibrating during speech, or imaging tests, which can include X-rays and MRI to show growths or other tissue problems in the throat.
How are voice disorders treated?
Treatment for a voice disorder depends on what's causing it. Treatment may include:
Lifestyle changes: Some of these changes may help reduce or stop symptoms. They can include not yelling or speaking loudly, and resting your voice often if you speak or sing a lot. Exercises to relax the vocal cords and muscles around them can help in some cases. Warm up the vocal cords before long periods of speaking. Drink fluids to stay hydrated.
Speech therapy: Working with a speech-language pathologist can help with certain voice disorders. They will work with you or your child to evaluate voice characteristics such as roughness, breathiness, strain, pitch and loudness. They'll also assess how well you’re using related systems such as breathing, or respiratory effort, to produce voice. This will help in determining the severity of the voice disorder, and in developing a plan for treatment if needed. Voice therapy may include:
Exercises and changes in speaking behaviors, including timing deep breaths so that they power your speech with adequate breathing.
Identifying and eliminating harmful voice patterns (such as yelling, screaming, and making loud sounds while playing).
Improving vocal health by drinking more water and avoiding caffeine
Using specific voice exercises designed to balance, strengthen, or promote best vibration of the vocal folds. These help the voice to sound better.
Learning to use the new voice production in everyday talking.
Medicines: Some voice disorders are caused by a problem that can be treated with medicine. For example, antacid medicine may be used for GERD.
In other cases, voice disorders may be treated with injections or surgery. Your healthcare provider will determine the severity and cause of your voice disorder to recommend the best treatment plan.
How can teletherapy help with voice disorders?
As mentioned above, working with a speech therapist can help with certain voice disorders. If your healthcare provider recommends speech therapy, working with an online speech therapist can provide several advantages over more traditional in-practice settings.
Online speech therapy is more affordable
Practices have to pay for a lot of expenses that aren’t directly related to patient care, such as facility costs, marketing, and support staff. With online speech therapy, these cost savings are passed down to the customers.
Flexible scheduling and convenience
Instead of spending time traveling to and from in-person therapy sessions, patients can schedule and attend appointments from the comfort of their own home. You also have greater flexibility to schedule sessions on the dates that work best, and at the times that you prefer.
Just as effective as traditional therapy
If you're working with a licensed speech-language pathologist, there’s no difference in quality between teletherapy and on-site therapy sessions. A landmark study from Kent State University showed that there was no significant difference in scores between students who participated in teletherapy versus on-site therapy.
How can Expressable help?
Speech therapy with Expressable is just like traditional therapy, but sessions are held online with modern video conferencing software that our clients can access from the convenience of their home. Expressable can offer incredible speech therapy at a lower price because our therapists focus on serving families instead of dealing with long commutes and administrative tasks.
Find out if Expressable is right for you. Schedule a free consultation with one of our licensed speech therapists.
