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Voice Disorders

What are voice disorders?

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.

Your voice is the sound that air makes when it is forced out of your lungs and passes over your vocal cords. Vocal cords are the 2 folds of tissue inside your larynx, also called the voice box. The vibration of those cords is what produces speech.

Examples of voice disorders include:

  • Laryngitis. Laryngitis is when your vocal cords swell. It makes the voice sound hoarse. Or you may not be able to speak at all. Acute laryngitis happens suddenly, often because of a virus in the upper respiratory tract. It often lasts 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. Treatment of chronic laryngitis depends on the cause.
  • Vocal cord paresis or paralysis. The vocal cords can be paralyzed, or partially paralyzed (paresis). This can be caused by a viral infection that affects your vocal cord nerves, an injury to a nerve during surgery, stroke, or cancer. If one or both of your vocal cords are paralyzed in a nearly closed position, you may have noisy or difficult breathing. If they are paralyzed in an open position, you may have a weak, breathy voice. Some people will get better over time. In other cases, the paralysis is permanent. Surgery and voice therapy may help improve the voice.
  • Spasmodic dysphonia. This is a nerve problem that causes the vocal cords to spasm. It can make the voice sound tight, quivery, or jerky, hoarse, or groaning. At times, the voice may sound normal. Other times, the person may not be able to speak. Treatment may include speech therapy and injections of botulinum toxin to the vocal cords.                                                                     

What causes voice disorders?

For normal speech, your vocal cords need to touch together smoothly inside your larynx. Anything that interferes with vocal cord movement or contact can cause a voice disorder. Many voice disorders can be cured with treatment when diagnosed early.

Voice disorders can be caused by many factors. In some cases, the cause of a voice disorder is not known. Possible causes can include:

  • Growths. In some cases, extra tissue may form on the vocal cords. This stops the cords from working normally. The growths can include fluid-filled sacs called cysts, wart-like lumps called papilloma, or callus-like bumps called nodules. There may be patches of damaged tissue called lesions, or areas of scar tissue. In some people, a band of tissue called a web can grow between the vocal cords. 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. Certain medical conditions can affect the nerves that control the vocal cords. These can include multiple sclerosis, myasthenia gravis, Parkinson disease, Amyotrophic lateral sclerosis (ALS), and Huntington disease. Nerves can also be injured from surgery or chronic inflammation of the larynx (laryngitis).
  • Hormones. Disorders affecting thyroid hormone, female and male hormones, and growth hormones can cause voice disorders.
  • Misuse of the voice. The vocal cords can be stressed by using too much tension when speaking. This can cause problems in the muscles in the throat, and affect the voice. Vocal abuse can also cause a voice disorder. Vocal abuse is anything that strains or harms the vocal cords. Examples of vocal abuse include too much talking, shouting, or coughing. Smoking and constant clearing of the throat is also vocal abuse. Vocal abuse can cause the vocal cords to develop calluses or blisters called nodes and polyps. These change how the voice sounds. In some cases, a vocal cord can rupture from vocal abuse. This causes the cord to bleed (hemorrhage), and can cause loss of voice. Vocal cord hemorrhage needs to be treated right away.

What are the symptoms of a voice disorder?

If you have a voice disorder, your voice may:

  • Have a quivering sound
  • Sound rough or harsh (hoarseness)
  • Sound strained or choppy
  • Is weak, whispery, or breathy
  • Is too high or low or change in pitch

You may have tension or pain in your throat while speaking, or feel like your voice box is tired. You may feel a "lump" in your throat when swallowing, or feel pain when you touch the outside of your throat.

How are voice disorders diagnosed?

If you have a voice change that lasts for a few weeks, your healthcare provider may send you to see a throat specialist called an otolaryngologist (Ears, Nose and Throat specialist or ENT). An otolaryngologist will ask you about your symptoms and how long you've had them. He or she may examine your vocal cords and your larynx using certain tests. These may include:

  • Laryngoscopy. This lets the doctor view the throat. With indirect laryngoscopy, the healthcare provider holds a small mirror at the back of the throat and shines a light on it. With fiberoptic laryngoscopy, a thin, lighted scope called a laryngoscope is used. The scope is put through your nose down into your throat, or directly down into your throat.  
  • Laryngeal electromyography, or EMG. This test measures electrical activity in the muscles of the throat. A thin needle is put into some of the neck muscles while electrodes send signals from the muscles to a computer. This can show nerve problems in the throat. 
  • Stroboscopy. This test uses a strobe light and a video camera to see how the vocal cords are vibrating during speech.
  • Imaging tests. X-rays and MRI can 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 lifestyle changes may help reduce or stop symptoms. These can include not yelling or speaking loudly, and resting your voice regularly 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 extensive periods of speaking. Stay hydrated.      
  • Speech therapy. Working with a speech-language pathologist can help with certain voice disorders. Therapy may include exercises and changes in speaking behaviors. Some of these may include maneuvers that time deep breaths to power vocalizations with adequate breathing.
  • Medicines. Some voice disorders are caused by a problem that can be treated with medicine. For example, antacid medicine may be used for GERD, or hormone therapy for problems with thyroid or female hormones.
  • Injections. Your doctor can treat muscle spasms in the throat with injection of botulinum toxin. In some cases, your doctor can inject fat or other fillers into the vocal cords. This can help them close better.
  • Surgery. Your doctor can remove some tissue growths. If cancer causes the growths, you may need other treatment, such as radiation therapy.

Key points

  • Voice disorders are caused by a variety of reasons and affect the ability to speak normally.
  • An otolaryngologist should evaluate changes in vocal quality.
  • There are many different treatment options and each depends on what is causing the voice disorder.
  • Don't abuse your vocal cords by yelling or speaking loudly for long periods of time.
  • Therapy is directed at exercises that improve vocal cord function and strength and also allows for adequate rest periods.
  • If your job relies on the ability to use your voice then keeping it healthy is an important long term goal.
  • Stay rested, drink plenty of water, use a microphone, warm up your vocal cords, don’t smoke, learn proper breath flow, and seek care when there are changes to the voice quality.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Medical Reviewers:

  • Freeborn, Donna, PhD, CNM, FNP
  • Kacker, Ashutosh, MD