Voice Disorders

The voice is a powerful instrument that allows us to communicate verbally with each other. Each person’s voice is different and creates unique personalities. You are able to speak through your larynx, or voice box, which houses your vocal folds. Within your larynx are two vocal folds that vibrate to create the unique sound of your voice. The vocal folds are closed when you are speaking and open when you are breathing. A voice disorder, or dysphonia, occurs when external agents or factors negatively affect the vocal folds.

Voice disorders can occur at any time and may be due to:

• Colds and allergies
• Smoking
• Excessive alcohol and caffeine intake
• Screaming and shouting
• Excessive throat clearing
• Infections and growths
• Acid reflux or Gastroesophageal Reflux Disease (GERD)
• Vocal misuse, abuse, and overuse
• Neurological diseases
• Neck cancers and other diseases

Voice disorders include vocal cord nodules and polyps, vocal cord paralysis, paradoxical vocal fold movement, and spasmodic dysphonia.

• Vocal cord nodules are callouses that develop over time from vocal abuse and can become harder and larger gradually. Vocal cord polyps are blisters that develop from vocal abuse and misuse and are typically larger than nodules.
• Vocal cord paralysis occurs when one or both vocal folds are unable to move, which causes voice, breathing, and swallowing problems. If one vocal fold is paralyzed, abnormal or lack of vocal fold vibration will prevent the patient from speaking loudly and clearly. If both vocal folds are paralyzed, the vocal folds may not open or close, which may require surgical intervention.
• Paradoxical vocal fold movement occurs if the vocal folds close when they should open. Episodes are not always predictable. Signs of PVFM are difficulty breathing and wheezing, which can often be mistaken for asthma.
• Spasmodic dysphonia is a chronic voice disorder in which vocal fold movement is forced and strained due to involuntary movements of laryngeal muscles. The vocal quality can be jerky, quivery, hoarse, or tight. The voice can sound normal, spastic, or lack sound, also called aphonia.

Voice disorders can be treated in a variety of ways depending on the cause and severity. They are best treated when diagnosed early, so you should consult a professional if you notice any of the following signs and symptoms:

• Hoarse, rough or raspy vocal quality
• Tension in the neck muscles
• Chronic dry and scratchy throat
• Loss of voice
• Breathy voice quality
• Coughing or choking while eating
• Reduced pitch range
• Suddenly deeper voice
• Raw, achy, or strained feeling in the throat
• Painful or effortful speaking

Treatment procedures for voice disorders include:

Medical Intervention: An evaluation by an otolaryngologist (ENT) is recommended to ensure there is not another underlying cause to the voice disorder. The ENT will typically perform an endoscopic evaluation by inserting an endoscope into the mouth or nose to look at the larynx and movement of the vocal folds. Speech Therapy: A complete voice evaluation from a speech-language pathologist (SLP) is typical for voice disorders in which the SLP will evaluate vocal quality, pitch, loudness, and the ability to sustain voicing. The SLP treats vocal fold nodules, vocal abuse, and vocal misuse with behavioral therapy techniques. Good vocal hygiene is also targeted in this type of therapy. Surgical Intervention: In some cases, surgery is necessary for patients who have severe vocal fold pathologies that do not respond to medications or therapy.

Voice disorders can be prevented by following good vocal hygiene protocols. Good vocal hygiene includes:

• Staying hydrated by drinking plenty of water
• Limiting alcoholic or caffeinated beverages
• Using a humidifier in your home during winter months and dry climates
• Avoiding smoking and second-hand smoke
• Limiting consumption of spicy foods to prevent heartburn or GERD
• Getting plenty of rest as physical fatigue negatively affects the voice
• Exercising regularly for good breath support
• Avoiding gargling with mouthwash or other irritating chemicals
• Trying not to overuse your voice
• Avoiding screaming, whispering, and talking too loudly
• Avoiding cradling the phone when talking as this can cause muscle tension in the neck
• Considering using a microphone or amplification device in noisy environments

Goshen Speech and Hearing Center, located in Goshen, NY, has a team of well-qualified and experienced providers who are dedicated to serve patients in the community. Our professionals are ready to help serve you. Please contact us by calling (845) 294-0661.