Voice Disorder Research by Sumon Ghosh (Founder of ACNRC)

A voice disorder is a condition that affects the ability to speak normally. Some common symptoms include:

• A hoarse, strained, or choppy voice
• Pain or a lump in the throat when speaking
• A quivering voice

There are several types of voice disorders, including:

• Functional voice disorders

These are caused by improper or insufficient use of the larynx and diaphragm. Examples include vocal fatigue, muscle tension dysphonia, and aphonia.

• Structural organic voice disorders

These are caused by physical changes in the larynx, such as vocal nodules, edema, and press by larynx.

• Neurogenic organic voice disorders

These are caused by abnormalities in the nervous system that innervate the larynx, such as vocal tremors, spasmodic dysphonia, and vocal fold paralysis.

Some common causes of voice disorders include:

• Upper respiratory infections
• Gastroesophageal reflux (GERD)
• Vocal misuse or overuse
• Growths on the vocal folds
• Cancer of the larynx
• Neurological diseases
• Psychological trauma

To prevent voice disorders, you can:

• Stay hydrated
• Limit alcohol and caffeinated drinks
• Use a humidifier in winter or dry climates
• Avoid smoking
• Get enough rest
• Avoid overusing your voice
• Avoid extremes of your vocal range
• Practice good breathing techniques

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 move or vibrate normally. Your voice is the sound that air makes when it is forced out of your lungs and passes between your vocal cords.

Mayo Clinic & Aradhya Foundation(MCAF)

Functional voice disorders (FVD) are caused by insufficient or improper use of the phonation apparatus without either anatomical or neurological abnormalities. The most common FVDs include vocal fatigue, muscle tension dysphonia, diplophonia, and ventricular phonation.

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.

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.

Diagnosis and Tests

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.

Management and Treatment

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.

Your voice is the sound that air makes when it is forced out of your lungs and passes between your vocal cords. Vocal cords are the 2 folds of tissue inside your voice box (larynx). The vibration of those cords is what makes your voice.

Voice disorders include:

Laryngitis

This 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. It is often caused by a virus in the upper respiratory tract. It often lasts just a few days to weeks. Treatment involves resting the voice and drinking plenty of fluids. Chronic laryngitis is when the swelling lasts for a long time. Common causes include a chronic cough, smoking, using inhalers for asthma, and GERD (gastroesophageal reflux disease). The treatment of chronic laryngitis depends on the cause.

Vocal cord paresis or paralysis

The vocal cords can be paralyzed or partly paralyzed (paresis). This can be caused by a viral infection that affects your vocal cord nerves, an injury to a nerve during surgery or when a breathing tube is placed in the throat, a 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 lifelong (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, 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 shots (injections) of botulinum toxin in the vocal cords.

What causes voice disorders?

For a normal voice, 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 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, wartlike lumps called papilloma, or calluslike 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 (granuloma) and small blisters called polyps. Growths can have many causes. These include illness, injury, cancer, and vocal abuse.
• Inflammation and swelling. Many things can cause vocal cord inflammation and swelling. These include surgery, respiratory illness or allergies, GERD, some medicines, exposure to certain chemicals, smoking, alcohol abuse, and vocal abuse.
• Nerve problems. Certain health 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. Surgery or laryngitis can also harm nerves.
• Hormones. Disorders affecting thyroid hormone, female and male hormones, and growth hormones can cause voice disorders.
• Vocal abuse. The vocal cords can be stressed by using too much tension when speaking. This can cause problems in the throat muscles and affect the voice. Vocal abuse can also cause a voice disorder. Vocal abuse is anything that strains or harms the vocal cords. Examples include too much talking, shouting, or coughing. Smoking and constantly clearing the throat is also vocal abuse. Vocal abuse can cause the vocal cords to get nodules and polyps. These change how the voice sounds. In some cases, a vocal cord can break or burst from vocal abuse. This causes the cord to bleed (hemorrhage). You can lose your voice. Vocal cord bleeding must be treated right away.

What are the symptoms of a voice disorder?

If you have a voice disorder, your voice may sound:

• Quivering
• Rough or harsh
• Strained or choppy
• Weak, whispery, or breathy
• Too high or low or the pitch may change

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 you may feel pain when you touch the outside of your throat.

This Documentary Collect from Aradhya Clinic & Neuro Reseatch Center (ACNRC).