Voice disorders

Overview

People may get a voice disorder for many reasons. A voice disorder, also called dysphonia, is a change in how the voice sounds. Voice disorders may include vocal cord paralysis, also called vocal fold paralysis; spasmodic dysphonia; issues with the voice box, also called the larynx; and vocal cord cysts, nodules, polyps or growths. Healthcare professionals trained in ear, nose and throat conditions and speech-language pathology diagnose and treat voice issues.

Voice disorder treatment depends on what's causing the voice change. Treatment can include:

• Voice rest.
• Voice therapy.
• Medicine.
• OnabotulinumtoxinA (Botox) injections.
• Surgery and other procedures.

Symptoms

Voice disorder symptoms can vary depending on the cause.

A hoarse voice can be an early sign of a voice disorder.

Other voice disorder symptoms can include:

• Voice tremors.
• Weakened or strained voice.
• Changes in voice pitch.
• Trouble speaking with a louder voice.
• Breathy or raspy voice.

When to see a doctor

If you have a hoarse voice or other voice issues for 2 to 4 four weeks, and you don’t have a cold or respiratory infection, talk with your healthcare professional and get an exam.

Causes

The cause of voice disorders, also called dysphonia, is vocal cords that can't work properly.

The voice box, also called the larynx, is made of a smooth covering called mucosa, with underlying muscle and cartilage. The voice box moves the vocal cords, also called the vocal folds. The voice box sits at the top of the windpipe, also called the trachea, and the base of the tongue. The vocal cords vibrate to make sound.

Air moving through the voice box causes the vocal cords to vibrate and brings them closer together. The vocal cords also help close the voice box during swallowing to stop you from breathing in food or liquid.

If vocal cords become swollen or damaged, form growths, or can't move as they should, they won't work properly. Any of these issues might cause a voice disorder. Swelling of the vocal cords also is known as inflammation.

There are many kinds of voice disorders. Examples of some common voice disorders are:

• Laryngitis. Laryngitis is a common voice issue that happens when the vocal cords become inflamed or irritated. This causes the voice to become hoarse. The condition can be short-lived, called acute, or long lasting, called chronic.
• Spasmodic dysphonia (spaz-MOD-ki dis-FOE-nee-uh). Spasmodic dysphonia is a long-term voice disorder that may be related to a brain and nervous system condition, also called a neurological condition. It causes the muscles of the voice box to tighten or spasm at various times. The condition can cause a strained voice.
• Polyps, nodules or cysts. These are growths that can appear on the vocal cords. These growths aren’t cancer.
• Precancerous and cancerous growths. These growths, called tumors, can appear on the vocal cords or voice box.
• Vocal cord paralysis or weakness. Vocal cord paralysis, also called vocal fold paralysis, is a condition that affects the muscles that control the voice. The nerve impulses to the voice box are interrupted. This causes one or both vocal cords, also called vocal folds, to be unable to move, called paralyzed. This can lead to voice and breathing issues.
• White patches, also called leukoplakia (loo-koh-PLAY-key-uh). Leukoplakia causes white patches on the tongue, vocal cords, gums, insides of the cheeks and bottom of the mouth.

Risk factors

Many factors can lead to a voice disorder, such as:

• Aging.
• Alcohol use.
• Allergies.
• Gastroesophageal reflux disease, also called GERD.
• Illnesses, such as colds or upper respiratory infections.
• Brain and nervous system conditions, also called neurological conditions. Examples are Parkinson's disease; stroke; dysphagia; essential tremor; amyotrophic lateral sclerosis, also called ALS; multiple sclerosis; and myasthenia gravis.
• Scarring or injury from neck surgery or from trauma to the front of the neck, chest or voice box that damages the vocal cords.
• Screaming.
• Smoking.
• Throat cancer. Throat cancer can form in the throat, also called the pharynx, or the voice box, also called the larynx.
• Throat dehydration.
• Thyroid issues.
• Voice misuse or overuse.

Diagnosis

Your primary healthcare professional or a healthcare professional trained in ear, nose and throat conditions, also called an ENT specialist, may diagnose voice disorders using an exam and various tests. Voice disorders also are called dysphonia.

Your healthcare professional asks you about your voice issues, symptoms and medical history, and listens to your voice. You have a physical exam. You might be given a numbing medicine before the exam. Your healthcare professional might use one or more of these tools to see clearly in the neck and throat:

• Mirror. A healthcare professional might put an instrument such as a dental mirror in your mouth. It's long and has an angled mirror. This mirror is used in an exam of the voice box, also called the larynx. This exam is called laryngoscopy.
• Flexible laryngoscope. This is a bendable tube that holds a light and camera. A healthcare professional guides the instrument through the nose during a laryngoscopy.
• Rigid laryngoscope. This is a stiff viewing tube guided through the mouth to examine the voice box.
• Videostroboscope. A tiny camera along with a flashing light gives a slow-motion view of the vocal cords as they move during a test called a videostroboscopy.

Tests

A healthcare professional may use other tests such as:

• Sound analysis. Using a computer, this test can measure anything unusual in the sound the vocal cords make.
• Laryngeal electromyography. Small needles put into muscles through the skin measure the electric currents in the voice box muscles.

Treatment

Many methods are available to treat voice disorders, also called dysphonia. Treatment depends on your condition. Voice disorders are most often treated by a healthcare professional trained in ear, nose and throat, also called ENT, conditions. Your healthcare professional may suggest one or more of the following treatments:

• Rest and liquids. Like other parts of the body, the vocal cords, also called the vocal folds, need regular rest and fluids. Your healthcare professional may ask you to avoid speaking loudly or to speak only when needed for one to several weeks until you heal from your condition. Your healthcare team also may suggest that you avoid clearing your throat and coughing.

• Voice therapy. In voice therapy, which may include vocal cord dysfunction therapy, speech-language pathologists teach you to improve how you use your voice and vocal muscles. A speech-language pathologist also may teach you how to avoid damage to your voice. You also may learn how to clear your throat and how much liquid to drink.

  You may have to do many vocal exercises to learn how to change how you use your voice, strengthen your vocal cords, and take care of your voice and vocal cords. Voice therapy may include vocal cord exercises.

  Voice therapy also may be used with other surgeries or procedures to treat many voice disorders. For example, voice therapy may be used along with other therapies to treat spasmodic dysphonia, vocal cord nodules or cysts, or vocal cord paralysis.

• Allergy treatments. If an allergy is making too much mucus in the throat, a healthcare professional can find the allergy's cause and treat it.
• Stopping smoking. If you quit smoking, it can help improve your voice and many other areas of health. For example, it can boost heart health and lower cancer risk.
• Medicine. Your healthcare professional may prescribe various medicines to treat voice disorders depending on the cause. Medicine can ease vocal cord swelling, also called inflammation; treat gastroesophageal reflux disease, also called GERD; treat tremor; or stop blood vessel regrowth. Medicine can be taken by mouth, injected into the vocal cords or put on the vocal cords during surgery.

Surgery and procedures

• Removal of growths. You may have surgery to remove growths on the vocal cords. These may be growths that aren't cancer, such as vocal cord nodules, polyps or cysts. There also can be growths that are cancer, called tumors. A surgeon can remove growths using microsurgery and carbon dioxide laser surgery. If needed, a surgeon may use other laser treatments, including potassium titanyl phosphate laser treatment, also known as KTP laser treatment.

  KTP laser treatment is a therapy that treats growths on the vocal cords by cutting off the blood supply to the growth. This allows a surgeon to remove the growth while leaving in place most of the tissue near it.

• Injections. A healthcare professional gives you shots, also called injections, of tiny amounts of purified onabotulinumtoxinA (Botox) through the skin of the neck into the vocal cords. These shots can help stop muscle spasms or movements that aren't typical. This procedure treats certain voice issues that may be related to the brain and nervous system, such as spasmodic dysphonia and vocal cord tremor.

Vocal cord paralysis treatment

Sometimes one or both vocal cords, also called vocal folds, can't move. This condition is called vocal cord paralysis. A paralyzed vocal cord can cause hoarseness and choking when drinking liquids. But it rarely causes trouble when you swallow solid foods. The condition may go away with time.

If vocal cord paralysis doesn't go away, treatments can push the paralyzed vocal cord closer to the middle of the windpipe, also called the trachea. These treatments allow the vocal cords to meet and vibrate closer together. This improves the voice and repairs the vocal cords. It also allows the voice box to close when swallowing.

Treatments include:

• Fat or collagen injection. Injecting body fat or human-made collagen adds bulk to the paralyzed vocal cord and treats vocal cord weakness. A healthcare professional may give these shots, also called injections, through the mouth or the skin on the neck.
• Thyroplasty. A small opening is made in the cartilage of the voice box. A surgeon puts an implant into the opening and pushes it against the paralyzed vocal cord to reposition it.

Read more about vocal cord paralysis treatment at Mayo Clinic.