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Voice Disorders
Kevin Stuckey, M.Ed., CCC-SLP
What are voice disorders?
Voice disorders occur when there are changes in a person’s ability to produce their typical sounding voice. Children and adults can experience a voice disorder. As we speak, air moves through the voice box which causes the vocal cords vibrate together to create sound. If the vocal cords are overworked and stressed, they may become swollen and can’t function properly. One common example of a voice disorder can be observed in a person after they have cheered/yelled loudly at a sporting event or while playing outside. In this case, you may notice a hoarseness to how the voice sounds and feels. These issues tend to resolve themselves through vocal rest.
Additional factors that may impair voice sound and quality include aging, using alcohol, and having a cold or sinus/allergy issue(s). A voice disorder can also be present if a person is concerned about the quality of their voice that may be different from other speakers. If a person feels uncomfortable with their voice, they may choose not to interact/communicate with others which can negatively affect their social lives.
Who is the most susceptible to voice disorders?
  • Pediatric: significantly more prevalent in male than in female children, often exhibiting vocal nodules
  • Young Adults (aged 24–34 years): estimated to be 6% with no significantly different prevalence rate between male and female
  • Adults (60 years and older): a higher prevalence in female than in male adults
  • Occupation: People with occupations that require a lot of speaking during the day or a loud volume of speaking due to a noisy environment are more susceptible to developing a voice disorder. For example, teachers and singers have a higher risk of voice disorders due to the extended periods of time talking and singing
Types and symptoms of voice disorders
There are two types of voice disorders: functional and organic. The identified cause of the voice disorder will reflect the type of symptoms that may be present. The disorder may be present with one symptom or a variety of symptoms.
A functional voice disorder has no identified abnormalities with the physical structures, including the voice box (larynx), that work together to produce sounds. A person is not able to effectively use these components including the vocal cords to produce their normal voice quality.
Functional causes include the following:
  • Having a hoarse voice (such as after screaming/cheering at a sporting event)
  • Having a breathy voice (there is noticeable air escaping during speech)
  • High pitch or too low pitch (different pitch from a person’s typical voice quality)
  • Voice sounds too loud or too soft when speaking
  • Frequent coughing/throat clearing when speaking
Organic voice disorders have specific identified problems with the structure of the person’s voice box, vocal cords, or lungs.
  • Structural — organic voice disorders that result from physical changes in the vocal mechanism such as vocal nodules, cysts, or polyps on the vocal cords; there may also be structural changes in the larynx due to aging
  • Neurogenic — organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect the functioning of the vocal mechanism, such as vocal tremor, spasmodic dysphonia, or vocal fold paralysis
Collaboration with otolaryngologists/laryngologists is especially important to identify any underlying pathologies that may be present. These are diagnosed and treated by an Ear, Nose, and Throat doctor (ENT) as well as a Speech-Language Pathologist (SLP). Treatment varies depending on diagnosis from vocal rest to voice therapy and even surgery.
Strategies for short-term voice disorders (such as hoarseness) include:
  • Avoid shouting, singing, or straining your voice for several days
  • Drink plenty of water to keep your vocal cords hydrated
  • Reduce the amount of time spent talking (vocal rest)
People with more complex voice disorders may benefit from more focused interventions to improve their voice. These interventions include speech exercises and learning techniques to improve and maintain a healthy voice. Treatment for more complex voice disorders often includes a combination of the following:
  • Direct Approach – Modify the current vocal production with a direct focus on the voice-producing mechanisms. Work towards achieving speech production in a healthy manner.
  • Indirect Approach – Focus is placed on a person’s cognitive, behavioral, psychological, and physical environments including patient education and counseling.
    • Patient Education
      • Review and discuss aspects of normal voice production
      • Discuss the impact of vocal abuse and voice disorders
      • Provide strategies for maintaining good vocal health
    • Counseling
      • Identify all potential negative psychosocial factors
      • Provide strategies to reduce internal stress impacting good vocal health
Voice Disorders. American Speech-Language-Hearing Association. Accessed May 18, 2023.
Voice Disorders. Cleveland Clinic. Accessed May 18, 2023.

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