Voice Disorders
See also: Caring for Your BodyAs you might expect, voice disorders affect how the voice is produced. The best-known voice disorder is probably hoarseness, or ‘losing your voice’. This can be the result of an infection of the larynx (voice box) or even just shouting too much. It usually resolves fairly fast, and is relatively simple. However, voice disorders affect your ability to speak, and in the longer term may therefore become a barrier to effective communication.
This means it is important to understand a little about what can cause these problems, and when you might seek help. This page provides more information about several voice disorders, including chronic cough, vocal fold paralysis and spasmodic dysphonia. It explains what they are, how you can recognise them, and how they might be treated or managed.
Introducing Voice Disorders
This page does not cover short-term voice disorders like being hoarse after shouting, or losing your voice when you get a cold. These generally resolve fairly swiftly by themselves, although they can be disruptive in the short term. The page focuses on the longer term voice disorders that may be more extreme barriers to effective communication.
These should always be investigated by a doctor.
You should therefore see a doctor if you have a voice problem that goes on for more than a few weeks, including hoarseness or losing your voice.
The most common long-term voice disorders are chronic cough, vocal fold paralysis, paradoxical vocal fold movement, spasmodic dysphonia and vocal fold nodules or polyps. Most of these are most likely to be caused by abuse of the vocal folds or vocal cords, for example, through smoking or shouting or singing a lot. Coughing can also cause irritation of the vocal cords.
1. Chronic cough
A chronic cough is one that does not go away for at least four weeks (children) or eight weeks (adults). It is most likely to be caused by an ongoing allergy or sinus infection, acid reflux irritating your throat, or asthma.
However, coughs may have other causes, some significantly more unpleasant, so it is advisable to get any cough checked by a doctor.
Having a chronic cough affects your voice by making it sound rougher. Effectively, constant coughing inflames your throat and larynx, making it harder to speak normally.
Treatment will depend on the cause and effects. For example, a cough caused by asthma or an allergy may be treated by treating the underlying condition. You might also be advised to work with a speech therapist to understand what triggers your cough, and how to avoid those triggers, or to learn how to reduce your coughing.
2. Vocal fold paralysis
Vocal fold paralysis is when one or both of your vocal folds or cords do not move.
This means that they cannot vibrate to produce sound, and you may also have problems breathing or swallowing. The precise difficulty depends on whether one or both of your vocal cords is paralysed, and also the position in which they are held.
Unilateral (one-sided) vocal cord paralysis is more common, and this is likely to cause problems with the voice such as not sounding very clear or loud, or running out of breath while talking. This may mean that the voice sounds hoarse or disappears altogether, or there is limited control over pitch or duration.
Generally, vocal cord paralysis is caused by damage to the vagus nerve. This might happen through an injury or surgery, or as the result of a brain tumour or stroke.
There are various treatments, depending on the type and severity of the paralysis. These include surgery to move your vocal cords, or muscle–nerve transplantation. Voice and speech therapy can also help you to control your pitch, or improve your breath management.
3. Paradoxical vocal fold movement
Paradoxical vocal fold movement is when your vocal cords close when they should open.
This includes when you breathe in or out. This makes it hard to breathe, but it also makes it hard to talk. It may occur in both adults and children, and can cause serious problems when it happens. It does not happen constantly, but may be triggered by things like being out in the cold, being under stress, or acid reflux.
The biggest problem is not really your voice production, but actually being able to breathe.
However, people with this issue often find that their voice becomes raspy or rough when it happens, or that they lose their voice altogether.
Treatment might be to address the underlying triggers, especially if a condition like asthma might be involved. Speech therapy can also help to teach techniques to control and reopen the vocal cords when this movement happens.
4. Spasmodic dysphonia
Spasmodic dysphonia is when your vocal cords do not move in quite the right way.
Instead of vibrating normally, they spasm or tighten, making it much harder to produce the ‘right’ sounds. Your voice might therefore sound jerky, hoarse or tight, or you might be able to produce no sound at all. At other times, your voice could be perfectly normal.
Spasmodic dysphonia generally starts gradually and then gets worse over time, or when you are tired and stressed. It is most likely to start in adults between the ages of about 30 and 50. The cause is not obvious, but we know that dystonia, a brain condition that causes muscles to tighten, can be linked to spasmodic dysphonia. Stress can also cause spasmodic dysphonia, though this is rare.
There is no cure for spasmodic dysphonia, but there are some treatments that may help, including botox injections into the vocal cords and speech therapy.
5. Vocal fold nodules or polyps
Vocal fold nodules and polyps are growths on your vocal cords.
Nodules are little hard growths, a bit like callouses. Polyps are often longer and thinner, more like blisters. They generally develop when you use your voice wrongly, for example, shouting, or singing loudly. Usually this is a chronic issue, but they can also develop after just one episode of ‘vocal abuse’. Thyroid problems and acid reflux can also contribute.
Both nodules and polyps interfere with how your vocal cords move, meaning that they cannot vibrate in the right way. The two conditions therefore cause similar symptoms, including a rough or harsh voice, hoarseness, breathiness, and pain in the neck or throat. You may also find that you cannot change pitch easily, or that your voice gets tired quite quickly.
Treatment will depend on the cause of the polyps or nodules, and also the size. Doctors may want to treat the underlying problem first, if there is one. Surgery may also be an option to remove the polyps, especially if they are large. Speech therapy may also be recommended to help you to take care of your voice in the longer term.
A Final Thought
Voice problems may sound relatively benign—and indeed in many cases, there may be no treatment, or a brief course of speech therapy.
However, it is important to have any hoarseness, coughing or other voice issues investigated if they go on for more than a few weeks. They could be a sign of underlying conditions that need to be investigated and addressed.