Do you sometimes feel a change in your voice, a hoarseness, or difficulty speaking? Maybe something is stuck in your throat, or you feel tired when you speak? These may not just be symptoms of a cold. They may be symptoms of 'Voice Disorders' . Let's talk about this in a little more detail today.
What are Voice Disorders?
Simply put, voice disorders are anything that affects your ability to speak. This can change the quality of your voice, the pitch, or the loudness of your voice.
Imagine, when we normally speak, this is what happens. When we breathe, air from the lungs passes through the trachea (windpipe) at the top of the throat and into the larynx . Inside your larynx, at the top of the windpipe, are two vocal cords . When we breathe, these two vocal cords are open. But when we try to speak, these two vocal cords come together and vibrate as the air coming from the lungs passes through. That vibration is what produces our voice.
However, in someone with a voice disorder, something interferes with this process. That's when the voice sounds different.
These voice disorders can be divided into three main types:
1. Organic Disorders: This means there is something wrong with the structure of your larynx, vocal cords, or lungs. For example, abnormal growths in the larynx.
2. Neurological Disorders: This is when there is some kind of effect on the nerves that control the larynx. Imagine, if there is any damage to the nerves that control our voice, there may be changes in the voice.
3. Functional Disorders: In this, the structures that produce voice, such as the larynx, vocal cords, and lungs, are normal, but they cannot be used properly. This often happens when the muscles of the vocal cords become difficult to use properly. Sometimes, excessive stress, emotions, and changes in your mental state can also affect your voice.
Sometimes more than one of these types can occur together, causing a voice disorder. For example, let's say you have vocal fold paralysis . This means that one vocal fold is not working properly. Then the other vocal fold, which is the inactive one, has to work harder, causing tension in your throat. This is a functional disorder. Or, excessive tension in the throat (functional disorder) can lead to structural disorders such as vocal fold nodules.
A voice disorder can make it difficult for you to communicate with others and express yourself. This can have a major impact on your quality of life. But remember, there are treatments for this.
What are the common disorders that cause voice changes?
There are many types of disorders that can cause voice changes. Here are some of them:
- Laryngitis: This is an irritation or swelling of your vocal cords. Most of the time, it is temporary. It can be caused by allergies or an upper respiratory infection. This is what causes your voice to become hoarse when you have a cold.
- Muscle Tension Dysphonia: This is when the muscles in and/or around your voice box (larynx) become too tight. This condition can also affect the muscles in your neck, shoulders, and upper back. It can feel like you are choking while speaking.
- Spasmodic Dysphonia / Laryngeal Dystonia: This is a neurological disorder. It causes sudden spasms of the vocal cords. It can make your voice crack or feel hoarse when you speak.
- Vocal Cord Lesions: These are non-cancerous (benign) growths. For example, nodules, polyps, or cysts can form on the vocal cords. These can affect the voice.
- Vocal Cord Paralysis: This is when your vocal cords stop working properly, causing you to lose control of the muscles in your larynx.
In addition to this, there are also disorders of your upper airway. Although these are not directly related to the use of the voice, they are related to the larynx and vocal cords. They are:
- Inducible Laryngeal Obstruction (ILO): This is also called Paradoxical Vocal Fold Motion Disorder (PVFM). Or Vocal Cord Dysfunction.
- Exercise-Induced Laryngeal Obstruction (EILO):
If you have either `ILO` or `EILO`, your vocal cords or other structures in your throat may move incorrectly when you breathe. This can make it difficult to breathe properly.
What are the symptoms of a voice disorder?
The symptoms of a voice disorder vary depending on the cause. Your voice may sound like this:
- A tight, constricted voice (`Strained`): As if the throat is constricted when speaking.
- Raspy or hoarse: Like mucus.
- Breathy or airy: The voice lacks clarity, as if it were just air.
- A feeling of phlegm stuck in the throat, a wet feeling (`Gurgly or wet`):
- Weak, low-pitched, hard to project: Cannot speak loudly, seems to speak slowly.
- Voice too high or too low:
- Hearing the voice too loud or too soft:
- Uneven or shaky, with breaks or gaps in sound: Unable to maintain a steady voice while speaking.
In addition, you may feel pain when speaking, or you may have to strain to speak. You may feel like there is a `lump in your throat`.
What are the causes of voice disorders?
The main cause of voice disorders is overusing your voice . If you shout, sing, or just talk too much, your voice can be damaged. Think about it, because people like teachers and singers use their voices all the time, they are more likely to develop these conditions. For example, there was a singing teacher at our school who always had voice problems because he was tired of teaching songs to children all day.
Sometimes, these disorders are caused by short-term (acute) illnesses, such as colds, allergies, or sinus infections (sinusitis). These illnesses cause inflammation in the throat, which changes the way the air flows. Once the illness is over, the voice usually returns to normal within a few days or weeks.
However, more complex voice disorders occur when there is a problem with the structure, muscles, or nerves of the larynx, vocal cords, or vocal cords.
Who is at higher risk of developing voice disorders?
Voice disorders can affect anyone, but certain factors can increase the risk:
- Age and gender: Women over 60 are at higher risk.
- Occupation: For those who work in jobs that require a lot of vocal use, such as teachers, singers, and telemarketers. (In one study of about 1,000 teachers, more than half of them had voice disorders.)
- Behaviors: Things like drinking alcohol, smoking.
- Surgery: If you have had surgery on your throat (e.g., thyroidectomy) or if you have had a breathing tube used.
- Hormonal Disorders: If you have conditions like Diabetes Mellitus, Thyroid Disease, or Polycystic Ovary Syndrome (PCOS).
- Other medical conditions: Neurological Disorders, Autoimmune Diseases, Gastroesophageal Reflux Disease (GERD), Laryngopharyngeal Reflux (LPR), Laryngeal Cancer, Substance Use Disorders, or Alcohol Use Disorders.
How to diagnose voice disorders?
Your primary healthcare provider may be able to diagnose a voice disorder. Or, they may refer you to a speech-language pathologist (SLP) or an ear, nose, and throat doctor (laryngologist).
These doctors will ask you questions about your symptoms, your medical history, and how these challenges with your voice are affecting you at home, at work, and at school.
The doctor will listen carefully as you speak. He will look at your face, head, neck, and throat as you speak and breathe. He may tell you to say certain phrases, or to hold certain sounds longer, or to raise or lower your voice.
If you experience any symptoms while doing these exercises – such as pain, a scratchy throat, or difficulty breathing – don't forget to tell your doctor.
What tests are done to diagnose this condition?
To see how well your larynx and vocal cords are working, you may have imaging tests like these:
- Laryngoscopy: This involves using a thin, flexible tube (scope) with a video camera attached to it to look inside your throat. The doctor may also take samples (biopsy) from the vocal cords to check for any lumps (nodules), polyps, or cysts.
- Videostroboscopy: This uses a tube (scope) attached to a special camera. It can watch your vocal cords move slowly as you make a sound. It's like a slow-motion video.
- Laryngeal Electromyography (LEMG): This uses an electrode to measure the nerve signals produced when you use the muscles in your larynx.
- MRI or CT scan: These can take detailed pictures of the vocal cords and larynx. This can help the doctor see if there are any abnormal growths.
How are voice disorders treated?
Some short-term voice disorders can be cured by simply resting your voice. Your doctor may advise you to stop shouting, singing, or straining your voice for a few days. You may also be told to speak as little as possible.
Other treatments are:
- Voice Therapy: Speech-Language Pathologists (SLPs) teach you techniques and exercises to help you use your voice more effectively. This will help you communicate clearly. They also teach you how to care for your voice to maintain vocal health.
- Medications: If your voice problem is caused by LPR (acid reflux) or GERD (acid reflux disease), proton pump inhibitors (PPIs) or other medications may help. Some voice problems may require steroids or antibiotics.
- Medical procedures or surgery: You may need surgery to remove a lesion on your vocal cords. You may need botulinum toxin injections to relax tight vocal cord muscles. If you have paralyzed vocal cords, your doctor may inject filler to close the gap between your vocal cords. Or, you may need an implant to help bring your vocal cords together (called a medialization laryngoplasty).
Can voice disorders be prevented?
While some voice disorders caused by overuse can be prevented, many are difficult to prevent. However, you can reduce your risk by taking care of your voice. Here are some things you can do:
- Avoid smoking, recreational drugs, and alcohol.
- Keep your vocal cords hydrated by drinking plenty of water. (When you drink water, it is absorbed into your body and helps your vocal cords glide over each other more easily.)
- Take steps to prevent illness by doing things like washing your hands frequently.
- If you work in a job that requires a lot of voice, give your voice a break regularly.
- Learn what healthy limits are for using your voice.
If you have to talk or sing a lot, get your body used to it. Changing the amount of vocal use suddenly, without adequate preparation, can lead to fatigue and injury.
What is the outlook for people with this condition?
Voice disorders caused by overuse or acute illnesses are usually temporary. They do not cause permanent damage. However, if your voice disorder is more complex, it may take a little more effort to treat or manage the condition. You may need surgery or a few sessions of voice therapy. However, many people overcome their voice challenges with treatment.
How can I take care of myself?
The best way to take care of your voice is to follow your treatment plan. However, it is also important to take care of your mental health. When it is difficult to speak, people may feel that they cannot express themselves freely. For children, this can lead to low self-esteem. Having to make a big effort to get their voice out can be really distressing and isolating.
If you're struggling with these kinds of issues, talk to your doctor. Ask him or her about resources that can help.
When should I seek medical advice?
If you notice unexplained changes in your voice that don't improve after a few weeks, make an appointment to see a doctor right away. Getting treatment early can help prevent symptoms from getting worse. It can also prevent long-term damage to your vocal cords, which can often require more serious treatment, such as surgery.
What questions should I ask the doctor?
Here are some questions you can ask your doctor:
- What behaviors do I need to change to improve my voice?
- What kind of treatment do I need and how long will it take?
- What kind of healthcare providers will I have to work with?
- What are the chances of my voice problems being completely cured?
- Can you tell me what resources can help me deal with a voice disorder?
Finally, things to remember
Voice disorders can make it difficult to communicate with others. But with proper treatment, you can improve the quality of your voice. This can help you get one step closer to being understood by others without straining your voice.
If you notice a change in your voice that lasts more than a few weeks, see a doctor without delay. He or she can diagnose the cause and provide you with the treatment you need. Remember, early treatment is very important!
` Voice Disorders, Vocal Cords, Laryngitis, Voice Training, Sore Throat, Speech Therapy
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