Voice Disorders
Some changes in voice are temporary, such as after a upper respiratory infection, and go away in days or weeks. Others voice changes can signal important shifts in physiology and health, and so an initial evaluation by a medical doctor to identify the cause is key. Described below are the broad categories of voice disorders, and their related etiologies.
What Can Cause Voice Disorders?
Organic Vocal Pathologies - Structural tissue changes in and around the voice that result in alterations in coordination of respiratory and vibratory characteristics leading to poor vocal quality. Examples include: vocal nodules, polyps, cysts, ulcers, granulomas, hemorrhages, Reinke's edema. Various behavioral and environmental factors may be related to the emergence of organic pathologies:
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Hyperfunction/Overuse of the voice
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Environmental Pollutants
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Acid Reflux and other medical conditions
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Inhalants such as smoking & vaping
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Laryngeal and Oral Cancer
Neurologic Voice Disorders - Neurologic changes may result in abnormal control, coordination or strength of the vocal mechanism resulting in poor voice quality. Examples: Stroke, Multiple Sclerosis, Parkinson's Disease, Amyotrophic Lateral Sclerosis (ALS), Myasthenia Gravis, Spasmodic Dysphonia (Focal Laryngeal Dystonia). It is important to note that some causes of voice disorders co-occur with other disorders such as dysarthria (motor speech) and dysphagia (swallowing)
Functional Voice Disorders - When voice quality is poor despite a lack of apparent neurologic or anatomical cause to explain it, it is termed "functional." These disorders stem from improper use of the vocal mechanism, and can be amenable to treatment using various therapeutic techniques. Example: Muscle Tension Dysphonia (MTD), puberphonia.
What Can Be Done To Help?
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The first step in addressing voice disorders is to undergo a complete otolaryngological (ENT) exam to understand the underlying cause of voice quality changes, and to identify any anatomical and physiological changes. Following this, a comprehensive physiologic, acoustic, perceptual, and behavioral evaluation of voice by a Speech Language Pathologist will delineate treatment targets that may address some of following, based on the unique findings of the evaluation.
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Proper vocal mechanics and vocal muscle re-education
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Environmental contributions to voice health
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Vocal strengthening programs
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Resonance and voice "placement" or enhancement
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Respiratory support for voice and proper respiratory patterns for speech
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Increasing or Decreasing vocal function, whichever is appropriate
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Vocal dynamic range
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Appropriate pitch use
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Elimination of vocally straining or abusive habits
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Occupational voice use recommendations and strategies