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Voice Disorders

When your vocal quality, pitch, or volume differs from what is considered normal for speakers of your age, gender, or cultural background, it may be indicative of a voice disorder. The possible causes of a voice disorder vary widely. Structural, medical, or neurological changes in the respiratory, laryngeal, and vocal tract mechanisms may produce a voice disorder. Disorders also may develop following poor or inappropriate voice use over a period of time. Additionally, some voice disorders have a psychological component that needs to be addressed.

At the Voice and Swallowing Institute, we have extensive expertise in diagnosis and treatment of these disorders. As a patient, you will be cared for by our highly specialized team which includes Dr. Michael Pitman (laryngologist) and two voice pathologists/singing voice specialists.

What are the symptoms of a voice disorder?

An individual experiencing a voice disorder may have a voice quality that sounds:

  • Unstable or quivering
  • Rough, harsh, or husky (hoarse)
  • Strained or choppy
  • Weak, whispery, or breathy
  • Too high or too low
  • Significantly changed in pitch

Other symptoms include:

  • Tension or pain in your throat when you speak
  • Feeling that your larynx (voice box) is tired
  • Feeling of a "lump" in your throat when swallowing
  • Pain when you touch the outside of your throat

If you have been experiencing one or more of the above symptoms for more than 2 weeks, you should make an appointment with a specialist for an evaluation.

How is a voice disorder diagnosed?

If you have a voice change that lasts for a few weeks, your primary care provider may send you to see an otolaryngologist (throat specialist) or a laryngologist (an otolaryngologist with even further sub-specialized training in voice disorders). The specialist will ask you about your symptoms and how long you've had them. He or she may examine your vocal folds and your larynx using certain tests, including:

  • Videostroboscopy: This test uses a camera called an endoscope that can visualize your larynx. There are two types of endoscopes: flexible endoscope and rigid endoscope. A flexible endoscope is a small flexible camera that looks up through your nose and hangs over the back of your throat to view your larynx. It does not hurt and only takes one or two minutes to perform the test. A rigid endoscope is a slightly larger, but still small, firm camera that enters your mouth, just to the back of your tongue, and looks at your larynx via the mouth. It does not go down your throat and also does not hurt. Both endoscopes use light sources called strobe lights that allow the physicians to view the vocal folds vibrating in slow motion
  • Imaging tests: X-rays, CT scans, and MRI can show growths or other tissue problems in the throat. If your physician feels this test is necessary for your voice complaint, he/she may send you for one following the videostroboscopic examination.

How is a voice disorder treated?

Treatment for a voice disorder depends on what's causing it. Treatment may include:

  • Lifestyle changes. Some lifestyle changes may help reduce or stop symptoms. These can include not yelling or speaking loudly, and resting your voice regularly if you speak or sing a lot. Exercises to relax the vocal cords and muscles around them can help in some cases.
  • Speech therapy. Working with a speech-language pathologist can help with certain voice disorders. Therapy may include exercises and changes in speaking behaviors.
  • Medications. Some voice disorders are caused by a problem that can be treated with medication. For example, antacid medication may be used for gastric reflux; hormone therapy for problems with the thyroid or female hormones; or nasal sprays for allergies affecting your voice.
  • Injections. Muscle spasms in the throat can be treated with an injection of botulinum toxin. In some cases, fat or other fillers can be injected into the vocal cords. This can help them close better.
  • Surgery. Often surgery is used to restore laryngeal function, as in the case of vocal fold paralysis, a vocal fold polyp, or vocal fold scar.  For many procedures, a patient can remain comfortably awake in the office instead of under general anesthesia in the operating room.  Vocal fold lesions can be removed if necessary.  If growths are caused by cancer, other treatment, such as radiation therapy, may be needed.

Conditions We Treat

Structural Changes in the Vocal Fold

Neurogenic Voice Disorders

Other Voice Disorders