Voice Disorders
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Voice Disorders

Causes of voice disorders

Role of the Speech-Language Pathologist

How to minimise the risk of developing a voice disorder


​​Frequently asked questions





Voice is produced when there is a flow of air from the lungs through the vocal cords. This can be in the form of laughter, crying, singing and speech. The mechanism for generating the human voice can be subdivided into three parts: the lungs, the vocal folds within the larynx (the voice box) and the articulators.


When the vocal cords do not vibrate normally due to injury the voice produced is altered. Hoarseness, which is the most common symptom, is "unwanted air leak". Any disorder that disrupts that flow of air, allowing a leak, causes hoarseness. A voice disorder can be defined as a problem involving abnormal pitch, loudness or quality of the sound produced by the larynx. 

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Causes of voice disorders


Voice disorders can be the result of various physical, psychological and environmental factors. The following are the most common causes.

Vocal abuse (voice strain or overuse)


More than 50% of people with voice disorders have a diagnosis of vocal abuse and misuse. Professional voice users, such as teachers, fitness instructors and singers, use their voice more than the rest of the population. They are at a greater risk to strain their voices since they keep using it even when rest is needed and/or recommended. 


Allergies, colds or upper respiratory infections


Allergies, such as hay fever, as well as infections often cause swelling of the vocal cords (oedema). A hoarse voice or even a complete loss of voice (aphonia) is often the result. 


Throat dehydration


The area around the vocal cords should be kept hydrated in order to have a healthy voice. Dusty environments, air-conditioned rooms, smoking (including passive smoking), alcohol and frequent caffeine intake cause throat dehydration and voice changes. 


Gastroesophageal reflux


This refers to the feeling of ‘burning’ in the stomach induced by acids, which may be caused by alcohol and spicy food. The acid comes up the oesophagus and dribbles down into the laryngeal area. Medication and diet can prevent this. 




Apart from being a threat to the lungs and their function, smoking causes dryness in the mouth and vocal cords area. This causes hoarseness (sometimes even permanent), vocal nodules and Reinke’s oedema (swelling of the vocal cords).


Aging & neurological conditions


Aging causes changes in the structure of the vocal cords and the muscles around the vocal tract. Conditions such as Parkinson’s disease and other neurological conditions can also cause problems in the breathing mechanism which in turn reflects on voice production.



Psychological stress


A person may lose his/her voice even when no physical damage is apparent or present. Stress or psychological issues can cause a person to become hoarse or even lose the voice temporarily.


Normal menstrual cycle


Hormonal changes, secondary to the menstrual cycle, may result in physical changes that affect voice production. Increased subglottal (area beneath the vocal cords) pressure may cause hoarseness or loss of voice.


Other causes may include scarring from neck surgery, trauma and cancer of the larynx. 

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Role of Speech-Language Pathologist


The Speech-Language Pathologist (SLP) is trained in the assessment and intervention of communication problems including voice disorders. The SLP is responsible for voice therapy and rehabilitation of the voice. Several aspects of the voice are analysed including: voice use, breath support, voice placement, general health, as well as the person’s lifestyle. An individual treatment plan is then devised which may include advice on vocal hygiene, breathing and relaxation exercises and proper voice placement to project the voice in a manner which does not place any strain on the voice box. A variety of techniques are utilised to accomplish these goals.

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How to minimise the risk of developing a voice disorder


Very often a voice disorder is caused by vocal misuse and abuse. One can minimise this risk by following these simple tips:


 • Keep your vocal folds moist especially when you talk for a long time. Drink plenty of water. Breathing in steam is a very effective way of getting moisture to the vocal cords.


 • Humidify the atmosphere. Put a bowl of water in a air conditioned rooms.


 • Avoid too many caffeine containing drinks (e.g. coffee, tea) since this substance dries up the throat. Alcohol and certain medications also have drying effects.


 • Do not strain your voice. Rest if you must and pause between one phrase and another.


 • Throat clearing is not a gentle movement on the vocal folds. Try sniffing and swallowing instead. You may also try having a drink, sucking a sweet or yawning to relax your throat.


 • Avoid shouting or talking above background noise since this usually results in voice fatigue and can eventually damage the vocal cords.


 • Avoid whispering for long periods. You would still be using your vocal folds even though you think you cannot be heard!


 • Allergies can cause swollen and inflamed membranes. Persistent sinus and nasal problems cause catarrh and mucous to cling to the sides of the throat and the vocal cords. Therefore it is best to visit your GP or the ENT consultant to seek advice.


 • Try to balance the demands on your voice of work/family/leisure. Find times to rest your voice.


 • Think about how you deal with stress. Find time for yourself and for activities which help you relax.


 Moreover, the Speech-Language Department regularly delivers workshops for professional voice users as well as the general public on how to take care of this instrument thus preventing voice difficulties.

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Frequently asked questions

​When should I seek help?

If any of the symptoms below are present in the absence of the common cold or flu, one should seek help. 

    • Voice changes, such as change in pitch, volume or quality that last more than two weeks. 

    • Complete loss of voice lasting longer than a few days. 
    • Pain in your throat when talking. 
    • Persistent voice changes that inhibit your ability to do your normal activities.


In addition, smokers should not hesitate to seek advice if there are any changes in their voice, since smoking causes throat cancer, and hoarseness is one of its earliest signs. 


Where can I seek help? 

One can visit the Voice Clinic which is a specialist clinic within the Speech-Language Department. This clinic offers specialist advice in voice difficulties. An assessment is carried out and if required therapy is also provided. The person with voice problems may also be followed up by a Speech-Language Pathologist in the individual’s respective area health clinic or health centre. A visit to the Ear Nose and Throat specialist (ENT), may also be required for laryngeal examination. 


Will I need surgery to cure my voice? 

Not necessarily. It depends on the cause of the voice problem. In certain cases surgical intervention is required. However, for several types of voice disorders voice therapy is the better option, even if surgery will eventually be required.

What should I expect from voice therapy?

Voice therapy is a behavioural type of treatment which modifies the way a person uses his/ her voice. This involves various types of exercises which address the various subsystems of voice production (breathing, phonation and resonance). Intervention plans are devised according to the client’s individual needs. Therapy outcome is highly dependent on the client’s motivation and active participation. 



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