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Voice Disturbances
ICD 784.49

Article by:
Sarah Morales, BS
Children's Speech Care Center

Voice disturbances may occur for a variety of conditions. Any change in the shape or functioning of the vocal folds (vocal cords—two bands of muscle tissue) will cause a voice disturbance. The vocal folds sit above the trachea (windpipe), and air from the lungs causes them to vibrate, producing the sound of one’s voice. Voice disturbances may occur in adults or children, but they are more common in adults. The conditions that can interfere with vocal fold vibration fall into five categories, discussed below.

The first category is structural changes of the vocal folds. Lump-like growths such as nodules, polyps, cysts, papilloma, or granuloma (benign growths—non-cancerous) or malignant growths (cancerous) called carcinoma distort the straight edges of the vocal folds. This causes them to vibrate strangely, or not at all. Secondly, neurogenic voice disorders (caused by brain/nervous system damage or malfunction) include vocal fold paralysis, vocal tremor (quavering vocal fold motion—quavering voice), and spasmodic dysphonia (vocal folds “freezing” in open or closed positions) can interfere with normal vibration. Neurological diseases such as myasthenia gravis, multiple sclerosis, amyotrophic lateral sclerosis, and Parkinson’s disease can paralyze vocal folds, interfering with normal vibration. Third, diseases such as respiratory infections (cold, flu), allergies, and esophageal reflux disorder can cause swelling of the vocal folds (called edema), preventing normal vibration. Fourth, vocal abuse can cause swelling of the vocal folds or growths on the folds (i.e. excessive/loud talking, excessive caffeine or alcohol intake, lack of water consumption, exposure to fumes, smoking, etc.). The fifth category includes idiopathic voice disorders (voice disorders of unknown origin): e.g. deliberate use of an unnatural sounding voice. Persons with voice disorders often have breathy or hoarse voices, vocal fatigue, and pain in using their voices.

Certain groups of people are especially prone to voice disorders. Examples include persons who use their voice heavily, such as teachers, coaches, courtroom lawyers, and vocal performers. Therapy for these persons may include instruction in the use of amplification (i.e. microphone for the college professor lecturing to a room of 250 students) or breath management techniques to avoid straining the vocal folds (i.e. for professional singers). An athletic coach may be instructed to use a whistle or megaphone instead of yelling during practices; he/she may also be instructed to bring noisemakers to games to avoid yelling. Persons who abuse their voices through poor vocal hygiene (i.e. drinking excess caffeine, alcohol; smoking cigarettes) may be instructed to implement lifestyle changes to improve the health of their vocal folds and the quality of their voices.

Some voice disorders require surgery in addition to voice therapy. For example, vocal nodules (lump-like growths that occur due to strenuous overuse of the voice) are often treated by instructing the patient to rest his/her voice. A vocal hygiene program may be instated to assist in better care and use of the vocal cords. If the condition persists, surgery may be required. Other types of growths besides nodules (i.e. malignant ones like carcinoma) require surgery as well as rehabilitation by a speech-language pathologist. Conditions like vocal fold paresis/paralysis may also require surgery as well as therapy.

Voice disorders are often diagnosed and treated in a team approach (a group of professionals) including speech-language pathologists, ENT doctors (ear-nose-throat doctors), and physicians. Treatment is usually short and often involves changes the patient must implement (i.e. quitting smoking, drinking more water, refraining from yelling). Instruction on how to use the voice differently is frequently given. Exercises to improve tone and quality may also be beneficial.

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