Voice Disorders

Voice and resonance disorders can be a result of psychological, physical and/or physiological issues. Polyps, Vocal Nodules, granulomas, thyroidectomy, vocal overuse/abuse, Parkinson's Disease, Spasmodic Dysphonia, vocal performance, Paradoxical Vocal Fold Motion (PVFM), Post Surgical Rehabilitation and head/neck cancers are among the issues that Speech Language Pathologists (SLPs) address. 

What is a voice disorder?

A voice disorder is recognized when the quality of a person's voice is noticeably different when compared to others of similar age and gender. Voice is the sound produced by vibration of the vocal folds (or vocal cords) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate well enough to produce a clear sound. Children with voice disorders may have hoarse voices or noticeable differences with pitch, volume, tone, and other qualities of your voice. Resonance differences can include hyponasality or hypernasality. 

Causes of a Voice Disorder

The most common voice disorder in children is the result of “phono trauma” or vocal misuse such as yelling or making loud "play" sounds, throat clearing, and excessive coughing. These voice behaviors cause the vocal folds to close tightly against each other, causing blister-like bruises. Over time, if the vocal misuse is not corrected, the blistered areas can harden into callus-like bumps called vocal nodules.

Other types and causes of voice disorders can include:

• Vocal fold paralysis (one or both vocal folds do not move)
• Vocal fold cysts (fluid-filled sac)
• Papilloma (wart-like growths)
• Laryngeal web (band of tissue between vocal folds)
• Muscle tension dysphonia (excessive muscle tightness), resulting in a strained voice
• Subglottic stenosis (narrowing of the airway)

Signs and Symptoms of a Voice Disorder

• Hoarseness
• Breathiness
• Raspiness
• Strain
• Volume that is too loud or too soft
• Pitch that is too high or low for age
• Recent loss of voice (such as after an upper respiratory infection) that did not resolve
• Hypo or hypernasality

Assessing/Identifying Voice Disorders

One of the ways to assess your child's voice is by passing a small camera and light through the nose or mouth in order to see the vocal cords. This is typically done by an Otolaryngologist (Ear, Nose & Throat doctor) and will provide valuable objective information related to any medical reason for the voice disorder (vocal cord nodules, vocal cord polyps, paralyzed vocal cord, etc.). A Speech Pathologist can administer a subjective Voice Assessment, and can provide referral to an Otolaryngologist for further assessment if warranted. 

Treatment for Voice Disorders

Some voice disorders can be treated with voice therapy. Other voice disorders are treated with medication or surgery. Voice therapy consists of learning new habits and patterns of voice production and eliminating old ones. If the vocal misuse patterns aren’t corrected and the vocal nodules aren’t allowed to heal, surgical removal may become necessary. In many cases, a child is referred to a Speech Pathologist (SLP) for a trial of Speech/Voice Therapy prior to surgery in an attempt to improve vocal quality and heal the vocal nodules, and hopefully avoid surgery. If a child does require surgical intervention to remove vocal nodules or polyps, they are typically referred to an SLP after the procedure as well, to learn how to use the voice differently (proper vocal hygiene) to prevent the regrowth of the vocal lesions which were caused by vocal misuse. 

Voice therapy can include:

• Identifying and eliminating harmful voice patterns (such as yelling, screaming and making loud play sounds)
• Improving vocal health by increasing water intake and avoiding caffeine
• Using specific voice exercises designed to balance, strengthen or promote best vibration of the vocal folds. These help the voice to sound better.
• Learning to use the new voice production in everyday talking

Helping Your Child

The purpose of voice therapy is to teach your child a new improved way to produce voice. For this to become easier the child should practice the voice exercises daily. Family members should also look at their own voice use. 

Modeling your own good voice behaviors and rewarding good voice habits will help your child improve their voice.

• Avoid yelling and screaming across the house. Model the use of a gentle, softer voice. Walk over to your listener, then talk.
• Take turns talking with your child and other family members. Talking at the same time can result in increased volume.
• Drink plenty of water and avoid soft drinks or coffee. Vocal cords produce sound more effectively with less effort if well hydrated.
• Encourage “voice naps.” For example, play a game without any words. This helps your child give his or her voice a rest.
• Reward your child when they use the “better” voice, or practice good vocal health. Focus on the positive by telling your child about his good voice habits.

If you suspect a voice disorder -  schedule an assessment today