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world-voice-day-2018One of the components that define what we speak is ‘Voice’. It is produced by the vibration of the ‘vocal folds’ also called “Voicebox” that’s located in our throat. When this so-called ‘voice’ is abnormal, the overall quality of speech is affected and sounds unpleasant. People might have encountered brief episodes of hoarseness or rough voice when they have a cold or a cough excessively. It remains for the shorter duration. If the same abnormal voice quality lasts for more than 3 weeks, then it’s high time that we consult an ENT, SLP and get evaluated.

Voice disorders

A condition that presents with an abnormality in voice parameters, i.e. pitch, loudness and quality that impacts speech production.

Causes of Voice disorders:

Vocal abusive behaviours:

In our daily life knowingly and unknowingly we are causing damage to our vocal folds through behaviours called ‘abusive vocal behaviours’. Examples of such behaviours are yelling, screaming, talking loudly for a prolonged duration, talking in noisy places, etc. These behaviours result in damaging the vocal tissues and results in growths on vocal folds that include nodules, polyps or cysts which can change the voice quality to hoarse, harsh or breathy voice quality depending on the severity.

Unhealthy vocal habits:

Inadequate intake of water causes dehydration and reduces the mucous level at vocal folds and can cause vocal fatigue. Excess consumption of spicy foods can lead to gastrointestinal reflux disease which further causes damage to vocal fold tissues. Frequent throat clearing, excessive coughing might also cause damage to the vocal folds due to excess friction. Smoking, excess consumption of alcohol also has severe impact on vocal health as it dries up the vocal folds.

Professional voice use:

Professional voice users include singers, drama artists, public speakers, telemarketers, salesman, teachers, Speech pathologists (indeed) and the list goes on. People from these backgrounds have to use their voice for prolonged periods as per their professional requirements. Prolonged use of voice might result in vocal fatigue and may experience brief periods of ‘Aphonia’ i.e. loss of voice. People who put excess demands on their voice without proper training might end up damaging their vocal folds which result in serious health concerns.


From birth till puberty, both boys and girls will have high pitched voice quality. After puberty females remain high – pitched and males change to low pitch as they grow into adulthood. During this time the vocal folds lengthen and thicken, causing them to resonate at a lower frequency, which produces a lower pitch. These changes are regulated by levels of testosterone in male’s body. If these changes do not happen according to the age, the high pitched voice quality remains unchanged, a condition called “Puberphonia” where males sound like females.

Neurological causes:

Neurologic voice disorders occur as part of an underlying neurologic condition such as Parkinson’s disease, multiple sclerosis, myasthenia gravis, or ALS. They can also happen as the result of a stroke. These disorders can affect the strength of the muscles of the voice box, and impact the control of the voice.When there’s damage to the nerve that controls vocal fold movement can cause paralysis of vocal folds which can be unilateral or bilateral. This will lead to incomplete closure of vocal folds resulting in breathy or hoarse voice quality. It can also cause breathing and swallowing problems.

Diagnosis of Voice disorders:

An ENT surgeon will diagnose the condition of vocal folds structurally and underlying aetiology through varied diagnostic procedures

A Speech Pathologist will evaluate Voice and its parameters, history of abusive vocal behaviours, vocal health habits using checklists, questionnaires and screening tools.


Surgical procedures are available to remove vocal nodules, polyps or cysts based on the severity and presence of co-morbid conditions.

Post-surgery Speech pathologist will provide Voice rest and vocal hygiene program after which therapy will be provided to restore the voice.

Neurological treatment procedures are available to treat voice disorders of neurologic origin.

Tips to maintain Great Voice:

– Increase daily intake of water.

– Frequent intake of warm water during prolonged use of voice

– Limit intake of caffeine products

– Avoid smoking and alcohol consumption

– Avoid abusive vocal behaviours or misuse of voice

– A short vocal warm up will reduce the effects of prolonged use of voice

“Remember it’s not only what we say, how we sound is also important for effective communication”.

About The Author
Ms. Sai Harika Boppana– BASLP (Speech Pathologist), RxDx.

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