Voice Disorders

Each person’s voice is made by passing air from the lungs through the larynx (voice box). Once in the air is in the voice box, it vibrates the vocal cords, which are two bands of muscle that make sound while they vibrate.

What causes a voice disorder?

Voice disorders can the result of:

• Overusing or straining the voice.
• Paralysis of the vocal cords.
• Vocal cords that are too far apart from one another.
• Abnormal growths on the vocal cords.
• Allergies.
• Reflux.
• Cancer of the throat.
• Thyroid disorders.

What are the symptoms of a voice disorder?

A child with a voice disorder may experience some or all of the following symptoms:

• Problems with the pitch, loudness or quality of sound of their voice.
• Hoarseness while speaking or frequent laryngitis.
• Scratchy throat.
• Breathy speech.
• Difficulty being heard in group settings.

What are the different types of voice disorders?

There are many different types of voice disorders and some voice disorders are present at birth and others develop over time. Many disorders share the same symptoms. Because of this, it is very important that children with a suspected voice disorder see a specialist for diagnosis. Common voice disorders include:

• Paradoxical vocal cord dysfunction is a voice disorder. The vocal cords behave in a normal fashion most of the time, but, when the dysfunction occurs, the vocal cords close when they should open, such as when breathing. The disorder can be mistaken for asthma as it leads to wheezing and difficulty breathing, sometimes to the point of requiring hospitalization. A common treatment for paradoxical vocal cord dysfunction is biofeedback.
• Spasmodic dysphonia is also known as laryngeal dystonia. Children with this disorder experience spasms or movements in the muscles of the larynx (voice box) that they cannot control. These uncontrolled movements cause the voice to break, and have a tight, strained or strangled sound.
• Laryngitis is often characterized by a raspy or hoarse voice due to inflammation of the vocal cords. Laryngitis can be caused by overusing the voice, infections, inhaled irritants, or gastroesophageal reflux (GERD). Learn more about spasmodic dysphonia.
• Vocal nodules are benign (noncancerous) growths on the vocal cords caused by vocal abuse. Vocal nodules are a frequent problem for professional singers. The nodules are small and callous-like and usually grow in pairs (one on each cord). The nodules usually form on areas of the vocal cords that receive the most pressure when the cords come together and vibrate (similar to the formation of a callous). Vocal nodules cause the voice to be hoarse, low, and breathy.
• A vocal polyp is a soft, benign (noncancerous) growth, similar to a blister. Voice polyps cause the voice to be hoarse, low, and breathy.
• Paralysis of the vocal cords may occur when one or both vocal cords or folds does not open or close properly. This condition can range from relatively mild to life-threatening. When one or both vocal cords are paralyzed, the open cord(s) allows food or liquids to slip into the trachea and lungs. A person may experience difficulty swallowing and coughing. Vocal cord paralysis may be caused by head, neck, or chest trauma; surgical complications; stroke; tumor; lung or thyroid cancer, neurological disorders like multiple sclerosis or viral infection.

How are voice disorders diagnosed?

Any hoarseness or change in voice that lasts longer than two weeks should be brought to the attention of a child’s doctor. In addition to a complete medical history and physical examination, the doctor may examine the vocal cords internally with a small scope called a laryngoscope. In the case of paralysis, the doctor may also perform a laryngeal electromyography that measures the electrical current in the vocal cords.

What is the treatment for a voice disorder?

Vocal cord disorders caused by abuse or misuse are easily preventable. In addition, most disorders of the vocal cords can be reversed. Specific treatment for vocal cord disorders will be determined by the child’s healthcare team based on:

• The child’s age, overall health, and medical history.
• Extent and type of vocal cord disorder.
• The child’s tolerance for specific medications, procedures or therapies.
• Expectations for the course of the disorder.
• The family’s opinion or preference.

Therapeutic treatment of voice disorder includes teaching appropriate use of vocal pitch and intensity. Voice treatment may also include restricting how much a child uses his or her voice and other hygiene habits that promote healthy voices. An ear, nose and throat doctor may work closely with the patient during speech therapy to help determine if the child has other medical problems that need to be treated.