Voice Disorders

picture depicting the location of the nasal cavity, palate, tongue, vocal cords, larynx, windpipe (trachea), and the food channel

Voice is the sound made by air passing from your lungs through your larynx, or voice box. In your larynx are your vocal cords, two bands of muscle that vibrate to make sound. For most of us, our voices play a big part in who we are, what we do and how we communicate. Like fingerprints, each person's voice is unique.

Many things we do can injure our vocal cords. Talking too much, screaming, constantly clearing your throat or smoking can make you hoarse. These can also lead to problems such as nodules, polyps and sores on the vocal cords.

Other causes of voice disorders include infections, upward movement of stomach acids into the throat, growths due to a virus, cancer and diseases that paralyze the vocal cords. Treatment for voice disorders varies depending on the cause. Most voice problems can be successfully treated when diagnosed early.

Taking Care of Your Voice

On this page:

What is voice?

We rely on our voices to inform, persuade, and connect with other people. Your voice is as unique as your fingerprint. Many people you know use their voices all day long, day in and day out. Singers, teachers, doctors, lawyers, nurses, sales people, and public speakers are among those who make great demands on their voices. Unfortunately, these individuals are most prone to experiencing voice problems. It is believed that 7.5 million people have diseases or disorders of voice. Some of these disorders can be avoided by taking care of your voice.


What are some causes of voice problems?

Causes of vocal problems may include upper respiratory infections, inflammation caused by acid reflux, vocal misuse and abuse, vocal nodules or laryngeal papillomatosis (growths), laryngeal cancer, neuromuscular diseases (such as spasmodic dysphonia or vocal cord paralysis), and psychogenic conditions due to psychological trauma. Keep in mind that most voice problems are reversible and can be successfully treated when diagnosed early.


How do you know when your voice is not healthy?

  • Has your voice become hoarse or raspy?
  • Have you lost your ability to hit some high notes when singing?
  • Does your voice suddenly sound deeper?
  • Does your throat often feel raw, achy, or strained?
  • Has it become an effort to talk?
  • Do you find yourself repeatedly clearing your throat?

If you answer "yes" to any of these questions, you may be experiencing a voice problem. You should consult a doctor. An otolaryngologist (oh-toe-lar-in-GAH-luh-jist) is the physician and surgeon who specializes in diseases or disorders of the ears, nose, and throat. He or she can determine the underlying cause of your voice problem. The professional who can help you with improving the use of your voice and avoiding vocal abuse is a speech-language pathologist.


Tips to Prevent Voice Problems

  • Limit your intake of drinks that include alcohol or caffeine. These act as diuretics (substances that increase urination) and cause the body to lose water. This loss of fluids dries out the voice. Alcohol also irritates the mucous membranes that line the throat.
  • Drink plenty of water. Six to eight glasses a day is recommended.
  • Don't smoke and avoid second-hand smoke. Cancer of the vocal folds is seen most often in individuals who smoke.
  • Practice good breathing techniques when singing or talking. It is important to support your voice with deep breaths from the diaphragm, the wall that separates your chest and abdomen. Singers and speakers are often taught exercises that improve this breath control. Talking from the throat, without supporting breath, puts a great strain on the voice.
  • Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or esophagus (reflux).
  • Use a humidifier in your home. This is especially important in winter or in dry climates. Thirty percent humidity is recommended.
  • Try not to overuse your voice. Avoid speaking or singing when your voice is hoarse.
  • Wash your hands often to prevent colds and flu.
  • Include plenty of whole grains, fruits, and vegetables in your diet. These foods contain vitamins A, E, and C. They also help keep the mucus membranes that line the throat healthy.
  • Do not cradle the phone when talking. Cradling the phone between the head and shoulder for extended periods of time can cause muscle tension in the neck.
  • Exercise regularly. Exercise increases stamina and muscle tone. This helps provide good posture and breathing, which are necessary for proper speaking.
  • Get enough rest. Physical fatigue has a negative effect on voice.
  • Avoid talking in noisy places. Trying to talk above noise causes strain on the voice.
  • Avoid mouthwash or gargles that contain alcohol or irritating chemicals. If you still wish to use a mouthwash that contains alcohol, limit your use to oral rinsing. If gargling is necessary, use a salt water solution.
  • Avoid using mouthwash to treat persistent bad breath. Halitosis (bad breath) may be the result of a problem that mouthwash can't cure, such as low grade infections in the nose, sinuses, tonsils, gums, or lungs, as well as from gastric reflux from the stomach.
  • Consider using a microphone. In relatively static environments such as exhibit areas, classrooms, or exercise rooms, a lightweight microphone and an amplifier-speaker system can be of great help.
  • Consider voice therapy. A speech-language pathologist who is experienced in treating voice problems can provide education on healthy use of the voice and instruction in proper voice techniques.


What research on voice is NIDCD supporting?

The National Institute on Deafness and Other Communication Disorders (NIDCD) supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. NIDCD also supports the development of assistive or augmentative devices that improve communication for individuals who have communication challenges. Within the research support for voice is a range of activity from the molecular mechanisms of disease processes, such as papilloma virus, to clinical research that identifies strategies for diagnosis, treatment, or cure of voice disorders.

An active area of research is examining the dose of vibrational exposure that human vocal folds receive during phonation. At the cellular level, the effect of gene expression and protein production are being studied as a function of this vibrational dose. Results may lead to engineered vocal fold tissues that can withstand vibrational stress.

Other studies of voice disorders focus on determining the nature, causes, diagnosis, and prevention of these disorders. These studies may lead to the development of treatments and interventions that will improve the quality of life for those who are already challenged by severe voice disorders. Substantial progress has been made in the development of augmentative communication devices to facilitate the expressive communication of persons with severe communication disabilities. An investigation of conversational performance by users of augmentative communicative devices is in progress. Other funded research evaluates whether a low-cost, laser-activated keyboard for accessing personal computers is feasible. With access to personal computers, individuals with disabilities can immediately use software programs and speech synthesizers for augmentative communication. There is ongoing research on the mechanisms of laryngeal papillomatosis and of laryngeal cancer.

Because teachers are among the individuals with a high incidence of vocal disorders, NIDCD is supporting the development of an educational web site for teachers to support healthy behaviors and protection of their voices.