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Voice Disorders

Typically, we take our voices for granted and never give much thought to how the vocal fold (cords) produce voice. We know from our many years of clinical experience, that a voice problem can prove very limiting in our ability to communicate and to complete daily activities.

Symptoms of a voice disorder range from hoarseness or a chronic dry, scratchy throat, a pitch/tone that is not pleasing, limitations in the ability to speak clearly, or periods of voice loss.


Hoarseness is one of the most common voice complaints. About 1 in 3 people have their voice affected by hoarseness at some point in their lives. Research has identified that hoarseness costs "several billion dollars in lost productivity annually from work absenteeism."

Hoarseness affects 31% of telemarketers, 44% of aerobic instructors and 58% of teachers.

Hoarseness is most often caused by beign conditions, such as a cold, sore throat or vocal over use and usually goes away on it's own. Hoarseness that persists for several weeks may represent a more serious problem that requires medical and therapeutic attention.

If hoarseness persists for several months, full medical evaluation is warranted. (Clinical Practice Guidelines: American Academy of Otolaryngology Head & Neck Surgery AAO- HNSF).

In a recent report, AAO-HNSF found "almost half of adults are not aware that persistent hoarseness may be a symptom of cancer." Of people who are eventually diagnosed with throat cancer, 52% thought their hoarseness was harmless and delayed seeing a doctor. (Brouha et al 2005)

Many people depend on their voices for their work. in the last year, 7.2% of people missed one or more days of work due to a voice problem, for professional voice users, such as teachers, the rate increases to 20% and an annual cost of $2.5 billion.

The AAO-HNSF guidelines for hoarseness identify that "voice therapy is a well established effective intervention for hoarseness."

Vocal Fold Nodules

Vocal fold nodules are typically caused by vocal abuse such as loud, excessive talking or screaming. This results in a hoarse voice that may fatigue easily. The nodules (bumps) are considered benign and when identified early, respond well to voice therapy treatment.

Vocal Misuse and Abuse

Vocal misuse or abuse results in a voice that is hoarse, scratchy and gets tired easily. There may be soreness and tightness in the throat. The voice may be better in the morning, but fades out during the day when demands are made for speaking. There may be periods of voice loss.

A typical, healthy voice can —talk' for extended periods with little discomfort or strain. Sometimes when the voice is used inefficiently, increased effort and poor quality result. Vocal misuse can result from using the wrong speaking patterns when communicating.

These inappropriate patterns may include the wrong pitch level, too much tightness in the throat, poor breathing patterns for voice, lack of variability in pitch, excessive talking during illness, poor posture or adopting an inefficient —professional voice'.

Excessive loud talking, excessive throat clearing/coughing and yelling also affect voice use. Vocal misuse occurs with teachers, professional speakers and telemarketers.

Voice therapy is often highly effective in reestablishing healthy, appropriate voice use. Untreated, chronic voice misuse may lead to more serious throat, voice and vocal fold disorders.

Irritable Larynx Syndrome & Chronic Cough

Irritable larynx syndrome is a group of symptoms, often associated with acid reflux or an illness, such as a cold or the flu. The illness goes away, the cough doesn't. Nothing seems to help the cough.

Sometimes the coughing can be severe and persistent, occurring many times in the day, and often in response to a specific triggering event.

The symptoms include: Cough for more than 2-3 weeks and the absence of an illness, dry scratchy throat, throat clearing, Post Nasal Drip, lump in throat, effortful swallowing and throat spasms.

Chronic cough/irritable larynx, when correctly diagnosed is very responsive to the treatment techniques developed at the Voice & Swallowing Center of Maine.

Many patients get very fast relief. While we don't promise miracles, we're glad some patients do get very fast relief. Click here to see what one woman had to say about a 43 year old problem.


Polyps can be caused by vocal abuse or laryngeal refluxing. This results in a hoarse voice, periods of occasional voice loss and feeling of excessive voice fatigue during periods of sustained talking. Based on results of stroboscopic examination, it may be treated with voice therapy or direct medical intervention by physician.


Cysts occur initially as small bumps on the vocal cords. Cysts are a fluid collection in a sac-like structure. The voice will be hoarse and often at a lower pitch. Over time the cysts may grow larger, causing increased stiffness of the vocal cord and increasing voice problems.

A cyst can be mistaken for a nodule, making accurate diagnosis important. One of the most reliable ways to identify a cyst (and often the only way) is by stroboscopic examination.

Vocal Fold Paralysis

Failure of one vocal cord to move, resulting in very breathy voice. Can be accompanied by swallowing difficulty. May be seen after strokes, injury or a nerve disorder. Treatment often starts with voice therapy to see if the vocal cord can be strengthened. The physician may also decide to inject material into the vocal cord to —build it up'.

Laryngeal Cancer

Perhaps one of the most compelling reasons not to ignore a chronically hoarse, rough voice.

Spasmodic Dysphonia

Voice that is accompanied by struggle and strain to talk, the voice may sound tense, squeezed and sound like it rapidly stops and starts. May have uncontrolled changes in pitch and loudness.

After correct diagnosis, many patients are considered for botox injection. Injection of very small amounts of botulism toxin into the vocal muscles produces an ability to produce better voice. Botox is a treatment (not a cure) and often results in much improved voice production for weeks/months before any other injection is required. Many people find the injections a bit uncomfortable and some have likened it to a dental appointment.

Voice therapy may be helpful in maximizing the benefits of treatment.

Reflux Laryngitis/Polyps

Reflux is often characterized by heartburn. It is caused by the acidic contents of the stomach coming back up into the esophagus. However, many people who reflux don't have any symptoms of heartburn. This is especially true if the reflux involves the vocal folds/larynx.

A chronic hoarse voice, symptoms of laryngitis, frequent throat clearing and cough, and a sensation of a lump in the throat may indicate LPR (laryngeal pharyngeal reflux). This chronic reflux may then result in polyps developing on the vocal folds from constant irritation.

Untreated, this disorder also leads to more serious diseases of the throat and esophagus.

Early diagnosis and treatment of the reflux and treatment of any accompanying voice problems is important.

Vocal Fold (Cord) Bowing

An abnormal pattern of vocal fold movement when the vocal folds only partially come together to produce voice. The cause is often thought to be due to muscle atrophy (poor muscle tone, loss of strength). There can also be many other causes for vocal fold bowing and there can be more serious conditions that might initially appear as a bowing of the vocal fold. Careful and accurate diagnosis is important to differentiate the causes of the —bowing'.

Paradoxical Vocal Fold Movement (PVFM) or Vocal Cord Dysfunction (VCD)

This may also be called VCD and may be misidentified as an asthmatic attack (although may be seen in patients with asthma).

PVFM results in stridor during breathing, caused by abnormal vocal fold movement. Difficulty breathing, wheezing, shortness of breath and throat muscle tightness may accompany PVFM.

PVFM can be frightening to the patient and correct diagnosis is important to avoid unnecessary medications and other treatments related to asthma.

Voice therapy can often be effective in treating this disorder.

The Voice and Swallowing Center can be contacted by telephone at (207) 505-4409 or by email at [email protected]