Overview of Voice Disorders

The Facts About Impaired Phonation and Vocalization

Aug 2, 2009 Anthony Lee

There are several conditions that can affect the ability to use one's voice.

The voice is a feature that makes each person unique. It may not be something that sustains the physiological functions of life, but it still serves important roles in daily living. It provides the means to communicate with one another at work and during leisure. In some cases, the voice is an inherent part of work or leisure. Whatever benefit the voice provides for an individual, it can be disheartening when a disorder of any kind affects the voice, thereby disrupting one's quality of life.

Causes

The portion of the airway that functions in vocalization is the larynx, also called the "voicebox" in layman terms. It consists of two vocal cords that produce sound when air flows past them. These cords are pulled away from each other or closer together by various muscles. The larynx is found within the thyroid cartilage, which is the protuberance known as the "Adam's apple."

A variety of abnormalities can disrupt the structure and function of the larynx. There could be inflammation of the larynx (laryngitis) or benign polyps on the vocal cords due to factors such as significant vocal strain and acid reflux. Malignant tumors on the vocal cords are a concern for individuals with a history of smoking. As for the laryngeal muscles themselves, they can spasm involuntarily and interrupt the process of phonation (spasmodic dysphonia). Neurological conditions can cause a voice disorder, including but not limited to injury to the recurrent laryngeal nerve, stroke, head injury, and amyotrophic lateral sclerosis (Lou Gehrig's disease).

Diagnosis

The diagnosis of a voice disorder requires a patient history to elicit details about the vocal abnormality. Patients may frequently use the term "hoarseness" to describe a vocal impairment. However, it is a general term that encompasses a variety of more specific abnormalities of the voice, such as breathiness, strained voice, tremor, or change in pitch. Knowing what is exactly going on with the voice can sometimes help pinpoint a cause, such as nerve paralysis for a breathy voice. Other important facts the doctor must know involve risk factors that might play a role, such as one's occupation.

The physical examination is also important. The physician inspects and palpates the outside of the neck for any visible abnormalities that may be linked to the voice disorder. From there, the larynx itself is examined, either with a mirror in the back of the throat or with a camera (laryngoscope). The latter can be helpful if a biopsy sample of a tumor or other anatomical abnormality is necessary.

Treatment

The treatment of the voice disorder depends on its cause. Benign causes, such as laryngitis, can be managed simply by minimizing the contributing risk factor. For other causes, invasive intervention becomes necessary, such as Botox injections for spasmodic dysphonia and surgery for cancer of the larynx.

References

Bruch, Jean M. and Kamani, Dipto V. "Hoarseness in adults." In: Rose, Burton D., editor. UpToDate. Waltham, MA: UpToDate, 2009.
Merck Manual - Voice Disorders

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