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  • Writer's pictureJanet Savva

What is Dysphonia?

Updated: Mar 27

Simply, dysphonia is a medical term for a voice problem.  Dysphonia can occur gradually over time or suddenly depending on the cause.  Episodes that are occasional and mild often settle naturally with good vocal hygiene such as stopping smoking, keeping well hydrated, avoiding frequent throat clearing and avoiding straining.  However, it is essential a person seeks medical advice if they suffer:

 

  • Prolonged hoarseness for more than 3-4 weeks

  • Repeated spells of hoarseness without reason

  • Prolonged sore throat or difficulties swallowing for more than 2 weeks

 

It is particularly important a person see their GP with these symptoms if they smoke or drink more than the recommended amount of alcohol.  The GP may refer the person to an Ear, Nose and Throat (ENT) doctor who can perform an examination of their larynx.  This examination will help to identify the cause of the voice problems. 

 

Symptoms of Dysphonia

 

 

Causes of Voice Problems

 

There are many causes for a voice problem, therefore it is essential that any persistent voice problems are investigated by an ENT doctor or Laryngologist so that an examination of the larynx (voice box) can be performed, and the cause diagnosed.  A voice disorder may have one or more of the following causes:

 

Structural Causes:

 

Voice problems can be caused by changes in the tissues of the larynx (voice box) and or vocal cords. These are known as structural changes. These may include:

 

  • Benign growths on the vocal cords (such as nodules, polyps, cysts, papilloma or granuloma)

  • Hyperkeratosis (abnormal thickening), leukoplakia (white plaques) or dysplasia (abnormal cells) of the vocal cords which can be associate with pre-cancerous changes

  • Carcinoma (cancer)

  • Vocal cord bowing due to muscle atrophy (wasting) associated with aging (sarcopenia) also known as Presbyphonia or Presbylarynx

  • Hormonal changes e.g. puberty, pregnancy, menopause, thyroid gland disorders 

 

Structural changes can also be caused by inflammation.  Laryngeal inflammation, also known as laryngitis, occurs when the larynx and or the vocal cords becomes irritated and swollen. The cause can be infective or non-infective. 

Infective inflammation can be caused by:

 

  • Viral infections

  • Bacterial infections

  • Fungal infections

  • Tuberculosis

 

Non-Infective inflammation can be caused by:

 

  • Trauma (e.g., an irritant or dehydration)

  • Allergies

  • Medications

  • Autoimmune conditions

  • Rheumatoid Arthritis

  • Endocrinological (hormone-related) conditions 

 

Neurological Causes

 

Voice changes can also arise from a neurological problem such as:

 

  • Vocal tremor

  • Vocal spasms (Spasmodic Dysphonia) 

  • Paralysis of one or both vocal cords

  • Progressive neurological disease (e.g. Parkinson’s Disease, Multiple Sclerosis or Motor Neuron Disease) 

 

Functional Causes:

 

The majority of people have no structural or neurological abnormalities and their voice problems will be related to the way they are using their voice. This is referred to as functional or ‘Muscle Tension’ dysphonia’

 

Functional voice problems may arise from:

 

  • Shouting, yelling and raising your voice frequently e.g., calling from room to room, communicating with people who are hard of hearing.

  • Significant occupational or professional voice use

  • Repeated talking over background noise

  • Prolonged voice use, especially at louder volumes 

  • Lengthy or repeated telephone use

  • Singing without warming up the voice properly

  • Prolonged singing or poor singing technique

  • Extensive vocal impressions or unnatural voice use

  • Persistent whispering

  • Excessive muscle tension or strain in the larynx and vocal tract when speaking 

  • Poor breath control when speaking

  • Poor posture when speaking

 

These factors can be referred to as ‘voice misuse’ which can lead to phonotrauma (trauma to the vocal cords) and structural changes in the tissues of the vocal cords and larynx.

 

Psychogenic Causes

 

Voice quality can also be affected by psychological stressors such as chronic stress, anxiety, depression, and conversion disorders. When this is felt to be the primary cause of the voice problem it can be referred to as psychogenic dysphonia. Psychogenic dysphonia is rare and referral to a mental health professional such as a psychologist or psychiatrist to aid diagnosis and treatment is recommended.

 

It is important to add that structural, neurological and functional dysphonia frequently impact on a person’s mental health due to the debilitating impact having a voice problem can have on a person’s day-to-day life.  A voice problem can restrict one’s ability to communicate at work, home and in social situations with family and friends. This can lead to reduced quality of life which can impact on a person’s mental health.  This is normal and understandable and should improve as the voice problem lessens with treatment.  

 

Multifactorial causes:


Causes of dysphonia tend not to be mutually exclusive and can overlap. For example, the cause of vocal cord nodules is functional as they result from the way a person misuses their voice e.g., repeated trauma to the vocal cords caused by straining or overusing the voice, especially from singing, shouting, or talking loudly for prolonged periods of time. Over time repeated vocal misuse leads to structural changes in the tissue of the vocal cords i.e., nodules, blister-like lesions caused by the hardening of irritated vocal cord tissue. The voice problem can then be further exacerbated psychologically due to depression caused by loss of income or social isolation caused by the individual not being able to fulfil their day-to-day activities.

 

How can Speech and Language Therapy help with Dysphonia?

 

As a Speech and Language Therapist I have an expert knowledge about the larynx (voice box) and the complexities of producing a voice.  I will work with you to assess and diagnose your voice difficulties.  This may require additional investigations such as Videostroboscopy of your larynx (voice box) and your vocal cord movement and vibration by an Ear Nose and Throat (ENT) Consultant to aid diagnosis and treatment planning.  Before any voice therapy can take place you must have had an examination of your larynx by an ENT doctor within the past 12 months. 

 

At your initial consultation I will take a comprehensive case history which will include a review of your medical history and any medications you take regularly.  We will discuss your lifestyle including your voice demands and start to explore how these could be impacting on your voice difficulties.  I will take baseline assessments of your voice none of which are at all invasive. 

 

You will learn about how your voice works and will be given personalised strategies to best look after your voice to aid your voice recovery.  This will involve advising you to eliminate any harmful vocal behaviours and promoting vocal tract health and hygiene. 

 

You may need to have a block of voice therapy in which I will coach you in a variety of activities aimed at balancing your voice production.  The number of therapy sessions you require will depend on the cause of your voice problem and the severity of the problem or any contributing medical problems, but typically 3-6 sessions are usually required.  However most importantly your progress will be influenced by your commitment to making vocal health changes and practicing your therapy activities outside of sessions.     

 

Contact me for a free 15 minute telephone consultation to see if I can help you.


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