Voice Disorders

If you are diagnosed with singer’s nodes, you are probably experiencing a change in your voice quality, with your voice becoming hoarse, raspy and weak. 

Singer’s nodules are benign growths in the midpoint of the vocal folds that look like a callus. 

It results from a repetitive overuse or misuse of the voice. People who are required through their professional activity to speak a lot (teachers, preachers, tv anchors, lawyers, ect…) or put in a lot of effort while speaking (singers, sport coaches, ect…) are at a higher risk of developing singer’s nodes.

Voice problems are usually common: anything that interferes with vocal cord movement or contact can cause a voice disorder.  Symptoms vary according to the cause. They could range from a simple hoarseness due to an overuse of the voice, to swallowing problems, an acute laryngitis, or even a nodule or a growth that could be due to a tumor (benign or malign). 

It’s very important to seek help as soon as possible, meaning as soon as you experience any unusual voice symptoms,  by reaching out to an ENT physician. Many voice disorders can be cured with treatment when diagnosed early and properly.

Symptoms that indicate voice problems and that you should seek immediate for help include:

Treatments depend on the cause of the voice disorders. The voice disorders that are caused by a medical issue will be treated by either appropriate medications, or injections or sometimes surgeries. This will be done usually by the ENT doctor. 

The voice disorders that are caused by non medical issues, will be treated through voice therapy and some lifestyle changes. 

Voice therapy is an evidence based therapy done with either a certified speech therapist,  a vocal coach or a vocologist.  It aims at improving the problems of the vocal folds through targeted exercises and also providing the patients with daily strategies to protect his/her voice. 

The speech therapist will work closely with the ENT doctor in a team- based approach  to treat the voice disorders, by having the patients regain his voice and his confidence as soon as possible.

If a person is experiencing voice problems for more than two or three weeks, it’s very important to reach out to a specialist that will help determine the cause of the voice problems and propose a treatment.

The ENT doctor ( otolaryngologist ) is the  best suited to do the first examination for voice disorders. Usually, this examination will be followed by a voice assessment that will be done by a speech therapist who specializes in voice problems.

Every person might experience some voice problems at a certain point in their life or career.                        

Studies have shown that the prevalence of voice disorders is higher in adult females. 

Many other studies have identified some occupational groups or jobs that are at a higher risk of developing voice disorders. These groups are usually people that use their voice the most or speak for a long period of time such as:  teachers, public speakers, singers, lawyers, preachers, salespeople, factory workers,  sports instructors…

Different causes can affect the voice quality.

Some voice disorders can be caused by functional reasons. This happens when the physical structure or the vocal cord is normal and the vocal folds vibrate normally,  however, the patient either overuses or misuses his voice leading to voice disorders. This usually causes vocal fatigue, dysphonia or aphonia (total loss of voice) in extreme cases . 

Some voice disorders are due to structural reasons, they appear following physical changes in the voice mechanisms. It can be an alteration in the vocal fold tissues such as oedema, vocal nodules, polyps or an inflammation of the vocal cords, or even more serious and irreversible problems such as some changes in the larynx due to a tumor ablation or a radiology treatment.

Some voice disorders can also be caused by neurological problems. Typically the following conditions will cause a voice disorder: multiple sclerosis, Huntington disease, Parkinson disease, or Amyotrophic lateral sclerosis (also referred to as ALS or Lou Gehrig’s disease).

Finally some voice disorders are due to psychogenic reasons. No functional or structural causes can be detected. In those cases the speech therapist will do a complete exam to try to find out if there is any psychological underlying reason, and if needed the SLP will refer these patients to the appropriate professional and collaborate with them. 

If your profession requires a lot of talking and and using your voice loudly, you are probably at a higher risk of developing voice problems. Below are lifestyle and voice usage tips that will help you protect your voice. 

Lifestyle tips:

Ensure adequate sleep and exercise, because your voice reflects your general health and wellbeing

How to  use your voice, breath and posture in a harmless way:

Finally, if you are in a risky group and start having voice problems, it is recommended to seek the help of a speech language therapist who is experienced in treating voice problems. She/he will teach you how to use your voice in a healthy way and avoid worsening the symptoms in the future.

Voice therapy is usually provided by a speech language pathologist. It is a comprehensive therapy that aims at reducing hoarseness through reprogramming the vocal behaviors (how one uses his voice) along with the lifestyle habits of the patients. Depending on the cause of the voice problem and the patient case, voice therapy will use different techniques, however they are all designed to stop the harmful vocal behavior, develop new healthy vocal behavior and when needed assist in the healing of wounds in the vocal fold caused by an injury or a surgery. 

The speech and language therapist will work with the patients both on his symptoms and on his lifestyle. She/he will provide exercises and techniques to address the specific voice problem. Those techniques can vary according to the cases of the patients. In parallel she/he will suggest the adequate lifestyle changes that are necessary for a better voice quality. Finally she/he will provide guidance and support along the journey of overcoming the voice problems.

The techniques used can be: respiratory exercises to coordinate between breathing and speaking,  or training to do Laryngeal massages, or vocal exercises to improve the quality of the voice, or myofascial release and vocal rest (relaxation exercises…). It also consists of a “lifestyle guidance” program to teach the patient how to reduce the risk of having voice problems in his daily life as well as optimize the function of his vocal folds. 

In some specific cases such as post- surgeries (removal of a polyp, a cyst or a tumor ) or a neurodegenerative disease such as Parkinson’s disease other techniques or protocols will be suggested. For Parkinson’s disease, the LSVT loud (Lee Silverman voice treatment) has been proven to be effective in helping patients with their voice. 

When someone loses his voice suddenly or due to a laryngitis (inflammation of the vocal cords), he might usually regain his voice within a couple of weeks by resting his voice and hydrating. However, if the voice loss becomes chronic, it might indicate an overuse or misuse of the voice, or other more serious health conditions. If you are losing your voice chronically and can’t identify an obvious cause, it is strongly recommended to seek the help of your doctor. 

After consulting with your doctor to identify the cause of the chronic voice loss, and if the cause happens to be a spasmodic dysphonia, or the existence of vocal nodules and polyps, vocal fold paralysis, or chronic coughing, then voice therapy with a specialised speech and language therapist is the recommended treatment. 

The recovery time of one’s voice, when having a voice therapy, depends both on the severity of the disorder. For example, voice therapy for mild dysfunctional hoarseness will typically start showing results after 6 weeks of bi-weekly sessions with a committed patient. 

It is important to note that a few factors other than the patients cases will also affect the speed of recovery: how much someone rests his voice, the intensity and frequency of the voice therapy, how committed the patient is to applying the recommendation of the voice therapy and changing his behavior outside the session both for his vocal cords and his lifestyle. 

When faced with a chronic loss of voice, voice therapy delivered by a specialised speech therapist can help improve or eliminate the voice problem.

In many cases, the person's voice could go back to normal following the voice therapy. The voice therapy will help the patient develop and implement good habits regarding his lifestyle and the usage of his vocal cords. For the voice therapy to be efficient it requires the patient’s commitment to incorporate the newly taught healthy behaviors outside the therapy sessions. 

In other cases, the person’s voice won’t go back to normal as it depends on the severity and extent of the condition, on how early the voice therapy intervention started and how consistent the patient is in following and sticking to the therapy’s recommendations.

After finishing voice therapy, you can go back to your normal life and activities. However, and in order to avoid losing it again, it is highly recommended to do the following:

Follow up with your speech language pathologist to make sure you are always using the right techniques and sticking to the good habits.

Voice loss can be due to many factors. Usually, when it’s temporary, it could be due to a punctual overuse (shouting in a concert, ect.. ) or an acute laryngitis (inflammation of the tissue covering the larynx or the voice box). It usually gets better in one or two weeks without a specific treatment. 

However,  frequent voice loss may underline a more serious condition like an underlying vocal folds abnormality or a chronic overuse/misuse of the voice. In this case it is recommended to seek the help of either an ENT or a specialized SLP.

The speech language pathologist will do a full assessment so he/ she can determine the correct diagnosis and propose a personalized treatment that will help you regain your voice and feel more confident.