Voice Disorders: Causes, Signs, Assessment & Voice Therapy

Your voice is an important part of communication. A voice disorder may affect voice quality, pitch, loudness, resonance, or the effort required to speak. Voice difficulties can occur in children and adults and may have structural, functional, neurological, or other contributing factors.

What Is a Voice Disorder?

A voice disorder occurs when a person’s voice is significantly different from what is appropriate for their age, background, or communication needs, or when the person feels that their voice is affecting their ability to communicate effectively.

Voice disorders may involve:

• Voice quality
• Pitch
• Loudness
• Resonance
• Vocal endurance
• Ease or effort of speaking

Common voice characteristics include hoarseness, breathiness, strained voice, weak voice, pitch changes, vocal breaks, or loss of voice.

Common Signs of a Voice Disorder

A person may experience:

• Persistent hoarseness
• Raspy or rough voice
• Breathy voice
• Strained or effortful voice
• Weak or soft voice
• Unusually high or low pitch
• Frequent voice breaks
• Loss of voice
• Vocal fatigue
• Reduced vocal endurance
• Frequent throat clearing or coughing
• Throat or neck discomfort while speaking
• Feeling out of breath while talking
• Changes in voice quality throughout the day

These symptoms may occur individually or together.

What Causes Voice Disorders?

Voice disorders can have several causes.

Structural Causes

Physical changes affecting the vocal folds or larynx may contribute to voice problems, including:

• Vocal nodules
• Vocal polyps
• Vocal cysts
• Vocal fold swelling or edema
• Laryngitis
• Reflux-related irritation
• Vocal fold paralysis

Functional Causes

Voice problems can also result from inefficient or excessive voice use, such as:

• Frequent shouting or yelling
• Speaking loudly for prolonged periods
• Excessive throat clearing
• Vocal overuse
• Muscle tension
• Vocal fatigue
• Using an inappropriate pitch

Neurological Causes

Conditions affecting the nervous system may also influence voice production, including Parkinson’s disease, multiple sclerosis, vocal tremor, spasmodic dysphonia, and vocal fold paralysis.

Voice Disorders in Children

Children can also experience voice disorders. Persistent hoarseness, unusual vocal quality, vocal fatigue, or difficulty sustaining an appropriate voice should not simply be ignored.

Some pediatric voice conditions may be associated with:

• Vocal nodules
• Laryngeal conditions
• Prolonged intubation
• Congenital differences
• Vocal misuse or overuse

A child’s voice concerns should be evaluated appropriately, particularly when symptoms are persistent.

How Is a Voice Disorder Assessed?

A comprehensive voice assessment may include:

• Case history
• Vocal habits and voice-use history
• Perceptual assessment of voice quality
• Pitch and loudness
• Resonance
• Vocal endurance
• Breathing and respiratory patterns
• Oral and motor examination
• Functional communication
• Self-perception of the voice
• Instrumental assessment when indicated

A medical examination by an appropriate physician, particularly an otolaryngologist/laryngologist, is important when a voice disorder is suspected. Medical professionals can investigate underlying laryngeal pathology, while SLPs assess and treat functional communication and voice-related difficulties within their scope.

How Can Voice Therapy Help?

Voice therapy is individualized according to the person’s voice condition, communication needs, and goals.

Therapy may focus on:

Vocal Hygiene

Learning healthy voice habits and reducing behaviors that may contribute to vocal strain, such as excessive shouting, throat clearing, or speaking over background noise.

Voice Production

Working on appropriate coordination of breathing, phonation, resonance, and vocal effort.

Vocal Efficiency

Helping the individual produce voice with less unnecessary effort or tension.

Pitch and Loudness

Supporting appropriate pitch and volume according to the person’s communication needs.

Vocal Endurance

Developing strategies to manage voice use during prolonged speaking.

Communication Strategies

Adapting voice use and the communication environment for home, school, work, or social situations.

ASHA describes voice intervention as potentially involving both direct approaches, which work on voice production, and indirect approaches, such as education, vocal hygiene, and behavioral or environmental changes.

Voice Therapy for Teachers, Professionals & Singers

People who use their voice extensively may be particularly vulnerable to voice problems.

This can include:

• Teachers
• Public speakers
• Customer-service professionals
• Call-center employees
• Actors
• Singers
• Coaches
• Fitness instructors

Voice therapy can help individuals understand healthy voice use and develop strategies for meeting the demands of their specific communication environment.

When Should You See a Voice Specialist?

Consider seeking professional assessment if you experience:

• Persistent hoarseness
• Repeated voice loss
• Pain or discomfort while speaking
• Significant vocal fatigue
• Sudden or unexplained changes in voice
• Difficulty projecting your voice
• Persistent breathiness or strain
• Voice problems that interfere with work, school, or daily communication

An SLP and ENT/laryngologist may work together when both medical and therapeutic management are required.

Voice Therapy at iSpeak Total Communication Clinics

At iSpeak Total Communication Clinics, voice therapy is individualized according to each person’s voice quality, vocal habits, communication demands, and functional goals.

Therapy may address vocal hygiene, vocal strain, voice quality, pitch, loudness, breath support, resonance, vocal endurance, and efficient voice production, as appropriate.

We aim to help individuals develop a healthy, efficient, comfortable, and functional voice for everyday communication.

Frequently Asked Questions

What is a voice disorder?
A voice disorder involves a problem with voice quality, pitch, loudness, resonance, or vocal effort that affects communication or causes concern.

Is hoarseness always a voice disorder?
Persistent or concerning hoarseness should be evaluated rather than assumed to be a temporary problem.

Can speech therapy help with voice problems?
Yes. SLPs trained in voice disorders can provide individualized voice assessment and therapy.

Do I need to see an ENT before voice therapy?
A medical examination is important when a voice disorder is suspected, particularly when an underlying laryngeal condition needs to be identified or ruled out.

Can children receive voice therapy?
Yes. Children with persistent or clinically significant voice difficulties may benefit from appropriate assessment and intervention.

Can shouting damage the voice?
Frequent shouting and other forms of vocal misuse can contribute to vocal strain and may be associated with voice problems.

References

American Speech-Language-Hearing Association (ASHA). Voice Disorders – Practice Portal.

ASHA Practice Portal – Voice Disorders

Recommended citation:
American Speech-Language-Hearing Association. (n.d.). Voice disorders [Practice Portal]. ASHA.

Copyright & Content Note

This article is original educational content prepared for iSpeak Total Communication Clinics. It summarizes information from the ASHA Practice Portal without reproducing ASHA’s copyrighted text, tables, graphics, or proprietary material. ASHA is credited as the clinical reference and the original resource is linked above.

Disclaimer: This article is for general educational purposes and does not replace medical evaluation, diagnosis, or an individualized speech-language/voice therapy plan.