Voice Disorders: Causes, Symptoms & Treatment

Dysphonia or voice disorder is predominantly manifested in the fact that temporarily the so-called phonation or articulation ability of the voice can be impaired people of all ages.

What are voice disorders?

Schematic diagram showing the anatomy of the vocal cords and their various disorders. Click to enlarge. In the context of a definition, voice disorders (dysphonia) are referred to as an altered sound of the voice. The voice disorders are characterized by the fact that the normal voice of the affected person sounds different than it did before this pathological impairment. Within the voice disorders numerous forms are characterized, which are also current. In particular, people who are highly stressed in their voice can suffer from varying voice disorders. Some types of voice disorders are based on natural causes, others are of acquired origin. As a rule, abnormalities of voice production occur, which can manifest themselves not only in articulation, but also in physical-organic complaints.

Causes

The causes of voice disorders are found in the physiology of the person himself as and in an overload of the vocal apparatus by external influences and favored by an unfavorable way of speaking. In addition, organic impairments of the larynx as well as the vocal cords are triggers for the voice disorders (dysphonia). During puberty, in connection with the change of voice in boys, as well as after menopause due to hormonal changes, voice disorders occur in women. So-called usogenic causes are determined by the fact that the voice is not used properly. In particular, continuous and loud talking, pressing the voice, as well as improper strain on the vocal cords can contribute to the development of voice disorders. The vocal cord nodules are the predominant triggers of dysphonia. Voice disorders can also be caused by inflammatory changes in the vocal cords, tumors and paralysis of the vocal apparatus, or can occur in the larynx and in harmony with colds. The causes of voice disorders (dysphonia) can also be rooted in the psyche.

Symptoms, complaints and signs

Voice disorders are usually accompanied by fairly clear and distinct symptoms. The underlying condition in many cases is irritation of the vocal cords. Typical symptoms are severe sore throat and a clearly audible hoarseness of the affected person. In addition, swallowing difficulties can occur, so that affected persons are very severely restricted in their entire everyday life. If such a clinical picture remains completely untreated, further unpleasant symptoms can develop. In addition to the sore throat, a purulent cough may develop. This is very difficult to cough up, so that the voice disorders will continue to worsen. The only way to alleviate the symptoms is to take appropriate medication. Voice disorders can arise due to various underlying diseases. In most cases, a bacterial infection is the cause of the voice disorder. If you do not visit a doctor, you can expect a significant worsening of the symptoms that occur. The sore throat and difficulty swallowing increase considerably, so that food intake is severely impaired. In addition, there is pus formation in the throat area, which occurs more frequently at night. On the other hand, those who opt for medical and drug treatment can expect the individual symptoms to subside quickly.

Diagnosis and course

Those affected by voice disorders complain of a limited ability to speak and an unusual sound in their voice. The voice is smoky, scratchy, sounds rough or shrill, or suffers from a lack of sound and becomes quieter. In addition to classic accompanying symptoms such as the need to clear the throat, the urge to swallow, sore throat, coughing irritation and a feeling of dryness, there is pressure in the area of the vocal apparatus. The diagnosis of voice disorders (dysphonia) is made by listening to the voice, examinations by the ear, nose and throat specialist, and further laryngoscopy. In addition, an interview with the affected person can provide important information for a clear diagnosis of voice disorders (dysphonia). During a laryngoscopy, the larynx is mirrored, i.e. looked at directly with an appropriate device.

Complications

Voice disorders can occur for many different reasons, so possible complications can also arise.In most cases, voice disorders arise due to an infection, so that various accompanying symptoms can occur at the same time. These accompanying symptoms include a long-lasting and stabbing headache, nausea, vomiting and an increased temperature. If these accompanying symptoms remain entirely without medical treatment, then there will be a significant increase in symptoms. Severe sore throat is also a complication that can often be associated with voice disorder. If existing sore throat remains without any treatment, then it can even lead to the formation of pus. The affected person will find it very difficult to speak, as any strain on the vocal cords will cause severe pain. The pus fluid that occurs may become lodged in the throat, making it very difficult to cough it up. If a doctor is consulted when pain occurs during speech, possible complications can be avoided at an early stage or effectively combated. In the worst case, permanent damage can even remain if a visit to the doctor is not made. For this reason, medical or drug treatment is sensible and essential, provided that possible complications want to be avoided.

When should you go to the doctor?

If the affected person suffers from sore throat, disturbances in the swallowing process or a feeling of tightness in the throat, a doctor should be consulted. If pronunciation can no longer take place as usual, there is a health impairment that must be diagnosed and treated. If food can no longer be ingested and consumed as usual, action is needed. If there is a scratchy throat, a raspy voice, or loss of usual vocal strength, there is a medical condition. If there is a cough, sputum, or swelling in the throat area, a doctor is needed to determine the cause. If unwanted side noises occur during speech, if the color of the voice changes, or if the affected person has no control over the flow of the voice, a doctor should be consulted. If emotional or mental irregularities occur due to the voice disorders, the affected person needs help. Sleep disturbances, inner restlessness, or a general feeling of malaise are signs of an existing health impairment. If the complaints persist over a longer period of time or become more severe over the course of several days, a doctor should be informed of the observations. Fatigue, a decrease in usual performance as well as internal weakness are further signs of an existing illness. A diagnosis is needed to establish a treatment plan.

Treatment and therapy

For the therapy of voice disorders, surgical treatments as well as voice therapy procedures are recommended in addition to medication. These depend on the extent of the dysphonia. In some cases, voice disorders resolve themselves. If the voice disorders are organically caused, operations to remove vocal cord nodules or polyps on the vocal cords, for example, can also be successful. Voice exercises or electrotherapy procedures are used to treat vocal cord paralysis as the cause of the voice disorders. In the case of damage to the vocal apparatus, voice and breathing exercises are considered useful therapeutic measures against dysphonia. In addition, psychotherapeutic treatments can also be helpful in some cases to treat voice disorders caused by emotional problems. In many cases, a combination of appropriate treatments is suitable to cure dysphonia permanently.

Prevention

An important component to prevent acquired voice disorders is an efficient use of the voice in everyday life that is as gentle as possible for the voice part. This concerns in particular the avoidance of overloading the vocal cords as a prophylaxis of voice disorders. Especially in professions with a permanent strain on the voice, it is necessary to learn special speaking and breathing techniques to prevent voice disorders. Other ways to prevent dysphonia in time are reduced tobacco consumption and prolonged stay in environments heavily polluted with dust. Very hot or spicy foods and dehydration of the mucous membranes should also be avoided.Partly unconscious processes such as throat clearing and coughing as well as permanent soft speaking have a very favorable effect on the development of voice disorders (dysphonia). Therefore, it is better to speak clearly and in pauses.

Follow-up

If the voice disorder must be treated by surgery, such as in the presence of vocal cord nodules, aftercare follows. This involves voice rehabilitation. During the first 10 to 14 days after surgery, it is important to consistently rest the voice. Following this rest period, special voice exercise therapy should begin. This is necessary in order to bring the postoperative stress limits of the affected voice back to the usual stress level. A significant role is played by the timely start of exercise therapy. For example, it can have a negative effect on the voice if treatment is started too early or is carried out too intensively. During voice therapy, the patient is freed from the hyperpressure patterns that develop in his voice. Even after the procedure, the hyperfunctional vocal patterns that were often the trigger of the voice disorder are still basically present. In order for physiological vocal function to be restored in the long term, differentiated vocal exercise treatments are required. In order to exclude the danger of a renewed voice disorder, the follow-up treatment must not be too short and must be of an appropriate quality. Here, the response of the voice to the exercises as well as the results of the voice sound are the focus of the therapy.

What you can do yourself

Voice disorders can occur throughout life for a variety of reasons. For this reason, they should be considered by everyone as a natural process. It is part of human development that voice color as well as pronunciation change several times over the lifespan. If the changes are perceived by the affected person as unpleasant, he should realize at the beginning that it is often a temporary phenomenon. They occur in phases of hormonal change or during an illness and usually regulate themselves within a few weeks or months. If irregularities persist, logopedic therapy can help. In addition, outside of treatment hours, patients can work independently to change their vocal environment. Targeted training and exercises help with changes and can be used by the affected person independently. In addition, risk factors for voice change should be minimized. The intake of nicotine in active or passive form leads to voice disorders. Therefore, areas where smoking is common should be avoided. Supportive measures can be taken early on, especially during times of the change of year, to avoid catching a cold. There are a variety of methods that lead to improved voice color and strength. Provided the individual wishes, he can apply them for himself.