Have you lost your voice? Do you often get a hoarse voice? The are many causes of voice problems. Injury and stress may be causes of problems with your voice, or other people believe that if you have a problem with your voice it is often symptomatic of wider health problems. When there is misuse, trauma or injury the little folds of muscle that create our voice (vocal folds – sometimes called vocal chords) become swollen, damaged and may start to form a small growth (polyp, cyst, nodule etc). When any of these things happen it may change the way these muscles come together, they might not make contact properly, or air might escape between the muscles when they meet. This will change the quality of the voice and may make it hoarse, breathy or croaky, and you may also loose your voice. These difficulties are not initially harmful to your health, but if you do not address the problems via therapy or surgery they can lead to further deterioration of voice over time and possibly long term damage.
Reasons for lost voice or hoarse voice
Misuse or abuse is probably the most common cause of a lost, hoarse or croaky voice. Misuse can occur for a number of reasons:
Stress and not using our voice correctly
Often when we are stressed our muscles tighten and our posture changes. These factors can also change the way we breath and the way we use our voice. Tense muscles around the head and neck will have an affect on the muscles that help our voice. A combination tense muscles and poor breathing technique may mean we start to inadvertently put too much strain on certain voice muscles or even start to rely on the wrong muscles to work our voice. Over a period of time this can make our voice tired and sometimes lead to a growth such as a nodule.
Misuse can also cause voice problems.
If we shout and scream excessively, or use our voices all day long in our job, this can put a strain on the voice. This damage can lead to the formation of a growth (polyp, nodule or cyst etc). When people do have some damage to their vocal folds or a small growth such as a nodule, the voice changes and can become hoarse. When the voice becomes hoarse, many people will inadvertently try to compensate by trying even harder to get their message out, and this can aggravate the voice problem further.
Lifestyle can be a factor in voice problems.
Voice problems may occur if you are generally unhealthy, if you drink too much alcohol and smoke, if you indulge in social activities such as singing or shouting at sports events, or you use your voice a lot at work.
Disease and illness can cause voice problems
Chest illness may often have secondary effect on voice, with continued coughing impacting on the vocal folds. One of the most serious illnesses affecting voice is laryngeal cancer. This cancer is common amongst smokers and is the most common head and neck cancer. The good news is that there is a high success rate of treatment if it is caught early enough. However, if treatment is unsuccessful, the patient may have to have a partial or whole laryngectomy and thus loose there voice completely. With new surgical and technological advances there are now ways to create a voice for many patients without a larynx. See our section, Voice Treatment.
Other causes of voice problems
Another cause of voice problems is spasmodic dysphonia. This is a condition that occurs when one or more of the muscles of the larynx and vocal folds have involuntary movements causing strained, and strangled voice, and/or conversely quiet breathy voice. Progressive neurological illnesses, brain injury, stroke or lesions to the brain can also cause voice difficulties, usually because of muscle weakness or damage to the nerves that send signals to the larynx or lungs.
Croaky or Hoarse Voice
This may be caused by a growth on the edge of the vocal fold which causes air to escape when the folds are coming together to make sound. There are several different types of growths that cause voice problems and these include nodules, cysts, polyps and tumours. These growths are usually caused by misuse or abuse of voice, lifestyle or stress, but are also the result of an injury to the larynx. These growths are differentiated by there presentation, size and location on the vocal folds, but they generally present with similar symptoms of a hoarse, croaky or breathy voice.
This can also be caused by a growth on the vocal folds, or because of breathing difficulties. A weak breath may display as speech which is short and low in volume. Illness, weakness or stroke can cause a weakness in breath support. Breath is the power and energy behind voice and any difficulties with breath control will impact on voice. In these circumstances the individual should try and slow their speech and produce less words per breath.
Warning signs that you may have a voice problem
• Constant loss of voice
• Hoarse or croaky voice
• Recurrent sore throat
• Deterioration of voice through the day
• Uncontrolled changes in pitch
• Persistent need to clear throat
If you have concerns about your voice, visit a qualified speech therapist /pathologist for assessment and speech therapy.
See our next section Voice Treatment, for information, and strategies to help the voice.
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets with helpful hints about Adult Speech Difficulties go to the Downloads section.
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