Have you lost your voice? Do you often get a hoarse voice? Many things can go wrong with voice. Misuse, injury and stress can all cause problems with your voice.  Some people say if you have a problem with your voice it is often symptomatic of wider health problems. Voice problems (dysphonia) usually begin because a small growth develops on the vocal folds (a nodule, cyst or polyp etc). These 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 is probably the most common cause of regular lost voice, or hoarse and croaky voice problems. 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 effect on the muscles that help our voice. A combination of these things 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 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 apparatus 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 aggravate the voice problem further.
  

• Lifestyle can be a factor in voice problems. If you are generally unhealthy, if you drink too much alcohol and smoke, if you are often dehydrated, if you sing, play sports where you shout, or use your voice a lot at work, these can all have an impact.

Disease and illness can cause voice problems. Chest illness’s often have secondary effect on voice, with continued coughing impacting on the vocal folds.  However, one of the most serious illnesses 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. The bad news is that if treatment to remove the tumour is unsuccessful, the patient may have to have a partial or whole laryngectomy and thus loose there voice completely. However, there are now ways to create a voice for many patients without a larynx, and we will touch more on this subject in our next section, Voice Treatment.

Any type of trauma or injury to the larynx can also cause vocal fold damage and/or paralysis. This can be more serious than a benign growth (as mentioned above) and may involve surgery to try and improve voice. 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.

There are many things that can happen to affect our voices. In some respects the voice is quite a tough little organ as we are using it all day, every day, but we also really need to have respect for, and look after our voices as they play such a huge part in our lives. 

What happens to our voice to make it go wrong? Well as mentioned in the last section, there are 2 folds of muscle that “bang” together many times per second to produce voice. When there is misuse, trauma or injury these little folds of muscle become swollen, damaged or start to form a small growth (polyp, cyst etc). When any of these things happen it may change the way the muscles come together, they might not come together 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.  You may also loose your voice frequently.

Croaky or Hoarse Voice - This is often 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.

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 speech and produce less words per breath.

• 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.

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