What are voice problems?

A voice problem (dysphonia) occurs when the sound-producing element of speech is disturbed. This can lead to complaints of:

• Hoarseness
• Voice breaks or vocal weakness
• Pain, tension or effort when talking or singing
• Change in pitch range

Think of this example of how several factors can combine to cause voice problems:

Bob had a bad cold last December while he was preparing the oral exams for his master's degree. He was very anxious about the exams. The cold caused vocal fold swelling (laryngitis). Since he continued to talk —and was feeling anxious, tired and unwell—he started using his throat muscles in a different way, with too much tension. This led to ongoing hoarseness and throat effort long after the swelling from the cold was over. The tense way of talking became an unconscious habit. 

Improper use of the voice and vocal muscles is the main factor that causes voice problems, but strokes, neurological diseases, cancer and chronic health issues such as gastroesophageal reflux can also lead to voice problems.

Other breathing problems caused by muscle spasm in the larynx, irritable larynx and chronic coughing may have complex causes. In these cases, individuals may need a care plan involving multiple health care professionals. 

A complex interaction of factors often causes disorders of the voice and larynx (voice box). The model we use to evaluate individuals with voice problems and decide on the most appropriate treatment plan is called ALERT. The model looks at these factors: Anatomical (physical), Lifestyle, Emotion, Reflux and Technique.

• Anatomical factors may be temporary conditions that change the structure of the vocal folds, larynx or vocal tract (e.g. cold or flu, allergic reactions or asthma) or more permanent conditions (e.g. injuries, Parkinson’s Disease).
• Lifestyle factors include over-using your voice because of your job or recreational activities (e.g. having to yell in a noisy area) or smoking. 
• Emotional factors include tensing muscles in the breathing system if an individual is scared (e.g. stage fright).
• Reflux refers to Gastro-esophageal Reflux Disease, commonly associated as heartburn or indigestion.
• Techniques like good body posture (not slouching) are important.

For more details on each of these areas, download the ALERT Model of Voice Dysfunction hand-out.