Understanding Dysphonia and Its Causes and Treatment

Dysphonia is a common, frequently harmless condition that describes impaired voice production. Symptoms and treatment of dysphonia depend on the underlying cause, such as infection of the larynx (voice box), growths on the vocal cords, or a nerve or muscle-related disorder that affects speech.

Jump to Key Takeaways.

What Are the Symptoms of Dysphonia?

Depending on the underlying cause, symptoms of dysphonia may include:

• A voice that is raspy, harsh, strained, trembly, breathy, or nasal-sounding
• A voice that is higher in pitch (shrill or chirpy sounding) or lower in pitch (deeper sounding)
• A soft voice
• A weak or fatigued voice that can make it hard to speak

What Could Be Causing My Dysphonia?

Dysphonia usually results from an abnormality in the larynx or vocal cords, but conditions affecting the muscles or nerves that control the vocal cords can also cause it.

The larynx is a cartilage tube between the end of the tongue and the top of the trachea (windpipe). It houses the vocal cords, which are delicate folds of tissue that vibrate to generate sound waves.

Besides speech production, other essential functions of the larynx include:

• Preventing food and water from moving into the windpipe when swallowing.
• Serving as a passageway during breathing,

While not a complete list, the leading causes of dysphonia include the following.

Infection or Inflammation

Infectious or inflammatory causes include:

• Acute laryngitis: Sudden swelling of the vocal cords, typically caused by an upper respiratory tract infection (e.g., common cold) or sudden voice strain, like after loud cheering at a sports event.
• Chronic laryngitis: Persistent swelling of the vocal cords, often caused by long-term exposure to irritants (e.g., tobacco, chemical fumes, allergens), acid reflux, or voice overuse
• Laryngopharyngeal reflux: Stomach acid moves backward into the throat, producing symptoms that can include dysphonia, persistent throat clearing, cough, and a sensation of a lump in the throat

Noncancerous Growths

Noncancerous (benign) growths include:

• Vocal cord nodules (lumps) or cysts (fluid-filled sacs): Benign growths on the vocal cords that may develop with voice abuse, such as excessive talking, yelling, throat clearing, or coughing
• Vocal polyps: Benign growths on the vocal cords that can develop with vocal abuse or from smoking, allergies, or other chronic irritant exposures
• Laryngeal papillomatosis: Wart-like growths in the larynx caused by the human papillomavirus (HPV)

Cancer

Laryngeal cancer occurs when abnormal cells within the larynx grow uncontrollably. Dysphonia can occur when the cancer develops or spreads to the vocal cords. Other potential symptoms of laryngeal cancer include:

• A persistent sore throat
• One-sided ear pain
• Trouble swallowing or breathing
• Spitting up or coughing up blood or bloody sputum

Neurological Problems

Neurological causes of dysphonia include:

• Spasmodic dysphonia: Strained voice quality and irregular voice breaks caused by sudden involuntary contractions of the vocal cords (spasms)
• Vocal cord paralysis: One or both vocal cords don’t move properly, with possible causes including injury to the nerve that controls the muscles in the larynx or underlying brain diseases like Parkinson’s disease or stroke

Other

Other causes of dysphonia include:

• Muscle tension dysphonia: Tightness in the muscles around the neck and throat causes an abnormal voice, with potential causes including emotional stress, recent illness, or weak/injured vocal cords
• Vocal cord atrophy: The vocal cords become thinner and looser due to aging
• Vocal cord hemorrhage: A blood vessel within the vocal cord bursts, filling it with blood, which may occur after strenuous or forceful vocal activity, such as repetitive singing or yelling

When Should You See a Healthcare Provider?

See a healthcare provider if you develop:

• Hoarseness or other changes in your voice that last for two weeks
• Persistent sore throat
• Pain when speaking or swallowing
• Trouble swallowing (dysphagia)
• A lump or mass in your neck
• Unintended weight loss
• Bloody sputum

You may be referred to an otolaryngologist (a doctor specializing in diseases of the ear, nose, and throat).

When evaluating dysphonia, otolaryngologists place a flexible tube attached to a tiny camera through a person’s nose or mouth—called a fiberoptic scope—to visualize the larynx and vocal cords.

To pinpoint a diagnosis, they look for structural and functional abnormalities, such as growths or abnormal vocal cord movements.

What Is the Treatment for Dysphonia?

Treatment of dysphonia depends on the underlying cause:

• Acute laryngitis: Management is with supportive care, such as voice rest, sipping warm fluids, and sleeping near a cool mist humidifier.
• Chronic laryngitis: Treatment requires identifying the culprit (e.g., alcohol, smoking, or chemical fumes) and limiting or avoiding it.
• Laryngopharyngeal reflux: Managment includes dietary/lifestyle interventions (e.g., low acid/fat diet) and/or medication (proton pump inhibitor).
• Noncancerous growths on the vocal cords: These are treated with voice therapy. In some cases, as with laryngeal papillomatosis, surgery to remove the growth is performed.
• Laryngeal cancer: Treatment depends on the stage (extent) of the cancer, but often includes surgery, radiation, and/or chemotherapy.
• Spasmodic dysphonia: Management includes Botox (botulinum toxin) injections into the vocal cord muscles every three to four months.
• Muscle tension dysphonia: The primary treatment is voice therapy. Neck and voicebox massage may also be helpful.
• Vocal cord paralysis: It is most commonly treated with voice therapy and surgery.
• Vocal cord hemorrhage: This is treated with immediate voice rest. Surgey is rarely needed.

Key Takeaways

• Dysphonia refers to a change in voice that makes the voice sound raspy, strained, shaky, breathy, weak, or soft.
• Examples of dysphonia causes include laryngitis, noncancerous growths on the vocal cords, acid reflux, vocal cord thinning, nerve or muscle-related disorders, and laryngeal cancer.
• If you are experiencing new or worsening dysphonia, see a healthcare provider for a diagnosis and a treatment plan that may include voice rest, voice therapy, or surgery.