Voice disorders

Also called Dysphonia, Aphonia, Hoarseness, Muscle tension dysphonia, Vocal cord nodules, Spasmodic dysphonia

When the voice itself is hoarse, weak, strained or gone: what dysphonia is, when to get it checked, and how to keep communicating while it heals.

What it is

A voice disorder, or dysphonia, is a problem with the sound the voice box produces rather than with the words or the articulation. The voice is hoarse, breathy, strained, too quiet, cracks or gives out. Aphonia is the complete loss of voice, with only a whisper left.

Causes range from simple overuse and laryngitis, through nodules and polyps on the vocal folds, to muscle tension, nerve damage after surgery, and neurological conditions such as Parkinson's and spasmodic dysphonia. Some people lose their voice under stress with nothing physically wrong, and that's real too.

Who it can help

Anyone whose voice has changed for more than three weeks, especially if they use it for a living: teachers, call handlers, singers, carers and anyone who talks over noise all day. And people whose voice change is part of a neurological condition and who need to plan around it.

A hoarse voice that lasts more than three weeks needs an ear, nose and throat examination before anything else, because the small proportion that's a growth needs finding early. That's not a voice therapy question.

How it works

The vocal folds vibrate hundreds of times a second and need to meet cleanly along their length. Swelling, a lump, a stiff fold or one that won't move leaves a gap, and air escapes: breathy, weak, tiring. Too much muscular effort to compensate gives the strained, effortful voice of muscle tension dysphonia.

An ENT clinic looks at the folds with a small camera, often with a speech and language therapist in the room. Voice therapy then works on breath support, easy onset, resonance and reducing strain, plus vocal hygiene: hydration, rest, no whispering (it strains more than quiet speech), no throat clearing. Nodules usually resolve with therapy alone; polyps sometimes need surgery.

While the voice is unreliable, the message still has to get out. A personal amplifier helps a weak voice carry. Text-to-speech on a phone covers the days when there's nothing there at all.

Getting started

See the GP if the hoarseness has passed three weeks, and ask for an ENT referral rather than a wait-and-see. Meanwhile rest the voice, drink water, and stop whispering and clearing your throat.

At work, ask for a microphone or amplifier as a reasonable adjustment; a classroom amplifier is cheap and the difference is immediate. Put a text-to-speech app on your phone for the bad days and try it before you need it.

Keep a note of what makes the voice worse and better across a week. The clinic will ask and the pattern is often the diagnosis.

Where to get help

The NHS route is GP, then ENT, then speech and language therapy for voice. The British Voice Association has plain guidance on vocal health and lists voice clinics. The RCSLT describes what a voice therapist does. If the voice change is part of a wider condition, Parkinson's UK and the MND Association cover it.