Treating Functional Voice Disorders and Maintaining Good Vocal Health

Have you ever overused your voice on a night out and somehow “lost your voice” the next day?

Usually after a day or two, your voice naturally bounces back--but what if it doesn’t? The prolonged loss of voice function may mean a functional voice disorder. It can make a person’s voice sounds rough. Their throat might feel tense or painful when speaking, or their voice might completely disappear.

In speech-language pathology, we break voice disorders down into a few different categories: typically organic, neurogenic, psychogenic, and functional. In this article, we'll mainly focus on functional voice disorders, where the actual structure of the voice mechanism is considered normal but the sound being produced is not.

What is a functional voice disorder?

Functional voice disorders are often caused by misuse or overuse of the voice.  The physical structure of the mechanism is normal, but the voice may sound raspy, gravelly, breathy, and quiet. The pitch might break easily, and it might just hurt to produce sound. Even famous singers such as Adele have been diagnosed with functional voice disorder due to overuse.

There are many causes of functional voice disorder. Yelling and excessive throat clearing can affect the voice. Laryngitis, irritants in the air, or stress can also cause a functional voice disorder. Even if the initial cause of the change in a person's voice does not persist, the voice disorder still can.

Different types of functional voice disorders

There are a few different types of functional voice disorders. For example, muscle tension dysphonia can be present when the sound of the voice changes due to excessive tension around the voice mechanism, such as the vocal folds or the larynx. While the initial cause of this dysphonia may disappear, the excessive tension to produce sound remains, resulting in a strained voice. Symptoms of muscle tension dysphonia often include:

  • Hoarse voice

  • Weak sound

  • A voice that sounds squeezed or tight

  • A voice that becomes tired at the end of the day

  • A pitch that sounds too high or too low

  • Pain or tension in the throat when speaking or singing

Excessive tension in the voice mechanism can result in having no voice at all, which is called functional aphonia.

Other functional voice disorders include:

  • Diplophonia: Characterized by sounding like two tones occurring at the same time.

  • Ventricular phonation: Happens when the ventricular folds, also known as false vocal folds, compress and squeeze over the true vocal folds. What results is a rough-sounding, low-pitched voice that can make the speaker feel and sound strained.

Other types of voice disorders

As mentioned, there are several different types of voice disorders classified in speech language pathology.

  • Organic voice disorders: Result of changes in the actual mechanisms of speech, whether it be respiratory, laryngeal, or in the vocal tract.

  • Neurological disorders: Takes place within the central or peripheral nervous system, and can also affect the voice, resulting in spasmodic dysphonia, vocal tremor, or even paralysis of the vocal folds.

  • Structural changes: The mechanism for speech that happens during the aging process is also considered organic in nature.

What do all functional voice disorders have in common?

They’re all preventable. Our voice is produced using muscles and cartilage, just like the muscles and cartilage we rely on to carry that package up a flight of stairs or ride a bike.  Pushing them too much can result in injury.

What causes functional voice disorders?

Functional voice disorders are often caused by overuse and abuse. Many professions rely on their voice all day long. Teachers and coaches often have functional voice disorders due to the strain of having to yell all day. Those who work in a loud environment such as a factory often develop functional voice disorders from having to make their voices heard over competing sounds. Even children can develop a functional voice disorder from excessive shouting.

What are the signs of a functional voice disorder?

Here are some common vocal symptoms that could signal you or your child have a functional voice disorder. It’s important to note that different types of voice disorders can have varying symptoms. If you notice any of these signs, it’s important to speak with a doctor or a speech-language pathologist.

  • Raspy or gravelly sounding

  • Breathy

  • Pitch is abnormally too high or low, or unable to vary pitch

  • Voice “breaks” in pitch

  • Voice sounds tremulous or shaky

  • Unable to maintain appropriate volume in conversation

  • Voice starts off well but is gone by the end of the day

  • Throat feels tense or painful when speaking

  • Frequent throat clearing or coughing, which may increase with more vocal use

  • Running out of breath when speaking

  • Feels like your breath is being held when speaking

  • Loss of voice entirely

How to treat a functional voice disorder

So you’ve noticed that your voice or your child’s voice is croaky, cracks in pitch, or just stops working by the end of the day. And this has been going on for quite a while, weeks or even months. Maybe you have a job where you’re required to speak all day. Or your child sings in a choir and their voice is spent by the end of rehearsal.

The first step is to speak with a doctor familiar with voice disorders, such as an ENT, to rule out any underlying medical condition that could be causing the change in voice.

If you have a functional voice disorder, then working with a speech-language pathologist, or speech therapist, to develop safe vocal techniques and hygiene is likely the next step in treatment. Speech therapists are communication experts, and many specialize in voice therapy to help evaluate, diagnose, treat, and manage voice disorders. Speech therapy can be delivered in person or with online speech therapy, where your therapist meets with you via a 1-on-1 video chat.

If left untreated, functional voice disorders can lead to an organic voice disorder, such as vocal nodules or polyps. Nodules are benign growths that form on the vocal folds due to abuse and appear like hard calluses. These develop over time and are often preventable. Abuse of the voice can also lead to vocal fold swelling that, over a period of time, can cause spots to form and become larger and callous, especially with continued overuse. Polyps are typically larger than a nodule and appear to look more like a blister on the vocal folds. However, both can be attributed to vocal abuse.

While this can sound scary, again, functional voice disorders are typically preventable and treatable.

Tips to maintain good vocal health

Maintaining good vocal health is just as important as maintaining overall health. Staying hydrated, cutting back on alcohol consumption, treating any allergies or reflux, quitting smoking, avoiding shouting over loud music or ambient noise, and allowing for vocal rest are essential to keeping a healthy, strong voice. A speech therapist can teach you safe, effective ways to care for your voice to ensure it will always be heard. Click here for more information on all types of voice disorders.

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