We can tell a lot about a person by just listening to their voice. We can guess their approximate age, their gender, their current emotional state, their wellbeing and even their level of fatigue. Our voice is linked with our identity. Needless to say, we depend on our voice to communicate verbally with others.

How does voice work?

Our voice box, or our larynx, produces voice. We make sound by bringing together our vocal folds while breathing air out from our lungs. When we do this, the vocal folds vibrate, making the buzzing sound that is our voice. We can modulate our voice to make it louder, quieter, higher and lower. We can also ‘put on’ various voices by constricting or stretching different structures in our throat, and by changing the shape of our mouth. A clear voice is achieved when the vocal folds are smooth and hydrated. Diet, lifestyle, illness and psychological wellbeing can impact on the sound of the voice.

The specific characteristics of voice that Speech Pathologists assess include:

  • Volume – how loud or quiet your voice typically is, including your range
  • Pitch – how low or high your voice typically is, including your range
  • Resonance – how nasal your speech sounds. When speech sounds too nasal it is called “hypernasal” and when speech sounds as though the nose is blocked it is called “hyponasal”.
  • Quality – this refers to the clarity of your voice. Your voice can be clear, breathy, hoarse, strained or rough.

What are some common causes of voice problems?

Voice problems are common in both children and adults. The causes of voice problems are various. Very commonly, voice problems are due to vocal abuse – that is, using your voice excessively or projecting your voice too loudly. Certain jobs rely on voice-use in loud environments (e.g. teaching a classroom of kindergarten children, teaching aerobics to loud music). These professionals commonly experience voice problems. Children also use their voice loudly while playing sports, calling out to each other in the playground and when putting on ‘funny voices’. When we yell, or shout excessively, the vocal folds develop small bumps called vocal nodules. Usually these go away on their own after a period of vocal rest, however if our vocal habits do not change, and we continue to exacerbate our voice, they will re-emerge. In the long-term, nodules can harden like callouses and eventually may require surgery.

Voice problems may occur temporarily due to mild illness, such as laryngitis. During illness, the vocal folds may become swollen and heavier than usual. This may result in a lower pitched voice and an intermittent “husky” vocal quality. Usually this goes away within a few days and no treatment is required.

Sometimes, changes in voice quality can be noticed when taking a new medication. Certain medications may dry the vocal folds. Speak to your GP if you notice changes after being prescribed a new medication.

Voice problems can be caused by gastro-oesophageal reflux. With this kind of reflux, acid from the stomach comes up the oesophagus and spills onto the vocal folds, inflaming the delicate tissue.  Reflux may be managed by changes to the diet and lifestyle, as recommended by your GP.

Voice problems, such as total lack of voice can ensue due to excessive stress or certain psychological problems.

Voice problems or disorders may also be the result of other, more serious medical conditions, such as granuloma, a cyst, papilloma, or vocal fold paralysis or paresis after stroke.

When to seek help

The voice undergoes changes across the lifetime, so it is normal to expect certain vocal changes as we age.

You should consider seeking help if you answer “yes” to any of the following:

  • it feels like there is something stuck in your throat
  • you feel a constant tickle or pain in your throat
  • your voice has not recovered after the illness or event that caused it
  • your voice is impacting on your ability to participate in your regular activities

If you are concerned about your or your child’s voice, it is recommended to visit your GP for a referral to see an Ear, Nose & Throat specialist (ENT). The ENT can view the voice box and determine the cause of the voice disorder. Depending on the diagnosis, the ENT may recommend sessions with a Speech Pathologist for education and intervention.

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