Functional Voice Disorders

Functional voice disorders are a group of disorders characterised by impaired voice production without structural abnormalities in the larynx (voice box) or vocal cords. These disorders are usually associated with the way the vocal apparatus is used, not with any visible physical lesion or limitation of movement. They can significantly affect quality of life. At the International Voice Clinic, we recognise that functional voice disorders can have a profound impact on your daily communication, professional performance and overall well-being. This comprehensive section will help you understand what functional voice disorders are, their causes, symptoms, diagnoses and the range of treatments available.

What are Functional Voice Disorders?

Functional voice disorders result from inappropriate or inadequate use of the vocal mechanism and often result in a faint, hoarse, strained or tired voice quality. Unlike organic voice disorders, which result from observable physical changes in the vocal cords, such as nodules or polyps, functional voice disorders have no clear physical basis. Instead, they result from patterns of vocal behaviour that place excessive stress on the voice and lead to vocal tension, fatigue and inefficiency.

These disorders can be broadly divided into two types:

1. Muscle Tension Dysphonia: The most common type of functional voice disorder, Muscle Tension Dysphonia occurs when excessive muscle tension in and around the larynx interferes with normal voice production. This tension can affect both the intrinsic muscles (those directly controlling the shape and stiffness of vocal cords) and the extrinsic muscles (those that stabilize the larynx in the neck).
2. Psychogenic Voice Disorders: These disorders are often linked to psychological factors such as stress, anxiety, or emotional trauma. In psychogenic voice disorders, the voice may become weak, hoarse, or may even disappear entirely (a condition known as functional aphonia), despite there being no structural cause for the symptoms.

What are the Causes of Functional Voice Disorders?

The causes of functional voice disorders are multifaceted, often involving a combination of physical, psychological, and environmental factors. Understanding these causes is essential for effective diagnosis and treatment.

1. Vocal Misuse and Overuse

One of the most common causes of functional voice disorders is vocal misuse or overuse. This includes behaviors such as:

• Excessive Talking: Speaking for extended periods without rest can lead to vocal fatigue and strain.
• Shouting or Speaking Loudly: Raising the voice frequently, especially in noisy environments, can cause tension and stress on the vocal cords.
• Poor Vocal Technique: Improper voice production techniques, such as using too much breath pressure or speaking at an inappropriate pitch, can lead to the development of functional voice disorders.

2. Muscle Tension

Excessive muscle tension in the neck, shoulders, and throat can contribute to functional voice disorders. This tension can result from:

• Stress and Anxiety: Emotional stress often leads to physical tension, particularly in the muscles surrounding the larynx.
• Poor Posture: Incorrect posture, especially during speaking or singing, can lead to strain on the voice.
• Compensatory Behaviors: In some cases, individuals may develop compensatory behaviors to cope with other voice issues (such as a cold or temporary hoarseness), which can become habitual and lead to a functional voice disorder.

3. Psychological Factors

Psychological factors play a significant role in the development of some functional voice disorders. These factors can include:

• Emotional Trauma: A sudden emotional event or ongoing psychological stress can manifest as a voice disorder.
• Performance Anxiety: Individuals who rely heavily on their voice for professional purposes, such as singers or public speakers, may develop voice disorders due to anxiety about their vocal performance.
• Psychosomatic Response: In some cases, emotional or psychological issues may manifest physically, affecting the voice.

4. Environmental Factors

Environmental factors can also contribute to functional voice disorders. These factors might include:

• Noise Pollution: Constant presence in a loud environment may lead to vocal strain as individuals try to speak over the noise
• Dry Air: Environments with low humidity can dry out the vocal cords, making them more susceptible to injury and strain.
• Allergens and Irritants: Exposure to allergens or irritants like smoke and dust can cause throat irritation, leading to compensatory vocal behaviors that contribute to a functional voice disorder.

What are the Symptoms of Functional Voice Disorders?

The symptoms of functional voice disorders can vary widely depending on the specific type and severity of the condition. However, common symptoms include:

• Hoarseness: A rough, breathy, or raspy voice quality is often one of the first signs of a functional voice disorder.
• Vocal Fatigue: Individuals with functional voice disorders may experience tiredness or discomfort in the throat after speaking for a short period.
• Pitch Variations: Difficulty maintaining a stable pitch, frequent pitch breaks, or an abnormally high or low pitch.
• Strained or Effortful Voice: The voice may sound tight or strained, and speaking may require more effort than usual.
• Voice Loss (Aphonia): In severe cases, individuals may lose their voice entirely, a condition known as functional aphonia.

These symptoms can be intermittent or persistent and may worsen with prolonged voice use or stress. It is important to note that the absence of structural or movement abnormalities of voicebox does not mean the symptoms are any less real or debilitating.

How are the Functional Voice Disorders Diagnosed?

Accurate diagnosis of functional voice disorders requires a thorough evaluation by a medical expert on voice, laryngologist - phoniatrician. At the International Voice Clinic, we use a comprehensive approach to diagnosis, which includes but not limited to:

1. Patient History and Interview

A detailed patient history is the first step in diagnosing a functional voice disorder. During the interview, we gather information about your voice use, any recent changes in your voice, your general health, and any physical, psychological or emotional factors that may be contributing to your symptoms. The history of voice is not only related with your daily speaking voice but does include the problems that you may be facing during your professsional voice needs like singing or lecturing.

2. General Ear Nose Throat, Head and Neck Examination

Voice problems are not always only limited to organic or functional problems of your larynx. They may also be related with problems of your nose, nasopharynx, oral cavity, oropharynx and even head and neck. At the International Voice Clinic, a thorough ear nose throat head and neck exam is part of the diagnostic steps of your voice problems0.

3. Visual Examination of the Larynx

Visualizing the larynx is crucial in ruling out organic causes of voice disorders. We use advanced techniques such as:

• Laryngoscopy: A procedure that allows us to view the vocal cords and surrounding structures using a flexible or rigid scope. This examination gives us the chance to evaluate the laryngeal structures wih high resolution and magnification with ease. The examination is performed under appropriate lighting with state of art chip on tip flexible or rigid endoscopes.
• Stroboscopy: This technique involves using a strobe light to slow down the visual perception of the vocal cords’ vibration, providing a detailed view of their function. The examination is recorded to video for further detailed analysis.

4. Perceptual Voice Assessment

A perceptual voice assessment involves the clinician listening to your voice and evaluating its quality, pitch, loudness, and overall function. This subjective assessment provides valuable insights into how the voice sounds to an experienced listener.

5. Acoustic Analysis

Acoustic analysis involves measuring various aspects of the voice, such as pitch, volume, and quality. This helps us identify any abnormalities in voice production that may indicate a functional voice disorder.

How are the Functional Voice Disorders Treated?

The treatment of functional voice disorders is highly individualized, taking into account the specific type of disorder, its severity, and any contributing factors related with the specific patient. At the International Voice Clinic, we offer a comprehensive range of treatment options designed to restore the optimal vocal function.

1. Voice Therapy

Voice therapy is the cornerstone of treatment for most functional voice disorders. Our highly trained speech language pathologists - voice therapists work with you to develop a personalized therapy plan that usually includes:

• Vocal Hygiene Education: Teaching you how to care for your voice, including proper hydration, avoiding vocal strain, and practicing good vocal habits.
• Relaxation Techniques: Techniques such as deep breathing, progressive muscle relaxation, and mindfulness that can help reduce muscle tension and improve vocal quality.
• Resonance Therapy: Exercises designed to improve the resonance of the voice, making it easier to produce sound without strain.
• Pitch and Volume Control Exercises: These exercises help you learn to use your voice more effectively, reducing the risk of strain and fatigue.

2. Behavioral Therapy

For individuals with psychogenic voice disorders, behavioural therapy can be an important part of treatment. This type of therapy focuses on addressing the psychological factors contributing to the voice disorder. Techniques may include Cognitive Behaviour Therapy, which helps to identify and change negative thought patterns and behaviours that may be affecting your voice, or Stress Management Techniques, which teach you how to manage stress and anxiety, which can be important in the treatment of psychogenic voice disorders.

3. Medical Management

In some cases, medical management may be required to address underlying conditions that contribute to functional voice disorders. These may include:

Medications: If allergies, acid reflux, or other medical conditions such as rhinitis or sinusitis are contributing to your voice disorder, medications may be prescribed to address these issues.
Botulinum Toxin Injections: In some types of dysphonia due to muscle tension, injections may be used to quickly reduce muscle tension and improve voice quality.

Contact Us

For more information about functional voice disorders or to book an appointment, please contact our clinic. We are here to help you and make sure you receive the best possible care for your voice.