Voice Diseases

We know that the importance of communication is increasing day by day with modern life. Although we can communicate with various methods, we need to emphasise that our most important communication tool is still our voice.

Who is a Voice Expert?

Whether we are a child, a teenager or an actively working adult, our need for voice does not decrease at any stage of our lives. We feel the need to use our voice effectively when communicating our needs, wishes, emotions and thoughts to others. People working in some professions are deprived of doing an important part of their work as they wish without their voice. This group, called voice professionals, actually covers many more professions than expected. If we list some of the first examples, teachers, lawyers, doctors, voice and stage artists, call centre workers, bank employees, lecturers, cashiers, television and radio programmers, clergy, marketers and many other professions can be included in this group.

How can voice disorders be prevented?

The development of voice disorders can be prevented through voice hygiene and voice therapy programmes tailored to the individual's voice needs. Hygiene and therapy methods to be applied in case of any voice disorder will contribute significantly to a more timely and successful treatment outcome.

What are the Causes of Voice Disorders, Voice Impairments, and Hoarseness?

Just like other organs of our body, many different causes in the vocal tract can lead to similar symptoms. For instance, a short-term cold, allergy, or reflux, which are easier to manage, or serious issues like vocal fold paralysis or vocal cord cancer, can all manifest as the first symptom of hoarseness.

How is a Correct Diagnosis Made for Voice Disorders?

In voice disorders, a correct diagnosis can be achieved by combining both objective (subjective) and subjective (objective) approaches. The condition of the individual's voice is evaluated according to both their perception and that of the relevant clinician. When necessary, standardized voice recordings are taken, and numeric data can be obtained through a method called acoustic analysis for comparison. A thorough examination of the ear, nose, throat, and head and neck, as well as a full-body examination when necessary, is performed.

Rigid (stiff) and flexible telescopes can be used for visualizing the vocal folds and other related structures. Since the vocal folds vibrate approximately 100-140 times per second in adult men and 200-240 times in women when producing sound, specialized tools are needed to see these structures. The light technology that enables this is called stroboscopy. The voice examination conducted under a stroboscopic light source (videolaryngostroboscopy) is considered the gold standard for diagnosis. In this way, many pieces of information that cannot be obtained through simple examination methods can be accessed, leading to accurate diagnoses.

What Are the Most Common Diseases Leading to Hoarseness or Recurring Voice Problems?

Voice disorders can be classified into two main groups: organic and functional causes.

Organic causes include conditions such as nodules, polyps, cysts, sulcus, white and red spots, granulomas, reflux, paralysis, and cancer. Functional causes refer to situations where no visual problem is detected in the vocal folds and ear, nose, throat examination, but there are issues related to the individual's use of the related structures.

How Are Voice Disorders Treated?

Treatment for voice disorders is determined based on the cause of the disturbance. Voice therapy, medical (drug) treatment, and surgical treatment are the three main methods of treatment.

What is Voice Therapy?

Voice therapy is a treatment method that can be used for all voice problems. While it is used as the sole treatment method for some voice disorders, in others it can be used as supportive therapy before and after medical or surgical intervention. Although it is very beneficial, there is no specific voice therapy method for any voice pathology. On the contrary, the voice therapy method selected for each patient should differ in intensity and duration according to the patient's needs. Ideally, the cause of the patient’s voice problem should be determined before starting voice therapy. For this purpose, objective voice analysis should be conducted and the vocal cords assessed through videolaryngostroboscopy.

The findings obtained should be evaluated together with the patient and the team that will actively participate in voice therapy, and if the patient is a voice professional, with other individuals concerned with their voice, in order to determine therapy objectives.

Recent increases in knowledge about the larynx (throat, windpipe) have also boosted interest in the physiology, disorders, and treatment of voice and voice disorders. This has led to significant advances in the objective evaluation of voice and visualization of vocal cords. Thus, much faster and more accurate diagnoses are achieved, and treatment processes can be initiated more quickly.

As the time constraints for health professionals dealing with voice disorders and voice professionals who earn their livelihood through their voice continue to increase, contemporary voice therapy protocols are planned to consist of approximately 6-10 sessions. While the objectives of each voice therapy method may differ, there are also some universal general goals applicable to all voice therapy techniques. These relevance for voice therapies administered before or after surgery or for those employed as sole treatments are:

Patient Education: Patient education is the first step for all treatment protocols. Every patient should understand how voice is produced and how their problem leads to issues in their voice. The patient should comprehend the logic of voice therapy, the techniques to be used, and the treatment objectives. If the treatment approach does not sit well with the patient or the therapist is unsure or does not provide sufficient explanation, it will be difficult for the patient to adhere to the treatment program.

Voice Hygiene: In addition to the voice hygiene rules that need to be applied to each patient, specific issues that should be adhered to or avoided must be determined accordingly for each patient. For instance, adequate fluid intake is important for all voice users, and if necessary, humidifying the environment is crucial. Being knowledgeable about personal voice usage habits, understanding the conditions and noise characteristics of the environment where the voice is predominantly used, and considering other environmental factors will facilitate the acquisition of healthier voice habits. Avoidance of smoking, reducing general stress, and awareness of the effects of medications on body fluids are also important requirements.

Correction of Excessive Voice Use Behavior: It is essential to encourage individuals with hoarseness to speak more softly, prevent loud speaking, and avoid habitual throat-clearing actions. Overall voice use should be minimized during the day. Laughing, crying, and coughing loudly are also behaviors that can harm the voice. All these rules can be applied to individuals with voice problems, except for those whose issues are due to neurological reasons or hypofunctional hoarseness.

Agreed Goals and Expectations: The individual with a voice problem and the voice therapist must agree on the existence of a voice issue, the necessity of taking action regarding it, the path to be followed, and the targeted objectives.

Recognition of Changes in the Patient’s Voice: If the patient does not notice or feel the changes in their voice resulting from therapy, voice therapy cannot be beneficial. This is a situation that we do not often encounter with voice professionals, but is very common in the elderly population and those with neurological issues.

Is it Possible to Treat Voice Disorders Solely with Voice Therapy?

Yes, some voice disorders can be treated solely with voice therapy methods. These include functional voice disorders, voice problems due to certain neurological and psychiatric conditions, and most vocal fold nodules.

Are Surgical Methods Successful in Treating Voice Disorders?

Yes, surgical methods can be up to 100% successful in treating many voice disorders. These include various causes such as vocal fold polyps, vocal fold cysts, granulomas, papillomas, and cancers. You can find information about voice surgery on our related page.

What is the Role of Medical / Drug Treatment in Treating Voice Disorders?

It is possible to obtain successful results with drug treatment in many different voice disorders, including laryngitis (infections and inflammations of various regions of the vocal folds and larynx) and reflux (the backflow of stomach contents to the level of the vocal folds).

Who Should a Person with a Voice Disorder Consult?

A person with a voice problem should consult an Ear, Nose, and Throat specialist who is specialized in voice disorders.