Treatment of Voice disorders

What are Voice Disorders?
Voice disorders affect your ability to speak normally, potentially altering the quality, pitch, or loudness of your voice. Such disorders can hinder your ability to communicate and express yourself, significantly impacting your quality of life.

How Does Your Voice Work?
Your voice is produced as air moves from your lungs, through your windpipe (trachea), and into your voice box (larynx). The vocal cords, located on either side of the larynx, vibrate as air passes through them, creating sound. This process is akin to whistling, where forcing air through your lips causes them to vibrate and produce a high-pitched sound.

Categories of Voice Disorders

• Functional: The structures that produce vocal sounds, such as the voice box, vocal cords, and lungs, are normal, but there are problems in their usage. This is often due to issues in using the vocal cord muscles.
• Organic: There are structural problems in the voice box, vocal cords, or lungs. Organic disorders can be structural (like abnormal growths on the larynx) or neurological (disorders affecting the nerves controlling the larynx).
• Psychogenic: These are rare and usually result from emotional stress or trauma, such as anxiety, depression, or conversion disorder.

Types of Voice Disorders

• Hoarseness: A raspy or weak voice caused by conditions ranging from viral infections to Parkinson’s disease.
• Laryngitis: Irritation or swelling of the voice box, usually temporary and due to allergies or upper respiratory infections.
• Muscle Tension Dysphonia: Excessive stress on the vocal cords causing muscle tightness.
• Spasmodic Dysphonia: Spasms in the voice box muscles.
• Vocal Cord Dysfunction (VCD): Prevents the vocal cords from fully opening, leading to breathing difficulties.
• Vocal Cord Lesions: Benign growths such as nodules, polyps, or cysts that affect the voice.
• Vocal Cord Paralysis: Inability to control the voice box muscles.

Who Gets Voice Disorders?

• Age and Sex: Women over 50 are more susceptible.
• Lifestyle: Smoking, drug addiction, or alcohol abuse can damage the lungs, larynx, and vocal cords.
• Occupation: Professions requiring extensive speaking or voice use, such as teaching or singing.
• Other Diseases and Disorders: Conditions like Parkinson’s disease, multiple sclerosis (MS), laryngeal cancer, or laryngopharyngeal reflux (LPR).

Prevalence of Voice Disorders
Between 3% and 9% of the U.S. population experience a voice disorder at some point, though less than 1% seek treatment. Teachers are particularly at risk, with studies showing about 57% of nearly a thousand teachers having a voice disorder.

Symptoms and Causes
Causes:
The most common cause of voice disorders is overuse of the voice, such as through yelling, singing, or excessive talking. They can also result from acute illnesses like colds, allergies, or sinus infections. More complex disorders may arise from structural, muscular, or nerve issues in the voice box or vocal cords.

Symptoms:

• Gurgly or wet voice
• Rough, strained, raspy, or hoarse voice
• Strangled or breathy voice
• High or low-pitched voice
• Loud or soft voice
• Uneven or shaky voice with breaks or gaps in sound
  

Diagnosis and Tests
Your primary healthcare provider may diagnose a voice disorder or refer you to a specialist, such as a speech-language pathologist or laryngologist. They will perform a physical exam, evaluate your symptoms and medical history, and may ask about the impact on your daily life.

Your provider will closely examine your face, head, neck, and throat during speaking or breathing exercises. You should report any discomfort or difficulty. Specialists might perform detailed voice assessments, including tests for tone, pitch, and volume. Imaging tests like a laryngoscopy can examine the voice box and vocal cords, and may include a biopsy to check for diseases.

Management and Treatment
Some voice disorders, like hoarseness, may improve with rest. More complex disorders might require voice therapy, where speech-language pathologists teach techniques and exercises to help regulate and improve your voice. 

• Accent Method: Coordinating breathing and speaking with relaxed vocal cord muscles.
• Auditory Masking: Amplifying your voice by speaking out loud while listening to loud background noise through headphones.
• Conversation Training Therapy: Using relevant conversations to improve speaking, along with hand gestures and facial expressions.
• Certain disorders might need medical or surgical treatments, such as botulinum toxin injections to relax tense voice box muscles.

Prevention

• Avoiding smoking, drugs, and alcohol
• Drinking plenty of water to keep vocal cords hydrated
• Resting your voice regularly if your occupation involves extensive speaking

Outlook / Prognosis

Voice disorders due to overuse or acute illnesses are typically temporary and do not cause permanent damage. Most individuals with more complex voice disorders can manage and overcome challenges with appropriate treatments.