Voice Disorders

Muscle Tension Dysphonia (MTD)

strained, effortful, hoarse, or rough quality; sometimes painful

due to stress, vocal misuse/overuse, or compensation for other pathologies

teachers & those with high vocal demand

Paradoxical Vocal Fold Movement (PVFM)

involuntary vocal fold adduction during inhalation

inspiratory stridor & sudden shortness of breath

exercise, reflux, stress, strong odors

Puberphonia (Functional Falsetto)

persistence of a high-pitched pre-pubescent voice despite normal larynx development

high-pitch, breathy, weak

psychogenic or failure to adapt to voice changes during puberty

Mental Health/Psychogenic Disorders

Voice disturbances caused by psychological factors rather than physical ones

wide range from sudden aphonia (loss of voice) to severe dysphonia

anxiety, depression, traumatic events

Vocal Fold Nodules

Chronic BILATERAL phonotrauma (screaming, excessive loud talking) leading to bilateral callous-like growths

Hoarseness, breathiness, & rough or raspy vocal quality

Vocal Fold Polyps

A single traumatic event (acute vocal abuse) OR long term irritation from smoking

Severe hoarseness, breathiness, and sometimes a “diplophonic” (two-pitched) sound

What is the difference between polyps and nodules

Polyps have their own blood supply

Also polyps can be unilateral but nodules are always bilateral

Vocal Fold Cysts

Blocked mucous gland or congenital presence; fluid-filled sac within he VF

Chronic hoarseness, lowered pitch, less responsiveness to voice therapy than nodules

Reinke’s Edema (aka smoker’s polyps)

Fluid accumulation in Reinke’s space due to chronic smoking & vocal abuse

Extremely low, gravelly, and masculine-sounding vocal quality

Contact Ulcers / Granulomas

Intubation trauma, laryngopharyngeal reflux, or chronic throat clearing / hard glottal attacks

Pressed quality, vocal fatigue, physical pain, globus sensation in the throat

Varix / Hemorrhage

Burst blood vessel or distended vessel caused by acute vocal trauma

Sudden, immediate loss of voice, or severe hoarseness following a traumatic event

Reflux Laryngitis

Chronic irritation and inflammation from stomach acid reaching the larynx

Hoarseness, frequent throat clearing, and a “thick” or “lump-in-throat” sensation

If it’s caused by reflex, it’s more likely to be …

longer lasting

Candida (Laryngeal Thrush)

Fungal infection of the laryngeal tissue (those with weakened immune systems or using inhaled corticosteroids for asthma)

Severe hoarseness & pain during phonation

Recurrent Respiratory Papillomatosis

Viral infection caused by the human papilloma virus (HPV) - (looks like raspberries)

Chronic raspy quality, severe hoarseness, and inspiratory stridor if the airway is narrowed

Sulcus Vocalis

Congenital or acquired furrowed or divot along the edge of the VF

Breathy, weak, thin voice with reduced vocal range

Presbylarynx (Vocal Fold Atrophy)

Age-related thinning and loss of muscle mass in the VFs

Weak, breathy, thin, quiet voice that lacks projection

Subglottic Stenosis

Narrowing of the airway below the VF due to trauma, intubation, or idiopathic causes

Inspiratory stridor and shortness of breath, voice may be weak if stenosis reaches the glottis

Laryngomalacia

Congenital softening of the laryngeal tissues above the VFs (in infants)

High-pitched, inspiratory stridor that worsens with feeding or crying

Laryngeal Web

Failure of vocal folds to separate fully during fetal development

Weak cry, high-pitched voice, potentially labored breathing

Ankylosis / Criciarytenoid Dislocation

Stiffening or physical shifting of the laryngeal joints due to arthritis or blunt force trauma

Breathy or strained hoarseness, can mimic VF paralysis

Laryngeal Cancer

Malignant cell growth (Squamous Cell Carcinoma) in older adults with significant history of smoking and/or alcohol consumption

Persistent, progressive hoarseness that does not resolve, may include a low-pitched or rough quality