Voice Disorders

Vocal cords, also called vocal folds, make it possible for you to talk, sing, and make other sounds. The quality of the voice is affected when vocal cords do not work properly. Voice disorders result in hoarseness, breathiness, roughness, harshness, weakness or a "scratchy" voice. 

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology) and Speech, Language and Learning.

Causes & Risk Factors

Voice disorders are often the result of straining your vocal cords, but can also be caused by injury, disease and other factors.

Causes include:

  • Head and neck injuries
  • Tumors
  • Disease
  • Surgery
  • Stroke
  • Vocal cord nodules and polyps
  • Damage to the vagus nerve
  • Allergies
  • Smoking
  • Tense muscles
  • Overuse (such as too much singing)
  • Talking loudly
  • Paradoxical vocal fold movement (also known as vocal cord dysfunction)
  • Vocal cord paralysis

Cause of vocal cord paralysis:

  • Damage to one of the branches of the vagus nerve. The vagus nerve runs from the brainstem to the larynx (voice box) and controls vocal cord movement.

Cause of paradoxical vocal fold movement (also known as vocal cord dysfunction):

  • Vocal cords close when they should open, affecting ability to talk
  • Can be mistaken for asthma

Symptoms & Types

Symptoms and Types include:

  • Hoarseness
  • Breathiness
  • "Rough" voice
  • "Scratchy" voice
  • Weak voice
  • Shooting pain from ear to ear
  • A "lump in the throat" sensation
  • Neck pain
  • Decreased pitch range
  • Voice fatigue
  • Inability to speak loudly
  • Wheezing
  • Difficulty breathing

Vocal cord problems can be triggered by:

  • Acid reflux
  • Post-nasal drip
  • Upper respiratory infection (cold)
  • Exercise
  • Strong odors or fumes
  • Strong emotions and stress

Diagnosis & Tests

It is important to know what causes your child's voice disorder. Do not begin a voice therapy program until your child has had a medical evaluation. An ear, nose, and throat doctor (otolaryngologist) can identify structural changes that might be the cause of the problem. Treatment may also include an appointment with a speech-language specialist.

Diagnosis is made by:

  • Evaluating vocal quality, pitch, loudness, and ability to sustain voicing
  • Inserting a thin flexible tube with a light on the end (endoscope) into the mouth or nose to look at the vocal folds and larynx (voice box)

Treatment & Care

Voice disorders may be treated medically, surgically,  behaviorally or through a combination of treatments.

Medical treatments:

  • Treating allergies, acid reflux, and thyroid problems should reduce their impact on the vocal cords.

Surgical treatments for paralyzed vocal cords:

  • Injection of a substance to increase size of the vocal cord
  • Restore function (reinnervation) of the damaged nerve

Behavioral treatments:

  • Voice therapy that teaches how to properly treat your voice, reduce vocal misuse, and direct voice treatment to alter pitch, loudness or breath support.

Living & Managing

Voice disorders impact a child's quality of life. Having a voice disorder may make it difficult for others to understand your child.

You can help your child cope through rewards and reminders.

  • Use positive language to develop good voice behavior, such as "nice talking" or "that was a lovely gentle voice" when your child makes an effort to talk at a moderate level.
  • Reward the good behavior and don't punish the bad behavior. Gently correct your child when his voice becomes too loud. Give your child a reward when he or she speaks properly.