Display Patient Information Leaflets

Date issued: July 2024 

Review date: July 2026

Ref: C-580/DC/SandLT/Voice Disorders

PDF:  Voice Disorders.pdf [pdf] 166KB  

How does the voice work?

The voice box (or larynx) sits at the upper end of the airway. The larynx has a hard outer structure, the “Adams apple” which protects the airway and the delicate vocal folds inside.

The vocal folds (also called vocal cords) are made of muscle covered with layers of delicate tissue. At rest, e.g. when breathing, the vocal cords stay open and air passes freely past them.

When we speak or sing, the vocal folds come together gently and vibrate in the air stream coming from the lungs to produce a sound. This sound is shaped and made more interesting as it passes through the mouth and nose. The tongue, lips and teeth shape the sounds into words.

Voice change

Illness, stress and sometimes overuse can cause problems with the voice.  It can start to feel and sound different.

When the voice changes, we sometimes work harder to carry on speaking. The muscles in the throat and larynx tighten, creating tension.

Tension in the neck, shoulders or vocal folds can affect the voice.  When muscles are tense, they become tight, rigid, and less flexible. The vocal folds vibrate less effectively, and the voice can begin to feel strained. This is called a muscle tension dysphonia.

Increased tension also means that muscles damage more easily.  Sometimes there are also structural reasons why the voice sounds different e.g. nodules, polyps, vocal fold palsies.

During your appointment today in Ear Nose and Throat (ENT), the therapist may have discussed referral for voice therapy. Voice therapy is a course of treatment to help improve your voice quality.

• If you have declined voice therapy, but change your mind, your GP can rerefer you within the next 6 months.

• If you have waited longer than 6 months from your appointment today, you will need another ENT appointment to repeat the assessment of your voice box.

Vocal Care

• Here are some simple things you can do to help your voice.

• Try to drink plenty of water or decaffeinated (decaff) drinks.

• Don’t throat clear repeatedly, sip water instead.

• Try daily steam inhalation, use a bowl of warm water and a towel, or a portable steam inhaler cup.  Breathe in the steam through the nose for five minutes.  Make sure the steam is not too hot.

• Don’t force your voice over background noise e.g. the TV or in the car.

• Try to manage any reflux or heartburn.  Ask you GP for advice if you are struggling.  Your Speech and Language Therapist (SLT) can also help.

• Don’t shout, scream, or whisper.

• Try to use a quiet voice instead.

• Don’t smoke and try to avoid too much alcohol. It is important to monitor for any red flag symptoms, particularly if you have smoked in the past or continue to smoke now.

Red flag symptoms include:

• Persistent, unexplained hoarseness or changes in your voice.

• An unexplained, persistent sore throat, difficulties or pain on swallowing, or the feeling of something in the throat. This may be linked with unintentional weight loss.

• Unexplained, persistent ear pain or nasal blocking on one side only.

• New lumps in the neck or mouth, or any ulcers that are not healing.

• Changes in breathing, such as breathing becoming noisy or more difficult.

If you notice any of these symptoms, or if you are concerned that your original symptoms are not improving, then return to your GP and request a referral back to the ENT department.