Joseph R. Anticaglia MD
Medical Advisory Board
Your voice is not healthy if it doesn’t sound right to you or others. The way the voice sounds is a clue, a symptom to an underlying problem which can be due to many causes; including vocal misuse, smoking, infection, cancer or neurologic (nerve) problems.
Abnormal changes in the voice can occur alone or in combination with other voice changes. For instance, lung cancer can cause both a husky and breathy voice. Below are examples of sounds that suggest a voice problem, how people describe them and what they often ask, “What’s the matter with your voice? You sound hoarse.”
Abnormal Voices
- Hoarse
- Strained
- Breathy
- Husky
- Tired
Hoarseness
Hoarseness, also called dysphonia, is an abnormal change in a person’s voice. It’s a general term that describes a combination of breathiness and harshness. It’s a ‘symptom’ – not a disease – and one needs to diagnose the cause of the problem. Laryngitis and smoking commonly cause the voice to sound rough or harsh. There are many other conditions which can interfere with the motion of the vocal folds and cause hoarseness.
Strained Voice
One afternoon, a few years ago, I was driving home from the office listening to the Diane Rehm radio show. I was intrigued by her voice that seemed tight and required a great effort on her part to speak. It almost seemed as if someone had their hands around her neck while she was trying to speak and then let go.
It was reported that her symptoms of difficult, strained speech were mild and infrequent at first but became more frequent and worsened over a period of twelve months or so. The irregular, choppy, “strangled speech” interfered with her ability to read scripts and interview guests for her radio show.
Spasmodic dysphonia, the type Rehm has, is forceful, involuntary contractions (spasms) of the muscles of the larynx causing her strained voice to break up sometimes in the middle of sentences. The symptoms usually plateau, do not worsen, approximately one and a half years after the onset of the problem. This disorder brought Rehm to the brink of a nervous breakdown.
Breathy Voice
Alexandra, a 47 year old housewife said, “Six weeks ago I had a viral infection and sinusitis. I was hoarse and sounded like a man for about a month. Now I have a weak, soft, breathy voice and it’s not going away. Just listen to me, this is what I sound like all day>”
Examination by her throat specialist revealed that the vocal folds were not meeting in the midline because of a paralyzed left true vocal fold that was causing her problem. Viral infections can damage the nerve that triggers the muscles responsible for vocal fold movement.
Husky Voice
Actors, singers and media personalities with a signature voice do not want anything done to their larynx that might jeopardize their characteristic voice and their career. For example, Kathleen Turner and Harvey Fierstein have distinctive husky-gravel voices that set them apart from other performers and add to their persona.
Tired Voice
Teachers, telephone marketers and others have complained of a tired voice, one that “fatigues out” as the day goes on. Singers might complain of difficulty singing loudly, softly or of “hitting the high notes.” Their problems can be due to excessive use or misuse of their voice or medical conditions (e.g. reflux disease) that cause irritation and changes in the motion of the vocal folds. Myasthenia gravis shows a rapid, fatiguing quality to the voice.
More Voice Problems
Raspy Voice
Consider Jennifer, a 15 year old student who had a good time at a rock concert – as she put it – “screaming my lungs out” The problem, it’s been five days since the concert and the raspy quality to her voice has not gone away. The first day after the concert, she had “no voice at all.”
After examining the larynx -voice box- the doctor informed Jennifer and her mother that a blood blister (hematoma) was on Jennifer’s swollen and inflamed vocal folds. With voice rest and medication her voice returned to normal. The common cold is a more frequent cause of a raspy voice.
A nasal voice has been associated with cleft palate, enlarged adenoid tissue, rhinitis and other nasal conditions. Some voices lack enthusiasm, a monotone voice has been noted in Parkinson disease and depressed patients.
A crackling voice is one that unintentionally breaks into a weak and thin sound. These “voice breaks or drop outs” may occur when a singer holds a note or when going from one register to another, Also, boys during puberty experience voice breaks when the voice is getting deeper and changing.
For the voice to be in good shape, the lungs, larynx and vocal tract (the part above the voice box) must work in healthy harmony. Any disorder that interferes with the optimal, symmetrical movement of the vocal folds will result in hoarseness.
There are many other conditions that make your voice sound abnormal. The reality is that no clinician can always diagnose a patient’s problem by just listening to the sounds of the voice. She or he must obtain a good medical history of the voice problem, visualize the larynx and utilize the latest instrumentation to make an accurate diagnosis and initiate proper treatment.
Not every person with an abnormal voice needs a costly workup; however, if an unexpected change in the voice persists for three weeks or more, make an appointment to have your larynx examined by an ENT specialist.
References
Sataloff, Robert T.; Professional Voice; Singular Publishing Group, Inc.; San Diego, London.
Wood, Dan; Diane Rehm’s Voice; March 8, 2013
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.