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What is a Voice Disorder?

Understanding and Treating Damaged Vocal Folds

The way we perceive ourselves is intricately tied to the sound of our voices. When disruptions to one’s vocal function arise such as discomfort or pain when speaking, difficulty controlling various aspects of voice, changes to quality or expressivity, and fatigue, it can provoke a significant sense and anxiety.

Often vocal issues extend beyond mere discomfort; they can significantly impact an individual’s daily life and sense of self. For professionals who rely on their voice, such as teachers, singers, or public speakers, these conditions can interfere with job performance and overall quality of life. Social interactions may be affected, leading to feelings of frustration, isolation, and diminished self-confidence.

If disruptions to voice occur, it can be a sign of damage to the vocal folds or structures involved in voicing. In this blog, we will review various voice conditions including true vocal fold nodules (TVF nodules), polyps, redness, inflammation, and muscle tension dysphonia. Understanding these conditions is crucial for individuals seeking solutions to enhance their vocal health and overall well-being.

Understanding True Vocal Fold Nodules

True vocal fold (TVF) nodules are non-cancerous, callus-like growths that develop on the true vocal folds. They typically result from prolonged vocal strain and misuse. Consistent misuse can alter the coordination of the subsystems of respiration/breathing, phonation/voicing, articulation, and resonance. This can give rise to ineffective breathing patterns and increased muscle tension in the larynx which alters how the vocal folds move and vibrate. Over an extended period, these patterns can lead to swollen areas on your vocal folds, usually near the midline, spurring phonotrauma-like TVF nodules as these areas harden and callus.

TVF nodules can cause the voice to sound hoarse, breathy, and strained. It can also make it difficult to reach high or low notes and easily intonate to convey expression when speaking. Those who require the use of their voice professionally, such as singers, actors, voice artists, and teachers, are particularly susceptible.

In addition to significant impacts on voice quality, TVF nodules may lead to discomfort and pain when speaking or singing.

Speech therapy exercises are practiced with the support of a licensed speech-language pathologist who specialize in training individuals in healthy vocal hygiene and the use of optimal breathing and voicing techniques. Given the right treatment plan, TVF nodules will usually heal and healthy vocal function will be restored.

Exploring Vocal Fold Polyps

Similar to TVF nodules, vocal fold polyps are lesions on the vocal folds. They differ in that polyps are typically larger, present as fluid-filled blisters, vary in shape, and may appear on one or both vocal folds. They often develop due to vocal abuse such as intense yelling at a concert, or following adverse long-term habits. Negative habits are such as smoking, loud talking, chronic overuse, allergies, and consuming caffeine and alcohol which are dehydrating. In some instances, they can arise in the face of underlying medical conditions such as thyroid conditions, or chronic acid reflux. In all of these instances, the vocal folds have experienced damage, causing swelling, and contributing to phonotrauma which will alter the movements and function of the vocal folds and laryngeal structures.

The American Speech and Language Association (ASHA) outlines the following symptoms of polyps and TVF nodules:

  • Hoarseness
  • Breathiness
  • A “rough” voice
  • A “scratchy” voice
  • A harsh-sounding voice
  • Shooting pain from ear to ear
  • Feeling like you have a “lump in your throat”
  • Neck pain
  • Less ability to change your pitch
  • Voice and body tiredness

Addressing Redness and Inflammation

Redness and inflammation of the vocal folds are indicative of irritation and stress on the vocal folds. This condition can be caused by various factors, including viral infections, acid reflux, medications, allergies, dehydration, or exposure to environmental irritants like smoke. Prolonged inflammation of the vocal folds can disrupt their smooth vibration, resulting in a scratchy or sore throat, persistent cough, and voice fatigue.

In these kinds of circumstances, it’s common for there to be overlapping issues. While voice troubles may stem from functional causes due to the misuse, overuse, or inefficient use of the voice, such practices can result in recurrent trauma to the vocal folds. This potentially leads to structural (organic) changes in the highly sensitive laryngeal and vocal fold tissue. While initial anatomical problems may be absent, the voice may subsequently be employed in ways that are ineffective or harmful. This may prompt individuals to exert excessive muscular effort during speech to compensate for symptoms of fatigue and difficulty projecting.

Muscle Tension Dysphonia (MTD):

Muscle tension dysphonia is a voice disorder characterized by excessive tension in the laryngeal muscles surrounding the vocal folds. This tension can be triggered by stress, anxiety, or vocal misuse. In many cases, it arises as a secondary symptom following prolonged misuse, overuse, or inefficient use of the voice system. Individuals tend to compensate for voice symptoms such as hoarseness or difficulty projecting by over-exerting muscular effort during speech leading to MTD.

Individuals with MTD may experience pain, discomfort, and fatigue. Some may note their voice sounds strained and tense or, it may be challenging to speak loudly or maintain vocal stamina.

Diagnosis and Treatment

Accurate diagnosis and tailored treatment plans are essential for addressing vocal issues effectively and efficiently. If difficulties have persisted for 2 to 3 weeks, seeking the expertise of a licensed speech-language pathologist and otolaryngologist (ENT) is crucial. Individuals should also consider consulting an allergist or neurologist when appropriate.

This team of healthcare professionals will guide you through a series of tests designed to gather data about how your voice sounds. In addition to voice data, the tests also visualize how the voice structures are moving, and learn more about the impact of vocal difficulties on your daily lived experience to determine an accurate diagnosis and better understand your goals and needs.

In addition to listening to how various aspects of your voice quality, pitch range, resonance, volume, and stamina sound under various conditions, specialists may also use a variety of diagnostic tools. Tools such as laryngoscopy or videostroboscopy are utilized to visualize the vocal folds when phonating (voicing) and identify potential structural (organic) issues.


Rehabilitation plays a crucial role in restoring and optimizing vocal health. Open Lines® offers specialized vocal wellness programs designed to address various vocal challenges. All individualized treatments for vocal wellness programs begin with a one-to-one evaluation with a licensed speech-language pathologist. Our experienced and uniquely trained clinicians consider various factors, including age, severity, and the underlying cause (etiology) of the disorder. Additionally, the specific vocal requirements in diverse settings, such as school, home, and work environments, are taken into careful consideration during the treatment planning process.

Open Lines® clinical approach adheres to the highest standards of evidence-based interventions following a structured hierarchy of sensorimotor speech therapy exercises aimed at enhancing the strength, ease, and efficiency of voicing. Progressing from simpler to more complex tasks, we also incorporate conversational and simulated professional demands to facilitate the transfer of skills to your everyday communication requirements. The ultimate objective is to guide you in discovering your authentic voice – a voice that is distinctly yours and feels effortless and natural.

If you’re struggling with communication difficulties, it’s time to turn to Open Lines®. Contact us via phone (212-430-6800), email [email protected], or by filling out our convenient contact form. Improve your communication skills and unlock your potential with Open Lines® Speech and Communication in New York today!

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