What Causes Voice to Change?

There are a variety of medical conditions that may lead to voice changes and problems

There are a variety of medical conditions that may lead to voice changes and problems:

Voice misuse and overuse:

• Excessively loud, prolonged voice use can lead to voice fatigue.
• Excessive tension in the neck and laryngeal muscles, as well as poor breathing technique during speech, leads to vocal fatigue or weakness, increased vocal effort, and hoarseness.
• Voice misuse and overuse cause the vocal cords to swell or bruise leading to hoarseness.

Benign vocal cord lesions:

• These are noncancerous growths or bumps on the vocal cords most often caused by talking too loudly and shrill, which causes injury or trauma to the vocal cords.
• These lesions or bumps on the vocal cord alter vocal cord vibration and lead to hoarseness. The most common vocal cord lesion occurs at the point of maximal wear and tear. These are usually treated with voice therapy to eliminate the vocal trauma that is causing them.
• These types of problems typically require microsurgical treatment for cure. Sometimes, voice therapy is also used, and a combined treatment approach is given to patients.

Laryngopharyngeal reflux disease (LPRD):

• Reflux of stomach acid into the throat can cause a variety of symptoms in the esophagus (swallowing tube) as well as in the throat.
• Hoarseness, swallowing problems, sensing a lump in the throat, or throat pain are common symptoms of stomach acid irritation of the throat.
• LPRD can occur without any symptoms of frank heartburn and regurgitation that traditionally accompany gastroesophageal reflux disease (GERD).

Acute laryngitis:

• It is the most common cause of hoarseness and voice loss that starts suddenly.
• Most cases of acute laryngitis are caused by a viral infection that leads to swelling of the vocal cords. When the vocal cords swell, they vibrate differently, leading to hoarseness.
• The best treatment for this condition is to stay well hydrated and rest or reduce the use of voice.
• Serious injury to the vocal cords can result from strenuous voice use during an episode of acute laryngitis.
• Since most acute laryngitis is caused by a virus, antibiotics are not effective. Bacterial infections of the larynx are much rarer and often are associated with difficulty breathing.
• Any problems breathing during an illness warrants emergency evaluation.

Severe or chronic laryngitis:

• It is a nonspecific term, and an underlying cause is yet to be identified.
• Chronic laryngitis can be caused by acid reflux disease, exposure to irritating substances (such as smoke), and low-grade infections (such as yeast infections of the vocal cords in people using inhalers for asthma).
• Patients with low immunity or who are receiving chemotherapy can develop severe laryngitis.

Laryngeal cancer:

• It is a serious condition requiring immediate medical attention. Severe hoarseness warrants evaluation by a doctor to rule out laryngeal cancer.
• It is important to remember that prompt attention to voice changes facilitates early diagnosis.
• Laryngeal cancer is highly curable if diagnosed in its early stages.

Hormone changes:

• Hormonal changes can affect the voice. Therefore, boys’ voice “break” around puberty, and some pregnant women notice a deeper voice.
• The lack of thyroid hormone sometimes causes swelling of the vocal cords and a husky voice.

Upper respiratory infection:

• Voice changes sometimes follow an upper respiratory infection lasting up to 2 weeks. 
• Typically, the upper respiratory infection or cold causes swelling of the vocal cords and changes their vibration resulting in an abnormal voice.
• Reduced voice use (voice rest) typically improves the voice after an upper respiratory infection, cold, or bronchitis.
• If the voice does not return to its normal characteristics and capabilities within 2-4 weeks after a cold, a medical evaluation by an ENT (ear, nose, and throat) specialist is recommended.
• A throat examination after a change in the voice lasting longer than 1 month is especially important for smokers.

Allergies/irritants and injuries:

• Seasonal allergies can cause runny nose and itchy eyes as well as voice changes, such as hoarseness. 
• Substances, such as alcohol and smoking, may directly irritate the vocal cords.
• Medications, such as inhaled corticosteroids for asthma, can cause voice changes. Also, situations that require intubation (a tube placed in your larynx to assist with breathing) during surgery can cause injury and irritation of the larynx.

Vocal fold paralysis:

• Vocal fold paralysis is damage to the recurrent laryngeal nerve or superior laryngeal nerve that can produce a vocal fold paralysis.
• These are branches of the X cranial nerve. When the vocal fold is paralyzed, it loses its mobility causing voice problems and changes.

For many voice problems, resting vocal cords is all that is needed, although this can be difficult for some people. If patients have extremely serious or chronic voice problems, they may need medicines, surgery, voice therapy, or a combination of these. Treatment frequently succeeds in restoring the voice to normal. However, it may take some time for the voice to return to normal, depending on the severity and causes of the voice problem.