From the Guidelines
Dysphonia is a voice disorder characterized by abnormal changes in voice quality, pitch, or volume, and clinicians should identify it in patients with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL) 1. It occurs when the vocal cords (vocal folds) in the larynx don't vibrate properly during speech, resulting in a hoarse, raspy, strained, or weak voice. Common causes include vocal cord inflammation, nodules, polyps, muscle tension, neurological conditions, or overuse of the voice.
Key Characteristics of Dysphonia
- Abnormal changes in voice quality, pitch, or volume
- Impaired communication or reduced quality of life (QOL)
- Can be caused by various factors, including vocal cord inflammation, nodules, polyps, muscle tension, neurological conditions, or overuse of the voice Treatment depends on the underlying cause and may include:
- Voice therapy with a speech-language pathologist
- Medication for inflammation or acid reflux
- Proper hydration
- Voice rest
- In some cases, surgery
Importance of Early Intervention
If you experience persistent voice changes lasting more than two weeks, you should seek medical evaluation from an otolaryngologist (ENT doctor) for proper diagnosis 1. Early intervention is important as some causes of dysphonia can worsen if left untreated. The condition affects many people, particularly those who use their voices professionally such as teachers, singers, and public speakers, but can impact anyone's ability to communicate effectively 1.
Recommendations for Clinicians
- Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist (SLP) 1
- Clinicians should advocate for surgery as a therapeutic option for patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency 1
- Clinicians should offer, or refer to someone who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia 1
From the Research
Definition of Dysphonia
- Dysphonia is any alteration of voice quality or vocal effort that impairs communication and affects quality of life 2
- It occurs when normal voice quality is altered, caused by structural and/or functional issues 3
Characteristics of Dysphonia
- Voice qualities often are described as tremulous, hoarse, strained, or raspy, with altered pitch, breathiness, or vocal fatigue 2
- Dysphonia can have a substantial influence on interpersonal interactions and lower overall quality of life since effective communication relies significantly on spoken language 3
Causes and Risk Factors
- The most common cause of dysphonia is acute laryngitis, with the majority of cases lasting fewer than 3 weeks 2
- Longer duration of symptoms occurs with chronic laryngitis, laryngopharyngeal reflux, muscle tension dysphonia, benign vocal fold lesions, vocal fold paresis or paralysis, and spasmodic dysphonia 2
- Laryngeal malignancy is uncommon; the major risk factors are smoking and concurrent alcohol use 2
- Etiological factors of muscle tension dysphonia can be categorized into three subgroups: psychological and/or personality factors, vocal misuse and abuse, and compensation for underlying disease 4
Evaluation and Management
- Evaluation includes a history, physical examination, and, in some cases, laryngoscopy 2
- Laryngoscopy should be performed in all patients with dysphonia that does not resolve or improve within 4 weeks or of any duration if a serious underlying etiology is suspected 2
- Management is directed at the underlying etiology, and may include vocal hygiene, voice therapy, pharmacotherapy, and surgery 2, 3
- Speech and language therapy is often the first-line treatment option for dysphonia patients who do not meet the criteria for surgical intervention 3