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Causes of Voice Disorder

 Most voice disorders and laryngeal pathologies will have contributions from more
than one etiologic factor and that there is considerable overlap among these three
groupings. For example, inappropriate vocal behaviors or excessive vocal demands
may generate organic pathology (e.g., polyps or nodules). Psychological trauma or
excessive emotional stress may accompany the onset of spasmodic dysphonia.
 Any disturbances in the physiologic balance of vocal subsystems (Respiratory
system, phonation system, and resonance system) may lead to voice disturbances.

A) Functional misuse or abuse of the voice components

(Respiration, phonation, resonance, pitch, loudness, and
rate):

Vocal hyperfunction may be characterized by intermittent periods of laryngeal area

tension, as may occur when someone shouts or clears the throat (1).
1) Inappropriate respiration:
o Reduced respiratory support
2) Inappropriate phonation:
o Glottal attacks
o Glottal fry
o Breathy phonation
3) Inappropriate resonance:
4) Inappropriate pitch:
o Using too low pitch
o Using too high pitch
5) Inappropriate loudness
o Using too loud voice
o Using too soft voice

6) Functional causes (2):

1) Diplophonia
2) Falsetto
3) Vocal Fold thickening
4) Functional aphonia
5) Functional dysphonia
6) Muscle tension
7) Nodules
8) Phonation breaks
9) Pitch breaks

Dr.Hani Abdulsattar Shaker

Medical Speech & Swallowing Disorders
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10) Polyps
11) Reinke's edema
12) Traumatic laryngitis
13) Ventricular dysphonia

B) Pathological causes:

1) Congenital:
o Laryngomalacia
o Laryngeal web

2) Trauma:
o Thermal and chemical burns
o Swallowing of sharp objects
o Gastroesophageal reflux
o Laryngeopharyngeal reflux
o Vocal abuse and misuse.
o Puberphonia/ Mutational Falsetto  Persistence of high pitched voice
beyond the age at which voice change is expected to have occurred.
o Phonation and pitch breaks

3) Infections:
o Viral laryngitis
o Bacterial laryngitis
o TB
o Fungal laryngitis

4) Allergic laryngitis

5) Tumor
o Vocal nodules
o Vocal polyps
o Reinke's edema/ polypoid degeneration
o Vocal cord granulomas/ contact ulcer
o Vocal cord cyst
o Laryngeal papilloma
o Squamous cell cancer of the larynx
o Hemangioma
o Laryngeal adenoma
o Hyperkeratosis
o Leukoplakia

6) Neuromuscular:
o Vocal folds paralysis
o Spasmodic dysphonia

Dr.Hani Abdulsattar Shaker

Medical Speech & Swallowing Disorders
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o Velopharyngeal weakness
o Paralysis and Ankylosis
o Spastic Dysarthria
o Ataxic Dysarthria
o Paradoxical Vocal Folds Motion (PVFM)
o Myasthenia Gravis
o Cerebrovascular accident
o Parkinson's disease
o Essential tremor
o Multiple Sclerosis
o Amyotrophic Lateral Sclerosis (ALS)
7) Endocrine:
o Hypothyroidism (myxedematous laryngitis)
o Sex hormone imbalance
o Pubertal changes

8) Drug effects:
9) Miscellaneous:
o Vocal cord atrophy
o Vocal cord scarring
o Muscle tension dysphonia
o Medications (Anti-histamine – Anti-depressant – Large Vitamine C
doses)
o Presbylaryngis (age-related voice changes)
o Subglottic and tracheal stenosis
o Zenker's diverticula
o Barrett's esophagus
o Sulcus vocalis
o Contact ulcers

C) Psychogenic Voice Disorders

Works Cited
1. Stemple, J.C., Glace, L. and Klaben, P.B. Survey of voice management. Clinical Voice
Pathology: Theory and Management. 3rd. San Diego : Singular Publishing Group, 2000, pp.
312-314.
2. Shipley, K.G. and McAfee, J.G. Assessment of Voice and Resonance. Assessment in
Speech-Language Pathology: A Resource Manual. 3rd. Clifton Park : Thomson Learning Inc,
2004.

Dr.Hani Abdulsattar Shaker

Medical Speech & Swallowing Disorders