Western Baptist Hospital provides therapy to persons with voice disorders caused by nodules as a result of overuse or misuse of the vocal cords.

What is a voice disorder?

A voice disorder causes the voice to draw attention to it. This may be a voice that sounds hoarse or harsh, has a too high or too low pitch, or a shaky quivering sound during speech activities.

How does the larynx/voice box produce sounds?

The larynx is made up of two cartilages that are suspended in the neck by a series of muscles that connect to the jaw and collarbone. This allows the larynx to rise and fall slightly in the neck during speech and singing. Inside the larynx are two vocal cords that are covered with a thin membrane of moist tissue. These vocal cords vibrate when air passes over them, much like the reed in a wind instrument. The vocal cords vibrate very quickly. For example, in women the vocal cords may vibrate 230 times a second. This vibration produces sound.

What is the cause of a voice disorder?

The otolaryngologist will examine the vocal cords to determine if there is a physical reason for the voice problem. Sometimes growths have formed on the vocal cords from overuse or in reaction to some trauma. The vocal cords may be inflamed and swollen from overuse. Sometimes the vocal cords look normal but the voice does not sound normal. There is a relationship between gastroesophageal reflux (heartburn) and certain voice disorders. The acid from the stomach may "burn" the vocal cords. Other problems with voice may result when the speaker overuses or inappropriately use his voice. When this occurs nodules develop on the vocal folds, much as calluses develop on our hands, due to excessive friction on the vocal folds, which occur during the periods of abuse/misuse. This problem has often been termed as "preacher's voice," "singer's voice," "cheerleader's voice," or "teacher's voice" as many in those occupations develop voice problems due to overuse or misuse.

How does the physical change in the vocal cords, such as nodules, cause my voice to sound different?

If you have a growth or nodule on your vocal cords, such as nodules, the cords are not able to close tightly. This is similar to trying to close a door when your foot is stuck in the doorway. If the vocal cords cannot close tightly and smoothly, the voice does not sound good. It will often sound breathy, harsh or hoarse. If misuse or overuse has caused the voice disorder, the cords might be slightly swollen and red (what we call laryngitis) or they may even be slightly bowed. This keeps the cords from closing smoothly. Many patients have reported their problems with their voice started with a "bad case of laryngitis."

If I have a growth on my vocal cords why can't my doctor remove it surgically?

Otolaryngologists often recommend speech/voice therapy to see if surgery can be avoided. Many times voice therapy is successful in reducing the size of, or eliminating the growths. Even if surgery is needed, voice therapy is still a good idea, as you will learn better ways to use your voice. If the growth is removed and you continue to use your voice as you always have, the growth may return.

What if the doctor can't see anything wrong with my vocal cords, but my voice still sounds hoarse?

Some times the vocal cords look healthy but the voice still sounds hoarse. This is probably due to misuse of the cords. The speech-language pathologist can teach ways to use the vocal cords to regain and keep a healthy voice.

What can a speech-language pathologist do to help my voice?

The speech-language pathologist may use a variety of techniques, including helping you identify the ways you are overusing your voice, such as talking all day at work, singing at night, etc. A healthy voice can be used throughout the day without problems. However, if you have a voice disorder and continue to use your voice as much as you have in the past, it will wear out. The speech-language pathologist will also teach you ways to use your voice that will help it sound better. These activities may include learning the correct way to breathe. You produce sound with your voice as you exhale. If you have developed faulty breathing patterns, this may be affecting your vocal quality.

The speech-language pathologist could also need to teach you exercises for your vocal cords so your voice lasts longer. This could include using a computer to help you see how you are using your voice and help you achieve the best pitch and loudness to keep your voice healthy.

Will my insurance pay for voice therapy?

Each insurance plan is different, but because voice disorders are related to something wrong with your vocal cords, there is a good chance that your insurance will pay.

For more information

For more information about voice therapy at Western Baptist Hospital or to schedule an appointment for outpatient speech therapy, please call the speech therapy department, located at the Baptist Rehab Center, at (270) 534-1200.

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