Voice disorders – Clinical information for SLTs | RCSLT (2023)

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What are voice disorders?

Voice disorders are a range of conditions which affect the larynx. They can cause changes to the voice called dysphonia or loss of voice aphonia. These changes can affect the way the voice sounds, for example, making it sound hoarse, croaky, strained, breathy or weak. Voice disorders can also make the throat feel different, for example it might feel sore, achey or dry.

Voice disorders can cause difficulties in day-to-day life for some people. For example, it may be difficult to be heard by other people, or it may affect your work, school or hobbies. Voice disorders can also cause frustration, low mood or isolation in some cases.

Voice disorders have many different causes, including how you use your voice, lifestyle factors, medical conditions and many more. In some cases, a hoarse voice can be a sign of cancer or another medical condition, so if you have had a hoarse voice for more than three weeks, it is important to see your General Practitioner (GP). Most voice problems are not due to cancer, but it’s important to rule this out (Cancer Research UK, 2018).

Before you are referred to speech and language therapy for voice therapy, you will need to be seen by an ear nose and throat (ENT) doctor, who will look into your throat using a camera to establish what is causing your voice problem. This procedure is called an endoscopy, laryngoscopy or nasendoscopy.

You may be asked to attend a multidisciplinary voice clinic or joint voice clinic. This is a specialist clinic where an ENT doctor and a speech and language therapist (SLT), and sometimes other professionals, will look into your throat with a camera and work together to agree the best management plan.

How can speech and language therapy help with my voice condition?

SLTs have an important role in helping people with voice disorders. After seeing an Ear, Nose and Throat (ENT) Doctor, you may be referred to speech and language therapy for voice therapy.

Input by an SLT may include:

  • Helping you to understand what factors have contributed to your voice problem.
  • Giving you information and advice about your voice.
  • Suggesting things that you can do to improve your voice or reduce the impact that it is having.
  • Teaching you some therapy techniques and exercises to improve your voice. You will usually be asked to practice these regularly at home, a bit like physiotherapy for your voice.
  • Helping educate those around you (for example, your family, work or school, with your permission) about your voice condition and things that they can do to help.
  • Teaching you how to keep your voice healthy in the long-term.

Some voice conditions may improve by themselves, and many others respond well to voice therapy. In some cases, a voice problem may be long-term. In this case, your ENT Doctor and SLT will try to work with you to find ways to reduce the impact of the problem on your everyday life.

There are several simple things that you can do to look after your voice – download our factsheet for top tips (PDF).

What to expect from speech and language therapy

Your first appointment

On your first appointment, your SLT will usually want to gather as much information about you and your voice as possible, in order to determine a suitable treatment plan. Your SLT will ask you a number of questions about your health, your lifestyle, your well-being and how you use your voice.

Following this:

  • Your SLT will likely assess your voice in detail.
  • They may ask you to make some sounds and use your voice in different ways.
  • Your SLT may also wish to make a recording of your voice, with your permission, or analyse your voice using some software.
  • They may also ask you to complete some questionnaires about your voice problem and/or symptoms.

After this, your SLT will usually give you some information about how the voice works and about the nature of your voice problem. They will discuss with you whether they think voice therapy will be suitable for you, and talk about what that will involve. They may also suggest some strategies, such as lifestyle changes, that you can implement to help improve your voice.

If you are having another type of intervention, such as surgery on your voice, your SLT may give you information about the surgery, advise you about recovery and after-care and take recordings before and after your surgery. You may also be offered voice therapy after your surgery has been carried out.

Voice therapy

If voice therapy is thought to be appropriate, you will likely be offered some therapy sessions. In these sessions, you will be shown some voice exercises and you will usually be asked to practice these at home, perhaps several times per day.

When you return for your next session, your SLT will review your voice and your exercises, and may make adjustments to the exercises, such as making them more challenging or adding new ones. As well as therapy exercises, your SLT may want to discuss with you things that are affecting your voice, such as lifestyle factors or your mental well-being.

If voice therapy is not thought to be suitable for you, your SLT may discuss some ways to lessen the impact of your voice problem, for example by changing aspects of your environment, or by using strategies to reduce the demand on your voice.

Usually, SLTs will expect you to take an active role in your voice therapy. This may include carrying out the exercises regularly, implementing the advice or strategies that you have been given. Without this active engagement, your progress may be limited.


During your speech and language therapy input, your SLT may suggest that you are reviewed by the ENT Doctor or that you attend the multidisciplinary voice clinic for a review. This gives your SLT an opportunity to gain an up-to-date visual picture of your larynx in order to guide further management.


You are likely to be discharged from speech and language therapy when one of the following outcomes has been reached:

  • Your voice has improved to a level that you feel you can manage.
  • Your voice has improved as much as it is likely to, given the nature of your voice condition.
  • Your voice has not responded to voice therapy and another type of intervention is required.
  • Voice therapy has not been possible and is unlikely to be possible due to other factors.

Public health and voice disorders

The Faculty of Public Health defines public health as: “The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.”

Public health in relation to voice disorders:

  • A number of lifestyle factors and medical conditions can increase the risk of voice disorders. These include smoking, reflux, dehydration and air quality.
  • Some groups of people may be at higher risk of voice disorders due to their occupation or hobbies. These include teachers, performers, call centre workers and bar staff.
  • SLTs have an important role in both treating voice disorders and in providing education and training to high-risk groups to help prevent voice problems from occurring.

Further information:

For more information, log in to see the RCSLT’s information on public health.


Factsheets and leaflets


  • Position statement: speech and language therapists working with individuals with voice disorders (PDF)
  • Voice care factsheet (PDF)
  • Public health factsheet (PDF)

British Voice Association

A variety of leaflets and factsheets for both children and adults have also been produced by theBritish Voice Association.

Dystonia Society

Voice dystonia leaflet

Some hospitals also provide online and downloadable resources, for exampleGreat Ormond Street Hospital


Many videos are available online which explain and/or demonstrate voice conditions. Unless specifically stated, the RCSLT does not endorse these videos or the companies who have made them:

Contacts and websites

Related topics

For related topics please see:

  • RCSLT clinical information
  • Acquired Motor Speech Disorders
  • Aphasia
  • Brain injury
  • Dysfluency
  • Dysphagia
  • Head and neck cancer
  • Motor disorders
  • Neonatal care
  • Progressive neurological disorders
  • Respiratory care adults
  • Stroke

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What voice disorders can SLP diagnose? ›

Speech-language pathologists (SLPs) may refer individuals suspected of having a psychogenic voice disorder to other appropriate professionals (e.g., psychologist and/or psychiatrist) for diagnosis and may collaborate in subsequent behavioral treatment.
  • vocal tremor,
  • spasmodic dysphonia, or.
  • vocal fold paralysis.

What are the 4 types of voice disorders? ›

Some common voice disorders include:
  • Laryngitis.
  • Voice changes related to the brain and nervous system, known as spasmodic dysphonia (spaz-MOD-ki dis-FOE-nee-uh)
  • Polyps, nodules or cysts on the vocal cords — growths that aren't cancer.
  • Precancerous and cancerous growths.
  • Vocal cord paralysis or weakness.
Oct 7, 2022

What are functional voice disorders in Statpearls? ›

Functional voice disorders (FVD) are caused by insufficient or improper use of the phonation apparatus without either anatomical or neurological abnormalities. The most common FVDs include vocal fatigue, muscle tension dysphonia, diplophonia, and ventricular phonation.

What does an SLP do in voice therapy? ›

Speech-language pathologists (SLPs) specializing in voice therapy are involved in the diagnosis, assessment, planning, and treatment of individuals with voice disorders.

What are the three types of voice disorders? ›

Examples of voice disorders include:
  • Laryngitis. Laryngitis is when your vocal cords swell. It makes the voice sound hoarse. ...
  • Vocal cord paresis or paralysis. The vocal cords can be paralyzed, or partially paralyzed (paresis). ...
  • Spasmodic dysphonia. This is a nerve problem that causes the vocal cords to spasm.

Can an SLP diagnose vocal nodules? ›

Testing for Vocal Nodules and Polyps

You may want to see an otolaryngologist, or ear, nose, and throat doctor, who knows about voice problems. An SLP can test how your voice sounds. You may also see a neurologist, allergist, or other doctor, if needed.

What is the most common vocal disorder? ›

Some of the more common vocal cord disorders include laryngitis, vocal nodules, vocal polyps, and vocal cord paralysis. Vocal cord disorders are often caused by vocal abuse or misuse. Symptoms may include a raspy, hoarse, low, or breathy voice, or trouble swallowing or coughing.

What is the most common cause of voice disorders? ›

Overusing your voice is the most common cause of voice disorders. You can overuse your voice by yelling, singing or simply talking too much. Sometimes, voice disorders are the result of a short-term (acute) illness like a cold, allergies or sinus infection (sinusitis).

What is the difference between a voice disorder and a speech disorder? ›

What's the difference between a voice disorder and a speech disorder? Speech is the sound produced by the lips, tongue, palate and throat, while voice refers to sounds produced in the voice box. Many people seen at Ogden Clinic have speech and voice complications.

What are the two categories of voice disorders? ›

Types of Voice Disorders
  • Organic.
  • Functional: the physical structure is normal, but the vocal mechanism is being used improperly or inefficiently.
  • Psychogenic: the voice problem starts as a symbolic, or outward, manifestation of some unresolved psychological conflict.

What is a neurological disorder of the voice? ›

Dysphonia is the medical term for disorders of the voice. Spasmodic dysphonia (SD) is a neurological voice disorder that affects the voice muscles in the larynx, or voice box, causing it to “spasm.” These spasms cause the voice to be interrupted and affect voice quality.

What is the difference between functional and organic voice disorder? ›

Organic abnormalities of the anatomy, such as nodules, scars, cartilage subluxations, and nerve injuries, are likely to cause voice anomalies. A functional voice disorder should be suspected when vocal quality is compromised without any identifiable anatomical or neurological factors.

What is the highest paid speech therapist? ›

The best SLP jobs can pay up to $124,000 per year.

Speech-language pathologists assess, diagnose, and treat various aspects of communication disorders.

How do you treat hoarseness of voice speech therapy? ›

Types of Voice Therapy Exercises
  1. Breathing exercises. Breathing exercises help you use your diaphragm to control your breath, which can help produce a stronger, more consistent voice.
  2. Resonance exercises. ...
  3. Voice projection exercises. ...
  4. Pitch and intonation exercises. ...
  5. Stretching and relaxation exercises.
Aug 31, 2022

What is the difference between voice therapy and speech therapy? ›

Are speech therapy and voice therapy the same? Speech therapy is a term that encompasses a variety of therapies including voice therapy. Most insurance companies refer to voice therapy as speech therapy, but they are the same if provided by a certified and licensed speech-language pathologist.

How do you fix voice disorders? ›

How are voice disorders treated?
  1. Lifestyle changes. Some of these changes may help reduce or stop symptoms. ...
  2. Speech therapy. Working with a speech-language pathologist can help with certain voice disorders. ...
  3. Medicines. Some voice disorders are caused by a problem that can be treated with medicine. ...
  4. Injections. ...
  5. Surgery.

What is the difference between dysphonia and hoarseness? ›

Dysphonia may be broadly defined as an alteration in the production of voice that impairs social and professional communication. In contrast, hoarseness is a coarse or rough quality to the voice.

Can SLPs diagnose spasmodic dysphonia? ›

How is spasmodic dysphonia diagnosed? A speech-language pathologist may test voice production and quality. An otolaryngologist, a health care provider who specializes in the ear, nose and throat, can diagnose the disorder.

Can a SLP diagnose apraxia? ›

Diagnosis and Tests

Childhood apraxia of speech is usually diagnosed by a speech-language pathologist (SLP). SLPs have extensive training and skill in treating speech disorders. To diagnose CAS, an SLP will learn about your child's history, including any known medical problems.

Can an SLP do a laryngoscopy? ›

(For more information, see Voice Care Team.) Who performs laryngoscopy and stroboscopy? An otolaryngologist or speech-language pathologist typically performs laryngoscopy and/or stroboscopy. The examiner's training and background experience is critical in performing and evaluating laryngoscopy and stroboscopy findings.

What diseases affect the voice? ›

Common Conditions That Can Affect Your Voice
  • Acute Laryngitis. ...
  • Chronic Laryngitis. ...
  • Laryngopharyngeal Reflux Disease (LPRD) ...
  • Voice Misuse and Overuse. ...
  • Benign Vocal Cord Lesions. ...
  • Vocal Cord Hemorrhage. ...
  • Vocal Cord Paralysis and Paresis. ...
  • Laryngeal Cancer.

Who is at the most risk for developing a voice disorder? ›

Who is most susceptible to a voice injury? A. Teachers are most at risk for developing a voice disorder. Call center workers, lawyers, Realtors, 911 dispatchers and anyone who uses his or her voice professionally is also at risk.

What is dysponia? ›

Dysphonia refers to having an abnormal voice. It is also known as hoarseness. Dysphonia has many causes which are detailed below. Changes to the voice can occur suddenly or gradually over time. The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely.

What part of the body is responsible for voice disorder? ›

Your larynx is a hollow tube that connects your throat (pharynx) to the rest of your respiratory system. It helps you swallow safely and contains the vocal cords, so it's often called the voice box. Certain conditions and behaviors can damage your larynx and your voice, but some strategies and specialists can help.

What mental illness causes a change in voice? ›

Some people with schizophrenia display atypical voice patterns. Some atypical voice patterns have been associated with the negative symptoms of schizophrenia, including blunted affect (lack of vocal intonation) and alogia (poverty of speech).

Is a voice disorder a disability? ›

Many individuals with voice disorders may not realize that their conditions can be classified as disabilities under the law, entitling them to workplace accommodations and time off to pursue medical treatment.

What does a voice disorder sound like? ›

A hoarse, grating voice that can also sound strained or strangled or hoarse and breathy (known as adductor dysphonia) Odd sounding speech that is difficult to understand. Gradual or sudden difficulty speaking.

How do you know if you have a speech disorder? ›

Common symptoms experienced by people with speech disorders are: repeating sounds, which is most often seen in people who stutter. adding extra sounds and words. elongating words.

Is speech disorder a psychological disorder? ›

A psychogenic speech disorder is a speech disturbance that is caused by underlying psychological processes. This is in contrast to an organic speech or voice disorder, which has structural or neurologic components that cause the speech disturbance.

What is an example of a neurogenic voice disorder? ›

Examples of neurogenic disorders are vocal fold paralysis, vocal paralysis or spasmodic dysphonia. These disorders may make it difficult for patients to communicate with caretakers or loved ones, potentially leading to depression or oversight of disease progression.

What are examples of functional speech disorders? ›

Conclusions. Functional disorders of speech and voice may manifest in a variety of ways, including dysphonia, stuttering, or prosodic abnormalities. Given that these disorders have been understudied and may resemble organic disorders, diagnosis may be challenging.

Can SLPs diagnose muscle tension dysphonia? ›

Examination by a speech-language pathologist is very important in the diagnosis of muscle tension dysphonia. Improvement in voice through trial voice therapy techniques is key to determining that the vocal disorder is due to a muscular imbalance.

Can SLPs diagnose aphasia? ›

Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with aphasia.

Can a speech therapist diagnose auditory processing? ›

SLPs are responsible for evaluating and diagnosing problems in the linguistic processing of the auditory signal. Audiologists and SLPs share responsibility for diagnosing problems in the phonemic processing of the auditory signal (Richard, 2013).

What is SLP muscle tension dysphonia? ›

Muscle tension dysphonia (MTD) is one of the most common voice disorders. It occurs when the muscles around the larynx (voice box) are so tight during speaking that the voice box does not work efficiently. MTD is more prevalent among people in the 40- to 50-year-old age group, especially women.

How do you assess voice for spasmodic dysphonia? ›

How is the diagnosis of spasmodic dysphonia made? There is no specific test to diagnose SD. Diagnosis is based on the patient's description of the symptoms, the sound of the voice, and the laryngologist's and speech-language pathologist's observation of the vocal folds during speech.

What is the difference between muscle tension dysphonia and spasmodic dysphonia? ›

The squeezing together (hyperadduction) of the vocal folds that is the hallmark of muscle tension dysphonia is very similar to that of SD. SD is, by definition, spasmodic, meaning that squeezing is irregular; with dysphonia, however, squeezing is generally sustained in muscle tension.

How do SLPs treat spasmodic dysphonia? ›

Treatments for Spasmodic Dysphonia

Your doctor may inject botulinum toxin, or Botox, into one or both vocal folds. Botox makes the muscles in your larynx weaker. This may lead to a smoother voice. Be sure to talk to your doctor about possible side effects of Botox.

Is functional dysphonia the same as muscle tension dysphonia? ›

Muscle tension dysphonia is a “functional dysphonia,” whereby a pattern of muscle use develops from irritants, laryngitis or even stress, among other conditions. While the initial cause may go away, the voice changes remain because of the excessive squeeze or tension that results with voice use.

What is Bruce Willis diagnosis? ›

Willis, famous for his roles in dozens of movies, including “Die Hard,” “Pulp Fiction,” “Looper” and “The Sixth Sense,” was diagnosed with aphasia in March 2022. This month, his family said he has progressed to frontotemporal dementia.

Can an SLP diagnose cognitive impairment? ›

HOW SLPs IDENTIFY A MILD COGNITIVE IMPAIRMENT. SLPs use differential diagnosis to correctly identify a patient's needs. What distinguishes MCI from typical aging or dementia? Think of cognitive decline as a continuum.

Can a speech therapist diagnose dysarthria? ›

Testing for Dysarthria

An SLP can test your speech and language. This will help the SLP decide if you have dysarthria or another problem. The SLP will look at how well you move your mouth, lips, and tongue and how well you breathe.

What are the 5 types of auditory processing disorder? ›

There are five basic auditory processing disorder types, and some people may experience more than one type. These include hypersensitivity, decoding, integration, prosodic, and organizational deficit.

What is the difference between language disorder and auditory processing disorder? ›

A language processing disorder (LPD) is not the same as an auditory processing disorder (APD). In an LPD, language disorders in children will have trouble understanding the words they hear, while children with Auditory Processing Disorder have trouble hearing and interpreting the message (source).

Is Misophonia part of auditory processing disorder? ›

Sensory Processing Disorders

Auditory sensory processing abnormalities are both commonly present in misophonia including general sensory processing differences and sensory hypersensitivity (Wu et al., 2014).


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