UNC Health Care
An illustration of a woman holding her throat.

Have a Problem with Your Voice?

Let’s set the scene: You’re at a sporting event cheering on your favorite team as loudly as you can. Toward the end of the game you start losing your voice from all the yelling. The next day, you sound hoarse and have a sore throat. Is it something that will get better on its own, or should you see a doctor?

Rupali (Pali) Shah, MD, is an otolaryngologist (ear, nose and throat doctor) at the UNC Voice Center. She treats patients for a wide range of voice and throat disorders and collaborates with other Voice Center members to provide tailored treatments that include medical, surgical and behavioral approaches.

To understand voice health, it’s good to know how your voice actually works. To make noise from our mouths, we use many parts of our body. The lungs act like a generator, providing air that “powers” the vocal cords. The vocal cords, also called folds, vibrate to regulate the flow of air from the lungs. That air then flows into your resonant chambers—the head, face, lips and sinuses—which give us each our unique sound.

“A good voice is crucial to human communication and an essential working tool in certain occupations,” Dr. Shah says. “Those with high vocal demands, such as singers, teachers or professional speakers, are at a higher risk of developing a voice disorder.”

Voice disorders can develop over time, or less commonly, can happen after one-time events. Here are some common symptoms and voice disorders to know about.

Hoarseness

Whether from sickness or a bout of cheering, your voice has probably sounded hoarse at some point. Hoarseness can be experienced in a variety of ways. The voice may be rough, raspy, breathy, weak or tight, or there may be a change in pitch or the inability to hit a note while singing.

That raspy rattle we call “losing your voice” isn’t always immediate cause for concern. If you rest your voice and stay hydrated, or recover from a cold, there may be nothing to worry about, Dr. Shah says.

If hoarseness lasts for more than two weeks, you should visit an ear, nose and throat (ENT) doctor to investigate the underlying cause.

A variety of voice disorders can cause hoarseness. To diagnose a voice disorder, ENTs use a procedure called videostroboscopy, which uses a very small camera to look at the vocal cords with a strobe light that helps see vibration.

Lesions from Overuse or Misuse of the Voice

Sometimes overuse or misuse of the voice can cause phonotraumatic lesions, or lesions on the vocal cords.

“A scream or a cough, or overuse, can cause a vocal fold hemorrhage,” Dr. Shah says. “This means that a tiny blood vessel on the vocal fold has ruptured, getting small amounts of blood in the vocal fold that can cause hoarseness.”

A hemorrhage is usually treated with rest, but it is important to consult an ENT for specific recommendations.

Vocal nodules are another example of a phonotraumatic lesion that could change the quality of your voice. A nodule, or node as it is sometimes called, is like a callus of the vocal folds. Nodules are best treated with voice therapy by a speech language pathologist.

Lesions also include vocal cord cysts, which have a fluid-filled or semisolid center, and polyps, excess fluid or blood in one of the layers of the vocal folds.

Polyps and cysts sometimes require surgery to remove them and sometimes voice therapy after for rehabilitation.

Neurologic Voice Disorders  

Spasmodic dysphonia is a neurologic condition that affects the muscles of the larynx. Specific muscles spasm and interrupt smooth speech. Symptoms include a tight, strained voice and breaks in pitch. There is no cure; however, there are treatments available, such as voice therapy and injecting Botox into the vocal folds.

A breathy or weak voice could indicate a unilateral vocal cord paralysis, which is when one vocal cord doesn’t move and therefore doesn’t close well while producing sound, possibly as a result of injury to the nerve that moves the vocal cord or infection. This can make talking a challenge. This paralysis can be treated in a number of ways, including injections that bring the vocal cord closer to the middle of the voice box or a procedure called thyroplasty, which uses an implant to reposition the vocal cord.

Voice Box (Laryngeal) Cancer

If throat soreness or hoarseness in your voice lasts more than two weeks, you should be evaluated by an ENT. Symptoms of laryngeal, or voice box cancer, include hoarseness, pain with swallowing, difficulty swallowing, lump in the neck, persistent sore throat, and in advanced cases, difficulty breathing. Voice box cancer is rare, but major risk factors include smoking and drinking alcohol.


If you are concerned about your voice quality, talk to your doctor or make an appointment with an ENT physician specializing in voice and swallowing disorders.