Voice is the sound produced by vibration of the vocal cords (vocal folds) in the larynx (voice box). A voice disorder occurs when the vocal folds do not vibrate effectively to produce a clear sound.


Causes of voice disorders can include abuse or misuse of the voice, such as yelling, excessive throat clearing, or speaking too loudly. These types of behaviors result in excessive hard closure of the vocal folds causing blister-like bruises that can harden into callous-like lesions called vocal fold nodules. Other causes of voice disorders can include Laryngo-Pharyngeal Reflux (excessive stomach acid backing into the larynx), vocal fold polyps, vocal fold paralysis, vocal fold cysts, etc.


  • Voice quality disturbance: breathiness, raspiness, harshness
  • Voice pitch disturbance: pitch too high for age and gender, pitch too low for age and gender, pitch fluctuates excessively, pitch is monotone
  • Voice volume is too low or too loud
  • Vocal fatigue (decreased stamina, increased hoarseness following speaking)
  • Effortful voice use (having to use too much effort to speak)


Voice evaluations are conducted by Speech-language pathologists who are experts in the area of voice. Evaluations include non-instrumental assessment and instrumental assessment. These assessments allow the Speech-language pathologist to measure the voice objectively, determine patterns that suggest how the larynx is functioning physically, and determine whether there is a hyper functional or hypo functional component present. Voice disorders are complex and this type of evaluation helps determine whether behavioral voice therapy, surgery or a combination of approaches would best serve the patient.


Types of voice treatment may include:

  • Vocal strengthening- exercises that can improve voice quality and stamina and can also reduce symptoms of vocal effort and fatigue. Examples of exercises are repetitions of high speech sounds, pitch glides, or glottal closure. These exercises are often used with singers.
  • Reduction of vocally abusive behaviors- During the evaluation and interview, vocally abusive behaviors are often identified. Some examples include:  talking in competition with background noise, yelling, throat clearing, loud cell phone use, not using a microphone, etc. In the treatment session, goals can be made to improve or eliminate these behaviors and provide strategies for care of the voice. 
  •  Improvement in vocal technique- improving respiratory support for proper voice use, reducing hard glottal attack, and improving vocal resonance. Goals are created during voice therapy sessions and home exercises are provided for continued practice. Carryover of these techniques into everyday situations is also expected.   
  •  Pre and Post surgical treatment- Counseling of proper voice care before and/or after vocal fold surgery can significantly improve surgical outcomes and assist patients in healthy return to voice use following surgery. Patients can expect gradual return to voice use following surgery.

Quick Reference

Phone 336-716-3103
Fax 336-716-7300

8 am - 5 pm Mon-Fri
Adult Speech Pathology
Hearing and Speech
4th Floor Janeway Tower
Medical Center Boulevard
Winston-Salem, NC  27157
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Last Updated: 07-08-2014
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.