What is a voice disorder?

voice disorder occurs when voice quality, pitch, and loudness differ or are inappropriate for an individual’s age, gender, cultural background, or geographic location (Aronson & Bless, 2009; Boone et al., 2010; Lee et al., 2004). A voice disorder is present when an individual expresses concern about having an abnormal voice that does not meet daily needs—even if others do not perceive it as different or deviant (American Speech-Language-Hearing Association [ASHA], 1993; Colton & Casper, 2011; Stemple et al., 2010; Verdolini & Ramig, 2001).

For the purposes of this document, voice disorders are categorized as follows:

  • Organic—physiological voice disorders that result from alterations in respiratory, laryngeal, or vocal tract mechanisms.
    • Structural—organic voice disorders that result from physical changes in the vocal mechanism, such as
      • alterations in vocal fold tissues (e.g., edema or vocal nodules) and/or
      • structural changes in the larynx due to aging.
    • Neurogenic—organic voice disorders that result from problems with the central or peripheral nervous system innervation to the larynx that affect functioning of the vocal mechanism, such as
      • vocal tremor,
      • spasmodic dysphonia, or
      • vocal fold paralysis.
  • Functional—voice disorders that result from inefficient use of the vocal mechanism when the physical structure is normal, such as
    • vocal fatigue,
    • muscle tension dysphonia or aphonia,
    • diplophonia, or
    • ventricular phonation.

Voice quality can also be affected when psychological stressors lead to habitual, maladaptive aphonia or dysphonia. The resulting voice disorders are referred to as psychogenic voice disorders or psychogenic conversion aphonia/dysphonia (Stemple et al., 2010). These voice disorders are rare. 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.

The complementary relationships among these organic, functional, and psychogenic influences ensure that many voice disorders will have contributions from more than one etiologic factor (Stemple et al., 2014; Verdolini et al., 2006). For example, vocal fold nodules may result from behavioral voice misuse (functional etiology). However, the voice misuse results in repeated trauma to the vocal folds, which may then lead to structural (organic) changes to the vocal fold tissue.

SLPs may also be involved in the assessment and treatment of disorders that affect the laryngeal mechanism (i.e., the aerodigestive tract) and that are not classified as voice disorders, such as the following:

  • Paradoxical vocal fold movement (PVFM)—a condition in which there is intermittent adduction of the vocal folds that interferes with breathing. When this is suspected, SLPs may be consulted to help identify abnormal laryngeal and respiratory function and to teach various techniques (e.g., vocal exercises, relaxation techniques, quick-release breathing techniques, and proper breath management) to improve laryngeal and respiratory control (Mathers-Schmidt, 2001; Patel et al., 2015; Traister et al., 2016).
  • Exercise-induced laryngeal obstruction (EILO)—EILO is most often diagnosed in adolescence and is typically due to obstruction at the laryngeal level due to inappropriate glottic closure or adduction/collapse of supraglottic structures (Maat et al., 2011). EILO may go by other names such as supraglottic airway obstruction during exercise (Murry & Milstein, 2016).

For further information, see ASHA’s Practice Portal page on Aerodigestive Disorders.