Voice and speech disorders

Voice and speech disorders are conditions that affect your ability to communicate. A voice disorder occurs when your vocal cords don’t vibrate normally. It may affect the pitch, quality, or sound of your voice. A speech disorder makes it difficult to create sounds that form words and to communicate with others.

Penn Medicine voice, speech, and swallowing specialists offer comprehensive care for a range of voice and speech disorders. Our team includes highly trained experts from otolaryngology and speech and language pathology. If your condition is related to airflow challenges, we work with our pulmonary medicine team to tailor a care plan for you.

If you have a voice or speech disorder, you may experience the following symptoms:

• Changes in the pitch of your voice
• Hoarseness that lasts for more than two weeks
• Pain or a lump in your throat when you talk
• Speech that sounds odd or different than normal
• Voice that’s too loud or too soft

When you talk, sound is produced by air pressure from your lungs through your windpipe, which vibrates your vocal cords. A disruption in airflow or vocal cord vibration can make it difficult to form the sounds you need to speak.

Conditions that can lead to voice disorders include:

• Hearing loss
• Spasmodic dysphonia
• Throat cancer
• Vocal cord lesion
• Vocal cord strain
• Vocal cord paralysis

Adults may also develop dysarthria, a speech disorder that can result from previous head and neck surgery or a nerve or brain disorder, such as:

• Bell’s palsy (nerve disorder that weakens facial muscles, causing slurred speech)
• Dementia
• Neurological disorders affecting the brain, such as Parkinson’s disease and Huntington’s disease
• Neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS), cerebral palsy, myasthenia gravis, and multiple sclerosis
• Stroke
• Traumatic brain injury
• Transient ischemic attack (temporary stroke)

These disorders can make it difficult to control the lips, tongue, larynx, and vocal cords, which work together to produce speech. As a result, you have trouble expressing certain sounds or words. You may slur your words, speak too quickly or slowly, or speak with uneven rhythms.

A person experiencing dysarthria may also have swallowing problems.

To diagnose a voice disorder, your doctor will start by asking about your symptoms and medical history. Then, they will likely examine your throat. Your doctor may give you a numbing medication to keep you comfortable during these exams. The tools they use for the exam may include:

• Mirror: a long, angled mirror similar to what a dentist uses
• Flexible laryngoscope: a bendable tube with a light and camera that’s inserted through your nose
• Rigid laryngoscope: a rigid tube that goes through your mouth
• Videostroboscope: tool that enables your doctor to get a slow-motion view of your vocal cords

Your doctor may recommend other tests as well. For example, a sound analysis uses a computer to measure anything odd in the sound your vocal cords make. A laryngeal electromyography (EMG) measures electric currents in your voice box muscles via tiny needles.

To diagnose a speech disorder, you’ll need to meet with a speech-language pathologist, who is specially trained to diagnose and treat conditions that impact your ability to communicate. They may recommend tests such as:

• CT scan or MRI of your brain, head, or neck
• Electroencephalogram (EEG) to measure electrical activity in your brain
• Electromyogram (EMG) to assess how your muscles respond to electrical activity from your nerves

Our approach at Penn Medicine includes surgical and non-surgical treatments. If your voice issue has only lasted a few weeks, you may be able to heal by simply resting your voice and drinking plenty of fluids. If that doesn’t help, medication may be an option. Depending on the cause of your voice disorder, your doctor may recommend prescription or over-the-counter allergy medicine or non-steroidal anti-inflammatory drugs.

In some cases, you may need a procedure to treat a voice disorder. For example, if you have a growth on your vocal cords, your doctor may recommend removing it with a laser. If you’re experiencing muscle spasms around your voice box (larynx), you may need botulinum toxin injections to relax them.

Working with a speech-language pathologist can help with voice and speech disorders. They teach you exercises and techniques that help you communicate more clearly.