The term voice disorder covers a huge spectrum of possible problems. If you think of voice
production, it's best to think of it in having three components. First is, you have to have
enough air coming up through the vocal cords to produce-- to make the vocal cords vibrate
and produce noise, the voice box itself has to be working properly to produce the raw
sound that then becomes your voice and thirdly, you have different structures between the
voice box on the outside world, which form words from that noise. They are things like
your tongue and your cheeks and your lips. All it takes is for one of these components
to go a little bit wrong and you have a voice disorder. There have been various studies
looking at how common voice disorders are. Needless to say, they all have slightly different
results, but generally, up to about 30% of adults would have had a voice problem at some
point and at any one point, probably 6% to 7% of adults will have an ongoing problem
with their voice. If you look at the elderly population, those numbers are higher with
up to about 50% of people having had a voice disorder. Certain subgroups as well have a
higher proportion of voice disorders and usually those are professional voice users and groups
such as teachers in particular.
So, in modern society there is an increasing demand for oral communication in many occupations.
It's been estimated that up to about a third of occupations need good oral communication.
If you think of the obvious ones such as teachers, entertainers, singers, lawyers, clergy, sales
representatives, fitness instructors, these people have to look after their voices and
there are many things which can contribute to problems with the voice, such as poor acoustics,
poor atmosphere, vocal load, which means how much they have to talk and how loud they have
to talk and how far they have to-- how long they have to talk for. If you think of some
professions such as actors and singers, they will often have vocal coaching prior to starting,
which means that they get lots of tips and help to help them with producing a good voice
and keeping it in good condition. Whereas many other occupations such as teachers often
don't get any help at all and are just expected to go into a very variable environment and
use their voice for prolonged periods of time. So, often those professions will have more
of an issue in terms of keeping their voice healthy.
There are two reasons for seeing a doctor with a voice problem. The first would be to
exclude serious physical cause for it. For example, a cancer of the voice box. You can
have other cancers causing a problem with the voice which don't directly affect the voice
box. For example, you can have tumours affecting the nerve which goes to the voice box or the
vocal cords; which can affect that nerve and if that nerve is damaged, then the voice box
doesn't work properly, and you get a hoarse voice. If you had a hoarse voice for a prolonged
period of time, so, for example, three weeks, then I think you should go and see your doctor
about it, particularly if you are at a high-risk group of getting a cancer of some sort. For
example, if you're a smoker. The other reason for going to see a doctor would be if your
voice problem is impinging on your ability to do your job, or if it's just affecting
your communication ability. So for example, if you're a teacher and you start in the morning
with a very normal voice, but during the day, that voice becomes sore and hoarse, so that
you're struggling by the end of the day, but recovers again the following day, it's very
unlikely that that can be anything sinister or serious, but you really do want that looked
at because in order to be able to continue doing your job, then you need to have that
addressed so that you can continue to use your voice where you want to. The only way to know
how best to address the problem would be to get an accurate diagnosis of what's causing
it, and hence the need to see a doctor.
Many of them can, but it depends on the cause. You can split voice problems into two large
groups, the first being actual physical problems with the voice production or the voice box.
So this will include things like cysts and nodules and cancers and also things which
cause an indirect effect on the vocal cord, but still in the physical way, so I'll include
things such as gastro-oesophageal reflux for postnasal drip. So, in the first with the
physical things, so for example, if you had a cyst on your vocal cords, then that can
be treated with surgery with good effect and with the second smaller group there, you can
often treat with medication. For example, with reflux or postnasal drip. So a good number
of those physical causes can be treated. The other group are the functional group. So,
these again can be split into two groups. The first being muscle tension dysphonia;
which is where you have a problem with your voice caused by overuse or overzealous use
of your voicebox - and in the second group can be the psychogenic group where you get
problems with muscle balance within the voicebox often in response to stress or some other
psychological disorder. Both of these groups often respond very well to voice therapy.
This is split into two areas. The first is helping with general relaxation and well-being.
The second is coming out with specific exercises to relax the voicebox and get the muscles
working as they should be used. Needless to say, we'll be able to effectively treat any
of these with an accurate diagnosis.