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What is Vocal Abuse/Misuse? (Signs, Causes, and Treatment)

February 10th, 2020 | 4 min. read

By Michael P Underbrink, MD

vocal abuse and misuse houston ent voice and swallowing center


Many individuals require their voices for work. Among those who need their voices for work, most commonly it's singers, public speakers, teachers, sales people, customer service representatives, and lawyers. Around 17.9 million individuals in the United States say they experience issues with their voice. Voice abuse/misuse can be avoided by properly caring for your voice.

What Is Vocal Abuse/Misuse?

Voice abuse/misuse is where you use your voice in specific ways that can contribute to or cause the development of laryngeal pathologies. This means that you sprain or strain your voice resulting in injury to one or more of your vocal cords.

Some include vocal abuse behaviors and using inappropriate vocal components like:

  • Loudness

  • Pitch

  • Speech rate

  • Phonation habits

  • Breathing strategies


What are Some Vocal Abuse/Misuse Disorders?

Some common vocal abuse/misuse disorders include:

  • Vocal polyps

  • Laryngitis

  • Contact ulcers

  • Vocal nodules

Health professionals with special voice and voice disorder training often refer to these disorders as "hyperfunctional voice disorders." 

Here you'll learn about each:

1. Vocal Polyps

A vocal polyp, also referred to as polypoid degeneration or Reinke's edema, is a benign growth that's like a vocal nodule, but is a bit softer and closer to a blister than it is a callous. It typically forms on just one vocal cord. It's often linked with long-term cigarette smoking, but could also be associated with:

  • Hypothyroidism (reduced thyroid gland activity involved in the development and growth of kids and energy control in adults)

  • Chronic vocal misuse

  • Gastroesophageal reflux

When you develop a vocal polyp, you typically will have a hoarse, low-pitched, breathy voce, like that of individuals with vocal nodules.

2. Laryngitis

This is a swelling or inflammation of your vocal folds. Laryngitis might be due to:

  • Viral or bacterial infections

  • Using your voice excessively

  • Gastroesophageal reflux (backup of stomach acids in your throat)

  • Inhaled chemicals or other irritants

Your voice will likely sound breathy, raspy and hoarse.

3. Contact Ulcers

These are a less common condition of vocal misuse or abuse. They're experienced by individuals using too much force when they bring together their vocal cords for speech. The extra force leads to a wearing away of the tissue near or on the larynx cartilages responsible for bring together the vocal cords or ulcerated sores. Individuals with gastroesophageal reflux often have these ulcers. Those with this type of voice disorder usually claim they experience pain in their throat, particularly while talking or their voice tires easily.

4. Vocal Nodules

These are small, noncancerous (benign) growths on your vocal cords. They're a common voice disorder that's caused by vocal misuse/abuse. This disorder is often referred to as "singer's nodes" since it's a common issue among professional singers. Unlike vocal polyps that are more like blisters, vocal nodules are more callous-like and typically form in pairs, with one on both vocal folds. 

They form at the location where the most pressure is placed on when your folds vibrate by coming together. Repeated pressure causes damage which causes the development of nodules and your voice will likely sound low-pitched, hoarse and slightly breathy.


What are the Signs of Vocal Abuse or Misuse?

Some signs of vocal misuse/abuse are:

  • Your voice becomes raspy or hoarse

  • Your voice sounds deeper suddenly

  • You've lost your ability, when singing, to hit some high notes

  • It's an effort to talk

  • Your throat feels strained, achy or raw

  • You're clearing your throat more often


What Are the Causes of Vocal Abuse/Misuse?

Vocal misuse/abuse occurs when your vocal folds are forced to come together (adduct) too forcefully and it leads to hyperfunction of your laryngeal process. When habitual or repeated, this hyperfunction might contribute to laryngeal tissue strain, maladaptive behavior and change of your laryngeal musculature.

Forceful behaviors linked with hyperfunction include loud talking or excessive shouting, like that of a factory worker trying to talk loudly over equipment noise or children shouting while playing on a playground. 

Vocal noises refer to the non-speech laryngeal noises kids make while they play. The standard noises might include an abnormally loud or high pitch, and can include mimicking:

  • A siren's piercing scream

  • Roaring of a truck, spaceship engine, motorcycle and car

  • Different barks, howls or growls of animals

A common form of vocal misuse/abuse is habitual, incessant and nonproductive throat clearing.  Breathy voice causes also includes  excessive coughing, which is also a form of vocal abuse. Excessive talking, screaming, yelling, smoking, and inhaling irritants are all forms of vocal abuse/misuse.


What are the Treatments for Vocal Abuse/Misuse?

Depending on the diagnosis your doctor gives you, they might suggest one or more of the following treatments:

  • Allergy treatments: If you have an allergy that creates too much throat mucus, the allergy specialist or doctor can find the cause of the allergy and provide treatment.

  • Liquids, rest and voice therapy: Like other parts of your body, your vocal cords require regular fluids and rest. Specialists in speech pathology can show you ways to more efficiently use your voice through voice therapy, the amount of liquid to drink and how to clear your throat properly.

  • Medicine: A few medicines are available to help treat voice disorders. Depending on the reason behind your voice disorder, you might require medicine for treating gastroesophageal reflux, reduce inflammation or prevent the regrowth of blood vessels. You can take medicines orally, apply them topically or have them injected into your vocal cords during surgery.

  • Quitting smoking: if smoking is causing your voice issues, quitting smoking could improve your voice and even help other health problems like lowering your risk of cancer or boosting the health of your heart.


Procedures to Treat Vocal Abuse Misuse

Treatment for vocal misuse or abuse, include:

  • Lesion removal: Benign lesions (i.e. cysts, polyps and nodules) on your vocal cords might require surgical removal. The doctor can remove precancerous, noncancerous and cancerous lesions, which includes leukoplakia (white patches) and recurrent respiratory papillomatosis using carbon-dioxide laser surgery, microsurgery and the newest laser treatments, when appropriate, which could include potassium titanyl phosphate (KTP) laser treatment.

  • Botox injections: These consist of purified botulinum toxin injections into the skin of your neck which helps reduce abnormal muscle movements or muscle spasms if you're suffering from a neurological movement disorder that impacts your larynx vocal muscles (spasmodic dysphonia).

In some cases, you may have one vocal cord that's become paralyzed. If this occurs, you may experience hoarseness. You may choke when you drink liquids, but will probably not have problems swallowing solid foods. This issue can go away with time in some cases.

If it doesn't, the doctor could perform one or two procedures to push your affected vocal cord closer to the middle of your windpipe, allowing your vocal cords to meet and vibrate more closely together. This can help to improve your voice and allow your larynx to close when swallowing. Some treatments might include:

  • Thyroplasty: The doctor creates a small opening in your cartilage from the outside of your voice box. They'll insert an implant into the opening and push it against your affected vocal cord which will move it closer to the other vocal cord.

  • Collagen or fat injection: The doctor injects synthetic collagen or body fat either through your neck's skin or your mouth to treat weakness of your vocal cord or add bulk to your affected vocal cord. This helps push your vocal cords closer together, so they can vibrate closer together.


Contact Houston ENT Voice and swallowing Center

For more information on voice abuse/misuse or if you suspect you have an ailment causing you to abuse your voice, contact Houston ENT & Allergy to set up an appointment. We'll determine what the problem is and will sit down and consult with you about which treatment plan we feel is best for your situation. 


Request An Appointment with Houston ENT & Allergy Today!


Michael P Underbrink, MD