Recognising and Responding to Voice Disorders

Vocal fold nodules, polyps, and cysts are benign lesions caused by vocal strain or misuse. Early detection is key.

Look out for:

• A breathy, rough, or hoarse voice that persists
• Vocal fatigue or effortful speaking
• Loss of vocal range, especially in higher pitches
• A sensation of a lump or tightness in the throat
• Frequent voice breaks or unpredictable pitch changes

If these symptoms last more than a couple of weeks, it's time to seek professional advice.

Temporary hoarseness after a cold or heavy voice use is normal. But persistent hoarseness—lasting two weeks or more—should not be ignored. It could be a sign of:

• Vocal fold lesions (nodules, polyps, cysts)
• Muscle tension dysphonia
• Reflux-related irritation
• Neurological voice disorders
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Chronic hoarseness is your body’s way of telling you something’s wrong. Early intervention can prevent a minor issue from becoming a major one.

Don’t wait until your voice stops working. You should see a specialist if:

• Hoarseness or vocal fatigue lasts more than two weeks
• You feel persistent discomfort or effort when speaking or singing
• Your voice quality has changed without an obvious reason
• You rely on your voice professionally and notice reduced control or reliability

Voice care professionals typically include:

• ENT (Otolaryngologist) – A doctor who specializes in ear, nose, and throat issues. Look for one with experience in laryngology (voice disorders).
• Speech-Language Therapist/Pathologist – Specializes in voice therapy and rehabilitation, often working alongside ENTs.

Laryngoscopy is a procedure used to view the vocal folds. It’s safe, quick, and usually done in a clinic. There are two main types:

• Flexible laryngoscopy: A thin, flexible camera is inserted through the nose to view the larynx while you speak.
• Rigid laryngoscopy: A slightly larger scope goes in through the mouth for a clearer, more detailed view—often used with stroboscopy for slow-motion visualisation of vocal fold vibration.

Voice assessment may include:

• Recording your voice to analyse pitch, range, and quality
• Perceptual and acoustic measurements
• Questionnaires about voice use and symptoms
• Discussion of your vocal habits and daily voice demands

Based on the findings, you may be referred for voice therapy, medical treatment, or (in rare cases) surgery.

Remember: Listening to your voice is as important as using it well. When something doesn’t feel right, act early—your voice will thank you.

As we age, natural changes occur in the vocal folds and surrounding structures. These changes can begin as early as your 40s or 50s and may include:

• Reduced vocal range, especially at the upper end
• Voice weakness or reduced volume
• Breathiness or a slightly rougher tone
• Slower voice recovery after extended use
• Less flexibility and stamina during prolonged speaking or singing

These shifts happen due to muscle thinning (atrophy), changes in tissue elasticity, and decreased lung capacity. While they’re a normal part of ageing, they can be managed effectively with proper care.

Think of your voice like a muscle—it needs regular training to stay strong.

Here’s how to keep it in shape:

• Warm up and cool down your voice daily, especially before and after heavy use.
• Stay hydrated to maintain vocal fold flexibility.
• Practice regular vocal exercises to support breath control, tone, and strength.
• Avoid vocal strain by managing your speaking volume and avoiding shouting or throat clearing.
• Work with a voice coach or speech therapist to adapt your technique over time.

Staying physically active and maintaining good posture also supports vocal stamina by promoting better breath support.

Hormonal shifts can significantly impact vocal quality—especially during menopause and andropause.

For women (menopause):

• Declining estrogen can cause vocal folds to become less supple and more prone to dryness.
• Some experience pitch lowering, voice fatigue, or reduced vocal agility.
• Hormone replacement therapy (HRT) or vocal training may help offset these effects.

For men (andropause):

• Gradual testosterone decline can lead to loss of vocal power and slight pitch elevation.
• Like with menopause, the vocal folds may become less flexible over time.

Both men and women may notice increased vocal dryness or reduced vocal clarity, especially in the mornings. Staying hydrated and maintaining a consistent vocal regimen can counter many of these changes.

Ageing doesn’t have to mean losing your voice—it just means learning to work with it differently. With awareness and the right habits, you can continue to use your voice powerfully and professionally for decades to come.