Voice issues – Symptoms and causes

weak voice issues causes

People can develop voice issues for so many different reasons. Diagnose and treatment of vocal disorders is given by doctors who are specialized in the ear, nose and throat disorders and speech – language pathologists. The treatment will depend on the cause for your voice disorder, but it can include voice therapy, medications, injections or surgery.

types of voice issues

Voice issues signs and symptoms

Here are some of the most common signs and symptoms of voice issues [1]:

  • Tremulous voice (loudness undulations, rhythmic pitch and shaky voice)
  • Roughness (perception of aberrant vocal fold vibration)
  • Shrill voice (high and piercing sound, as if stifling a scream)
  • The breathiness (perception of audible air escape in the sound signal or bursts or breathiness)
  • A pulsed voice (fry register, audible creaks or pulses in sound)
  • Strained quality (perception of increased effort, tense pr harsh as if talking and lifting at the same time)
  • Hoarse voice (raspy, audible creaks or pulses in the sound)
  • Gurgly or wet sounding voice
  • Asthenia, which is a weak voice
  • Phonation breaks
  • Aphonia, which is loss of voice
  • Abnormal resonance (cul de sac resonance, hyponasal, hypernasal)
  • Abnormal loudness or volume (it can be too high, too low, decreased range and unsteady volume)
  • Abnormal pitch (it can be too high, too low, pitch breaks and decreased pitch range)

But, there can be other signs and symptoms, such as:

  • Excessive throat or laryngeal tension, pain or tenderness
  • Increased vocal effort associated with speaking
  • Frequent coughing or throat clearing (this condition can worsen with increased voice use)
  • Running out of breath quickly
  • A variable vocal quality throughout the day or during speaking
  • A decreased vocal endurance or onset of fatigue with prolonged voice use
  • Increased vocal effort associated with speaking

The signs and symptoms of voice issues can happen in isolation or combination. It is very important to talk with your doctor about the signs and symptoms that you have, so your doctor will identify the problem that you have and he or she will give you the best treatment. The auditory – perceptual quality of voice in people who suffer from some voice issue, can vary and this depends on the type and severity of the disorder, the size and site of lesion and the compensatory responses of the person (if they are present).

But, the severity of the voice issues cannot be always determined by the auditory – perceptual voice quality alone. Your doctor will ask you detailed questions about your condition and he or she will examine you thoroughly. The treatment of your voice issue will depend on the problem that you have. Usually, it is recommended rest, liquids and voice therapy for people who have voice issues.

Voice issues causes

The voice box (also known as larynx) is made of cartilage, muscle and mucous membranes that are located at the top of trachea (windpipe) and the base of the tongue. When the vocal cords vibrate, then the sound is created. The vibration comes from the air moving through the larynx, which will bring your vocal cords closer together. Also, the vocal cords can help to close the voice box when you swallow, which will prevent you from inhaling liquid or food.

If your vocal cords become paralyzed, develop growths or become inflamed, then they cannot work properly and you may develop a voice disorder. Below are given some of the most common voice disorders:

  • White patches (leukoplakia)
  • Vocal cord paralysis or weakness
  • Precancerous and cancerous lesions
  • There can be polyps, nodules or cysts on the vocal cords (noncancerous lesions)
  • Neurological voice disorders (spasmodic dysphonia)
  • Laryngitis

Voice issues  risk factors

There are many factors which can increase your risk of developing a vocal disorder, such as

  • Voice misuse or overuse [2]
  • Aging [3]
  • Thyroid problems [4]
  • Alcohol use [5]
  • Throat dehydration
  • Allergies [6]
  • Throat cancer
  • GERD (gastroesophageal reflux disease) [7]
  • Smoking [8]
  • Illnesses, such as upper respiratory infections or colds
  • Screaming
  • Improper throat clearing over a long time
  • The scarring from neck surgery or from trauma to the front of the neck [9]
  • Psychological stress [10]
  • Neurological disorders


[1] National Institute on Deafness and Other Communication Disorders (NIDCD). Taking care of your voice. Retrieved from www.nidcd.nih.gov/health/taking-care-your-voice

[2] Carding P, Wade A. Managing dysphonia caused by misuse and overuse: Accurate diagnosis and treatment is essential when the working voice stops working. BMJ. 2000;321(7276):1544–5.

[3] Gois ACB, Pernambuco LA, de Lima KC. Factors associated with voice disorders among the elderly: a systematic review. Brazilian Journal of Otorhinolaryngology. 2018;84(4):506-13.

[4] Junuzović-Žunić L, Ibrahimagić A, Altumbabić S. Voice characteristics in patients with thyroid disorders. The Eurasian Journal of Medicine. 2019;51(2):101–5. doi:10.5152/eurasianjmed.2018.18331

[5] Landman SM. Qualitative analysis of alcohol’s acute effect on
vocal range. Alpenglow: Binghamton University Undergraduate Journal of Research and Creative Activity. 2018;4(1).

[6] Campagnolo A, Benninger MS. Allergic laryngitis: chronic laryngitis and allergic sensitization. Brazilian Journal of Otorhinolaryngology. 2019;85(3).

[7] de Arruda Henry MAC, Martins RHG, Lerco MM, et al. Gastroesophageal reflux disease and vocal disturbances. Arquivos de Gastroenterologia. 2011;48(2).

[8] Byeon H, Cha S. Evaluating the effects of smoking on the voice and subjective voice problems using a meta-analysis approach. Scientific Reports. 2020;10.

[9] Jones K, Sigmon J, Hock L, et al. Prevalence and risk factors for voice problems among telemarketers. Archives of Otolaryngology – Head and Neck Surgery. 2002;128(5):571-7. doi:10.1001/archotol.128.5.571

[10] Nerrière E, Vercambre MN, Gilbert F, Kovess-Masféty V. Voice disorders and mental health in teachers: a cross-sectional nationwide study. BMC Public Health. 2009;9.


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