Is Your Voice Shaky and Weak? Here’s the Checkup You Need

It’s easy to take your voice for granted. A brief bout of laryngitis may even be fun if you enjoy having the raspy sound of Clint Eastwood or Kathleen Turner. Such episodes usually improve in a week or so, and we can blame the problem on a cold or loud cheering for a favorite sports team.

But the culprit behind certain changes in your voice might not be so obvious or fleeting. What you need to know to figure out the cause…

Is It Time For A Voice Checkup?

Our vocal cords perform small miracles every day. They vibrate several hundred times per second when we speak—and even more when we sing.

With age, our vocal cords tend to thin and lose flexibility, often causing us to develop chronic hoarseness and/or a weak, shaky voice. But you don’t have to live with this. With the right checkup, you can get the treatment you need to improve (or even correct) the problem. Voice symptoms that should be investigated…

• Your voice is hoarse or your sound quality has changed for two weeks or more—regardless of your age. For example, if your voice is raspy, breathy or shaky or you notice a change in pitch—to a lower or higher range—you should find out what’s going on.  
• You feel pain or discomfort when you talk or sing. Some people with such symptoms are straining their neck muscles to produce sounds. 
• Your voice grows weaker or strained over the course of a day.

Unraveling The Problem

If your voice problems aren’t linked to an obvious cause, such as laryngitis, consider seeing an ear, nose and throat specialist (an otolaryngologist). 

If possible, it’s even better to seek out a laryngologist, an otolaryngologist who specializes in voice, airway and swallowing disorders. Such doctors often work as part of teams, along with speech therapists, at specialized voice centers. To find a laryngologist near you, consult the American Academy of Otolaryngology—Head and Neck Surgery, ENTnet.org. 

When you go for a checkup, you’ll be asked to describe what’s bothering you. When doing so, mention what—if anything—seems to help or make matters worse. Also describe how you use your voice. Are you a salesperson who is on the phone several hours a day? A teacher in a noisy classroom? Providing this information will help in evaluating your problem.

Your vocal cords will then be examined using a scope equipped with a video camera that passes through your nose or mouth to your larynx (voice box). This test is called laryngoscopy. 

The gold standard version includes stroboscopy, an exam in which a strobe light is combined with the camera on the scope.The strobo­scopy, which is available at most voice centers, allows for visualization of the vocal cord vibrations, so it provides more detail. 

You will be asked to speak so that the camera can capture and record ­video images of your vocal cord vibrations when you make sounds.  

Voice problems can be symptoms of many different conditions, including…

• Noncancerous growths, such as nodules, polyps and cysts, on the vocal cords. These often result from trauma caused by using your voice too much or incorrectly without adequate rest. This occurs more often in singers, teachers, ministers and other people who use their voices in their work.
• Allergies and/or postnasal drip can irritate the throat, leading to voice changes.
• Chronic throat clearing and coughing are both traumatic to the vocal cords and expose the delicate vocal cord tissue to undue wear and tear. Helpful: Try sipping water instead of throat clearing or coughing.
• Laryngopharyngeal reflux, in which stomach acid washes up into the larynx. The condition often improves with weight loss (when needed)…not eating right before going to bed…and other lifestyle changes. 
• Neurological conditions such as a vocal tremor. However, vocal tremors are not necessarily a sign of a systemic neurological condition, such as ­epilepsy or Parkinson’s disease.
• Cancerous growths. If your doctor sees something suspicious on the vocal cords or in the voice box, a biopsy will be performed to determine whether a malignancy is present. 
• Stress and anxiety are sometimes felt in the throat. For example, someone who is on the verge of tears may feel tightness in the throat.

Getting The Right Treatment

The cause of your voice problem will determine which treatment is most appropriate. Treatment options…

• Speech therapy. If your problems are caused by misuse of your voice, a speech therapist (ideally, one with special training in the voice) can teach you techniques that will help. By pairing sound production with diaphragmatic breathing, for example, most people speak more efficiently and without straining.

Note: People who are unhappy with the way their voices have changed with age also can work with speech therapists. Over time, changes occur to the vocal cord tissues and the respiratory system, which affect the quality of the sound. Voice therapy helps us optimize how we are producing sound to better adapt to changes that occur over time.

• Vocal pacing. This involves being aware of how much you are using your speaking and singing voice in a day. Reducing your “vocal dose” and pacing your vocal demands, such as resting the voice for five minutes for every 30 minutes of use, can help prevent injury to the vocal cords.

Also helpful: Teachers, fitness instructors and other public speakers may be urged to try a personal amplification system for the voice—basically, a microphone that helps them be heard without raising the volume of their voices.

• Hydration/vocal hygiene. Water is the best choice for hydration because it helps thin the mucus that then lubricates and protects your vocal cords as they vibrate. Best practice: Consume 64 ounces of water daily, drinking it throughout the day to keep the vocal cords hydrated. Important: Avoid too much caffeine and alcohol—both are drying. If you consume these fluids, match with an equal amount of water—­­in addition to the daily recommendation of 64 ounces. 

Also: Chronic use of decongestants is drying, and certain inhaled medications, such as inhaled corticosteroids to treat asthma and chronic obstructive pulmonary disease (COPD), can be irritating to the vocal cords.

• Surgery. People with vocal cord lesions may benefit from surgery to remove them. Oftentimes, however, voice therapy is recommended as a first step as most voice-related vocal cord abnormalities are reversible to an extent. If vocal cord surgery is needed, it is usually performed through the mouth with a microscope and under a general anesthetic. If vocal cord cancer is to blame, treatment for the malignancy typically includes surgery and another therapy, such as radiation.
• Laser treatment. Some specific types of vocal cord lesions benefit from laser treatments. These can be performed both in the operating room and in the office.
• Filler injections. People whose voices have become weaker due to age-related vocal cord atrophy or who have vocal cord weakness may be offered a procedure in which temporary fillers are injected into the vocal cords to help them vibrate more effectively. Often, insurance covers these procedures, which are usually performed in the office. All fillers are temporary and can last up to 12 months, depending on the material used.
• Botox. Neurological voice disorders, such as vocal tremors and spasmodic dysphonia, cause the vocal cords to spasm, resulting in a choppy-­sounding voice. For these individuals, a vocal cord injection with botulinum toxin (Botox) can be used. The treatment can ease spasms that interfere with smooth speech. The effects from these injections in the vocal cords typically last about two to three months. Insurance usually covers these injections, which are performed in the office.