Recognizing and Treating Voice Problems

A clear voice is important for effective communication. Speech-language pathologists (S-LPs) work with people of all ages to help them use their voice more effectively and efficiently. S-LPs also assist those unable to use their speaking voice to participate in activities that require the use of voice.

How does the Voice Work?

The human voice, produced by vocal folds (vocal cords) in the larynx (voice box), provides the basic sounds necessary for speaking and singing.

A person’s voice is made up of many features:

  • Pitch: how “high” or “low” the voice is
  • Intensity: how loud the voice is
  • Quality: how clear the voice is
  • Effort: how much ease or strain/discomfort a person experiences when using their voice

What is a Voice Problem?

When a person notices an unexpected change in their voice or has a concern with one or more of the components of voice, they may have a voice problem.

There are many different types of voice disorders. Speech-language pathologists assess voice disorders, often in conjunction with an ear, nose and throat physician (ENT) (also known as otolaryngologist), to determine the nature of the voice problem, identify any contributing medical issues and guide treatment planning.

Children can have voice disorders too:
  • Vocal nodules (small benign growths on the vocal folds) are the most common cause of voice problems in children.
  • If you have any concerns about your child’s voice see an ENT (otolaryngologist) to rule out or identify any structural abnormalities (e.g. nodules, inflammation).
  • See a speech-language pathologist for voice assessment and therapy.
Physical causes, such as:
  • Infection
  • Injury / trauma to the structures or nerves involved in speaking
  • Inhalation of vocal irritants (e.g. smoking, workplace fumes)
  • Cysts or other abnormal growths
  • Medications
  • Underlying medical conditions (e.g. acid reflux, vocal tremor, paralysis, Parkinson’s disease)

Overuse of the voice or inefficient vocal technique, such as:
  • Excessively loud talking, singing and cheering
  • Talking or singing in noisy environments
  • Prolonged use of the voice over long periods of time
  • Speaking in a way that is harmful to the voice
  • Excessive tension while speaking

Emotional causes, such as:
  • Stress
  • Anxiety
  • Depression
  • Conflict

Transgender Voice & Communication

The way we speak and communicate is a fundamental reflection of our identity. When a person feels that their voice or communication style is incongruent with their gender identity, they may elect to see a speech-language pathologist for voice and communication training.

A speech-language pathologist can assist with strategies to modify voice and/or communication styles in a safe and effective way.

Some areas that may be addressed include:

When to seek help for a voice problem

  • Unwanted or unexpected changes in how your voice sounds (e.g. hoarse, raspy voice, changes in pitch)
  • Feeling like you strain or ‘lose’ your voice frequently
  • Feeling like it takes more effort to speak
  • Running out of breath when talking
  • Frequent coughing or throat clearing
  • Tension or pain in your throat
  • Feeling that your voice is problematic

What can you do to protect your voice?

Control Factors that Lead to Voice Problems

  • Choose quiet environments when talking
  • Don’t smoke (anything!)
  • Seek help for acid reflux symptoms (eg. heartburn, coughing, throat-clearing)
  • Take regular voice breaks
  • Wear a mask when exposed to irritating fumes and substances

Reduce or Eliminate Behaviours that Strain your Voice

  • Yelling
  • Throat clearing
  • Excessive talking (e.g. use email or other nonverbal forms of communication)

Use Voice Amplification Devices when Public Speaking / Singing

  • Choose a voice amplifier that has adequate power and quality to allow you to speak a normal level
  • Use a microphone that sits in front of your mouth, not on your chest or lapel

Seek Professional Help if You are Concerned About Your Voice

  • Ask your doctor for a referral to an ENT (otolaryngologist) to rule out or identify any structural abnormalities (e.g. nodules, inflammation) that can contribute to voice problems.
  • Arrange to see a speech-language pathologist for voice assessment and treatment.


Drink enough water and fluids daily to keep your body healthy.

Why see a Speech-Language Pathologist for a Voice Disorder?

Speech-language pathologists  evaluate voice use and function and provide evidence-informed treatments for voice disorders. In addition to voice assessment and therapy, speech-language pathologists can address concerns in other aspects of communication, including non-verbal, social-pragmatics and articulation/pronunciation. 

Speech-language pathologists are knowledgeable about:
  • Anatomy and physiology of the vocal tract and respiratory functions required for speaking
  • Acoustic, aerodynamic and perceptual analysis of voice
  • Physical, functional and emotional causes of voice disorders
  • Techniques to help a person safely change the sound of their voice
  • Working with a interprofessional team to treat voice disorders (e.g. ENT physicians, psychologists, social workers, respirologists, allergists)

You may be able to access a publicly-funded speech-language pathologist in a hospital or clinic in your area. In addition, speech-language pathology services may be covered by work or private insurance coverage – be sure to check with your provider. 

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