Often problems with your voice?

We often take our voice for granted. However, the structures responsible for voice production are very vulnerable. In this blog, you will learn more about how our voice develops and when voice problems occur. The different types of voice disorders are explained. Furthermore, the examination and treatment of voice disorders are explained. We will give you tips on vocal hygiene to avoid voice complaints.

Structures of voice

Before we go deeper into how our voice is produced, it is necessary to know the main structures of voice production. Then we will explain how voice is produced.


The larynx is a structure located at the top of the trachea and consists of several cartilages – the thyroid cartilage, the ring cartilage and the two cup-shaped cartilages. These three play a role in voice production. The ring cartilage forms the base of the larynx. Above it is the thyroid cartilage. The thyroid cartilage is clearly visible in men and is also called the Adam’s apple. The cup-shaped cartilages are located on the broad back of the ring cartilage and can slide and turn on the ring cartilage.

Vocal cords

The vocal cords are two horizontal folds of connective tissue and muscle, surrounded by mucous membrane. They are attached in a V-shape between the cup-shaped cartilages and the thyroid cartilage. Between the vocal cords is an opening called the glottis or vocal fold. The vocal fold can open or close due to the movements of the cup cartilages.

The bones of the larynx are connected by internal and external laryngeal muscles. The activity of these muscles can change the length and tension of the vocal cords.

Voice Production

During breathing, the vocal folds are separated. When we give voice or phonation, the vocal cords are brought together and the vocal folds are closed. The opening and closing of the vocal folds is caused by a change in air pressure. The exhaled air pushes the vocal fold open and makes the vocal cords vibrate. This creates the sound of the voice.

Pitch (high and low tones), loudness (quiet and loud) and quality (clear, hoarse, …) of the voice are determined by a correct dosage of breathing pressure, length and closing force of the vocal cords. Loudness is influenced by exhaling with less or more force. If the muscles of the vocal folds are tightened or loosened, this affects the pitch.

In the throat, mouth and nose cavities (resonance chambers), the vocal sound is further shaped into speech sounds. Depending on the position of the soft palate, the tongue, the lips and the jaw, and whether or not the vocal cords vibrate, different sounds can be formed. In addition, the resonance chambers or the nasal insert are responsible for resonance.

Types of voice disorders

A voice disorder occurs when a voice sounds abnormal and hinders someone socially or professionally.

Organic voice disorders

They are caused by defects in the vocal apparatus itself. They can be congenital (primary) or caused by long-term incorrect use of the voice (secondary).

Examples are:

  • Vocal cord nodules are small swellings of the mucous membrane. The nodules are a type of callus formation caused by certain forms of incorrect voice use.
  • A vocal fold polyp is a smooth, bulbous, usually red swelling on the free edge of the vocal fold. It can be caused by a combination of inflammation of the airways and voice abuse.
  • A vocal cord cyst is a vesicle containing fluid that lies directly beneath the surface of the vocal cord.
  • In Reinke’s oedema, both vocal folds are usually swollen along almost the entire length of the vocal fold edge. This is caused by fluid accumulation in the “Reinke space”, often as a result of smoking and voice abuse.
  • Laryngitis is an inflammatory reaction originating from the mucous membrane that covers the vocal folds. It can be caused by a variety of harmful influences. The inflammation may be acute or chronic.
  • In vocal cord paralysis, one of the vocal cords is paralysed. Disruption of the function of the vocal cord nerve can reduce the mobility of the vocal cord.
  • Granulomas are white swellings on the posterior part of the vocal folds. The abnormalities can be either single or double-sided.
  • A carcinoma (cancer) is a proliferation of malignant abnormal cells. In small carcinomas, the vocal folds usually look irregular with white or red discolourations.

Non-organic or voice disorders

They occur because the larynx is not functioning properly. There is nothing wrong with the vocal apparatus itself.

Functional voice disorders

Not every larynx is the same and not all vocal folds can be used to achieve everything. The capabilities of a voice are closely related to the anatomy and construction of the larynx. A larynx that is potentially weak means that the voice is not able to carry a lot of weight. A cause of a functional voice disorder can be incorrect use of the voice, for example, due to poor coordination of breathing and giving voice. Long-term or intensive use of the voice may also reduce the quality of the voice, possibly triggering compensatory mechanisms. These vocal disorders usually start insidiously and worsen under vocal strain.

Psychogenic voice disorders

A voice disorder is psychogenic when there is a clear relationship in history between the development of the disorder and psychosocial stress factors, emotions and/or psychological conflicts. Often, the cause remains unknown. A psychogenic voice disorder can be manifested, among other things, as a voicelessness (aphonia) or a hoarseness (dysphonia).


Hoarseness is often the main symptom and first warning sign of a voice disorder. Other symptoms include an audible intake of breath, difficulty in swallowing, sore throat or coughing.

If the following symptoms persist for more than 10 days, professional help is recommended.

  • Hoarseness
  • Pain when swallowing
  • Pain when giving voice
  • Tingling sensation
  • Audible breathing
  • Coughing

Examination in case of voice disorders

If the above symptoms are present and the voice sounds abnormal, an examination is necessary.

Examination procedure

The examinations for voice problems consist of a standard NTE examination, a laryngovideostroboscopy (imaging of the vocal cords) and a functional voice examination by the speech therapist (phonetogram, acoustic and aerodynamic analysis).

If voice complaints persist, an appointment is made with the NKO doctor. He or she will check whether the voice problem is organic or functional in nature. The ENT doctor prescribes a prescription so that reimbursement is possible.

The speech therapist will take an anamnesis as well as a perceptual and acoustic examination. Based on these findings and the NKO doctor, speech therapy is recommended.

If speech therapy is indicated, a second prescription is needed so that the therapy sessions can be reimbursed. Once you have this, the start of therapy is possible.

Depending on the diagnosis, treatment may include speech therapy, medication, surgery, or a combination of these. Speech therapy treatment aims to improve voice quality through exercises.

If you have any questions, please contact Anouk.

Mail to info@voicetrainingcentre.org

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