Categories of Voice Disorders

The following information on voice disorders is intended to supplement what a certified speech language pathologist or otolaryngologist has already told you. The descriptions of these voice disorders should not be used as the only source of your information, so we recommend that any individual with a voice problem be seen by an otolaryngologist for an examination.

Types of Voice Disorders

  • Organic
    • Structural: something is physically wrong with the mechanism, often involving tissue of the vocal folds, or surrounding tissues or fluids
    • Neurological: something is wrong with the part of the nervous system that controls the voice
  • Functional: the physical structure is normal, but the vocal mechanism is being used improperly or inefficiently
  • Psychogenic: the voice problem starts as a symbolic, or outward, manifestation of some unresolved psychological conflict

The different types of disorders can often interact. For instance:

  • Individuals with a neurological or structural disorder may develop a functional (relating to use of the muscles) component as they attempt to compensate for their voice disorder.
  • Individuals with poor muscle function may develop a structural lesion (growth).

On the other hand, there are some ways in which voice disorders don't interact, but do cause other unhealthy factors to arise.

  • Individuals with any voice disorder may develop a psychological, or emotional component, because the voice disorder can be so emotionally devastating. However, we do not consider this to be a psychogenic voice disorder.
  • Individuals with a psychogenic disorder may develop an additional structural or functional component.
  • Poor muscle function can become habitual, but it will not cause a permanent problem in the nervous system.

A few lesions are considered pre-malignant, but in general, the common vocal lesions (nodules, polyps, cysts, granulomas) will NOT turn into cancer.

ORGANIC

STRUCTURAL
Structural disorders are caused by some lesion (physical abnormality) of the larynx.

  • Contact Ulcers
  • Cysts
  • Granuloma
  • Hemorrhage
  • Hyperkeratosis
  • Laryngitis
  • Leukoplakia
  • Nodules (nodes)
  • Papilloma
  • Polyps
  • Trauma
  • Miscellaneous growths 

NEUROLOGICAL
Neurological Voice Disorders are caused by some problem in the nervous system as it interacts with the larynx. See our About the Voice page for more information. Briefly, two nerves come from the brain to the larynx and control the movement of the larynx. The most important of the two nerves, the recurrent laryngeal nerve, comes down from the brain and wraps around the aorta before going back up to attach to the larynx on the left side. Because of this position in the neck, the recurrent laryngeal nerve is vulnerable to damage during cardiac, pulmonary, spinal and thyroid surgeries. When the nerve is damaged, it causes a paresis (weakness) or paralysis (complete lack of movement) in the vocal fold of the affected side. Other neurological voice disorders are related to other kinds of problems in the central nervous system.

  • Paralysis/Paresis
  • Spasmodic Dysphonia (Laryngeal Dystonia)
  • Tremor (Benign Essential Tremor)
  • Voice problem caused by another neurological disorder (e.g. Parkinson's disease, myasthenia gravis, ALS/Lou Gherig's Disease)

FUNCTIONAL

Functional disorders are caused by poor muscle functioning. All functional disorders fall under the category of muscle tension dysphonia. The different disorders listed here refer to different patterns of muscle tension. Remember that there can be a disorder in which there is no change to the sound of the voice, but rather that voice use causes additional effort, discomfort, or fatigue.

  • Muscle tension dysphonia (general)
  • Anterior-posterior constriction
  • HyperABduction
  • HyperADduction
  • Pharyngeal constriction
  • Ventricular phonation
  • Vocal fold bowing

PSYCHOGENIC

Psychogenic disorders exist because it is possible for the voice to be disturbed for psychological reasons. In this case, there is no structural reason for the voice disorder, and there may or may not be some pattern of muscle tension. While it is quite common for a psychological or emotional component to exist in a voice disorder, voice disorders that are caused by a psychological disorder are relatively rare. The two most common types of psychogenic disorders are listed on the right.

  • Conversion dysphonia or aphonia
  • Puberphonia (mutational falsetto)

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909 Fulton St. SE
Minneapolis, MN 55455

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