dysphonia

Dysphonia is an umbrella term for abnormal voice quality or difficulty producing voice, resulting in hoarseness, breathiness, roughness, reduced loudness, or altered pitch. It reflects dysfunction of the larynx or its neural control and can affect speaking and, in some cases, singing. Dysphonia is distinct from aphonia, where voice is absent.

Common signs include hoarseness, breathy or strained voice, pitch breaks, reduced vocal strength, and vocal fatigue. Symptoms may be present with or without pain and can be acute or chronic.

Causes are typically categorized as functional, organic, or neurogenic. Functional causes involve vocal misuse or overuse and maladaptive voice habits. Organic causes include structural lesions (vocal fold nodules, polyps, cysts, edema, scarring), inflammatory conditions (laryngitis, reflux-related laryngitis), infections, tumors, or other laryngeal pathology. Neurogenic causes arise from nerve injury or disease affecting vocal fold movement, such as unilateral or bilateral recurrent laryngeal nerve palsy, or broader neurologic disorders like Parkinson’s disease. Additional factors include smoking, alcohol use, allergies, gastroesophageal reflux, and thyroid disorders.

Evaluation typically involves a detailed history and laryngeal examination using flexible or

rigid endoscopy with videostroboscopy to assess vocal fold vibration. Voice assessments, imaging as indicated, and referral to a speech-language pathologist for therapy are common. In some cases, imaging or biopsy is needed to exclude tumors.

Management targets the underlying cause and may include voice therapy, medical treatment (for reflux, infection, or systemic disease), smoking cessation, and, when appropriate, surgical intervention for structural lesions or nerve-related problems. Prognosis varies; functional dysphonias often improve with therapy, while organic etiologies may require multidisciplinary care. Persistent dysphonia warrants timely evaluation.