phonotrauma

Phonotrauma is a term used in voice science and otolaryngology to describe injury to the vocal folds and surrounding laryngeal tissues caused by voice production. It typically arises from abusive or excessive phonation rather than disease alone and can lead to acute lesions or chronic changes if the behavior continues.

Causes include vocally abusive techniques such as prolonged loudness, shouting, throat clearing, coughing, and abrupt register changes, as well as habitual hyperfunction (excessive muscular tension) or hypofunction. Environmental irritants, dehydration, smoking, and reflux can aggravate injury. The mechanism involves repetitive friction and elevated subglottic pressure that damage the mucosa, producing lesions such as nodules, polyps, edema, hemorrhage, or contact ulcers.

Symptoms include persistent hoarseness, rough-sounding voice, reduced pitch range, vocal fatigue, throat discomfort, globus sensation, and episodic voice breakdown especially with long speaking tasks. Diagnosis relies on clinical history and laryngoscopic assessment, with videostroboscopy to evaluate vibratory function. Voice assessment may include acoustic and aerodynamic measures.

Treatment emphasizes voice therapy and behavioral modification. A speech-language pathologist guides techniques to reduce abusive production, improve vocal hygiene, and restore efficient voice use. In cases of structural lesions, medical or surgical management may be indicated. Addressing contributing factors such as reflux, allergy, or smoking is important. Voice rest may be advised after acute injury.

Prevention focuses on proper vocal technique, hydration, sufficient vocal warm-up, rest, and avoiding irritants. Prognosis is generally favorable with early identification and comprehensive voice therapy; chronic phonotrauma can lead to persistent dysphonia or recurrent lesions if underlying behaviors persist.