phonotraume

Phonotrauma is the mechanical injury to the vocal folds and surrounding laryngeal tissues that occurs during phonation when tissue tolerance is exceeded. It is not a disease in itself but a mechanism that can contribute to benign vocal fold lesions and other voice disturbances.

Causes and mechanisms include sustained or repeated vocal effort (for example, loud talking or shouting), hard glottal closures or abrupt onsets, excessive muscle tension in the larynx, and poor vocal technique. Contributing factors may include dehydration, respiratory infections, gastroesophageal reflux, smoking, caffeine or alcohol use, and prolonged voice use without rest.

Common lesions associated with phonotrauma include vocal fold nodules, polyps, hemorrhage, and contact ulcers or granulomas. These injuries can alter glottal closure and mucosal wave, leading to hoarseness, reduced vocal endurance, and voice fatigue.

Diagnosis typically involves laryngoscopic examination to visualize the vocal folds, with videostroboscopy used to assess vibration. Evaluation by a voice specialist often combines perceptual scales, acoustic measurements, and patient history.

Treatment emphasizes voice therapy aimed at efficient voice production, gentle onsets, proper breath support, pitch and loudness management, and vocal hygiene. In some cases, addressing underlying conditions (e.g., reflux, allergies) is important. Surgical intervention may be considered for certain lesions or when conservative therapy fails.

Prevention focuses on vocal education, adequate hydration, avoiding irritants, workload management for professional voice users, and regular voice rest. With early intervention and ongoing vocal care, prognosis for improved voice quality is generally favorable.