What are Hyperfunctional Voice Disorders

Hyperfunctional voice disorders are voice problems that happen when uncontrollable tightening (spasm) prevents the vocal cords from working properly.

Vocal cords normally move back and forth to make sounds when air passes through the voice box (larynx). If you have a hyperfunctional voice disorder, the area of the brain that controls vocal cord movement does not send the right signals.

This causes the vocal cords to spasm. Hyperfunctional voice disorders may also be called muscle tension dysphonia.

Sometimes the spasms force the vocal cords open when they should be closed. This makes you lose your voice. Sometimes the spasms cause the vocal cords to close too tightly. This makes your voice sound strained. You may not have spasms when you laugh, cry, or shout.

What are the causes?

The cause of this condition is not known. This condition may be passed down through families.

What increases the risk?

You may have a higher risk of this condition if you:

• Are a middle-aged woman.
• Have a family history of the condition.

What are the signs or symptoms?

Symptoms of this condition may include:

• Difficulty making certain sounds or saying certain words.
• A voice that sounds:
  • Husky.
  • Breathy or whispery.
  • Strained or tight.
  • Strangled.

How is this diagnosed?

You may be diagnosed with this condition based on:

• Your symptoms.
• Your medical history.
• A physical exam to check your larynx and evaluate your speech.
• Procedures that:
  • Examine your throat with a scope that has a tiny camera on the end (laryngoscope). The scope projects images onto a monitor (direct laryngoscopy).
  • Examine the movement of your vocal cords in the reflection of a mirror (indirect laryngoscopy).
  • Check the movement of your vocal cords in slow motion, using a flickering light (laryngeal stroboscopy).
  • Test the electrical activity of your larynx muscles (electromyogram or EMG).

You may also see a health care provider who specializes in conditions of the ear, nose, and throat (otolaryngologist or ENT specialist) or conditions of the nervous system (neurologist).

How is this treated?

There is no cure for this condition. The goal of treatment is to relieve symptoms and improve the quality of your voice. Treatment depends on the specific type of voice disorder you have, and may include:

• Injections of botulinum toxin to block the brain signals that cause your vocal cords to spasm. These injections need to be repeated because the effects last only 3–4 months.
• Voice therapy. Speech language specialists can teach you exercises that might help you speak more clearly.
• Physical therapy. A physical therapist can teach you exercises to relax and stretch the muscles in your shoulders and neck.
• Stress reduction techniques to prevent symptoms from getting worse.
• Surgery.

Follow these instructions at home:

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do vocal exercises as directed.
• Rest your voice as needed.
• Avoid straining your voice. For example, avoid speaking in noisy situations where you would have to speak loudly for a long period of time.
• Practice stress management techniques, such as deep breathing and relaxation.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have difficulty speaking.
• You pause or make different sounds when saying certain words or letter combinations.
• You lose your voice completely.