Unraveling the Mystery of My Changing Voice

My voice has been integral to my life’s work. From theatrical performances to radio broadcasting, voice acting, and writing books about national parks, my voice has always been my primary tool. I always took pride in its pleasant and assured quality.

Two years ago, at age 68, I noticed unsettling vocal tremors during presentations. Words became trapped, causing my speech to sound stilted and jerky. Singing proved equally challenging; I struggled to maintain pitch, and sustained notes frequently faltered.

Initially, I dismissed these episodes as insignificant oddities. However, their increasing frequency spurred concern. My mother had experienced similar vocal shakiness in her later years, prompting me to question if this was an age-related issue, or perhaps stress related. My husband, surprisingly, hadn’t noticed, which I now attribute to years of accustomed listening habits. My brother’s immediate confirmation of the problem ultimately made me seek medical attention.

An ear, nose, and throat specialist used a thin, illuminated tube to examine my vocal cords and larynx. The diagnosis surprised me: acid reflux. I contended that I’d never experienced heartburn. The doctor clarified it was a silent, laryngopharyngeal form of reflux; stomach acid was irritating my throat and vocal cords, likely due to age-related muscle weakening. He prescribed omeprazole, a proton pump inhibitor, and recommended a low-fat, low-acid diet. The dietary changes were significant, but regaining my voice was my priority.

The examination revealed a second condition: laryngeal dystonia (LD), an unfamiliar diagnosis. My vocal cords were not vibrating smoothly but shuddering. Speech therapy was recommended. I was skeptical, but decided to give it a try.

After two months of medication and dietary adjustments, the vocal cord irritation lessened, but the tremors persisted. I pursued speech therapy, specializing in LD. Tests included readings, vocal exercises, and breathing tasks. The diagnosis was adductor LD—uncontrollable contractions stiffening and closing my vocal cords.

Five weekly sessions focused on improving my vocal control, especially on challenging sounds. The therapist stressed vocal warm-ups and slower speech, along with increased water intake to lubricate my vocal cords.

My speaking engagements are as frequent as ever. Applying these techniques usually maintains my vocal strength. While unpredictable vocal hiccups remain, my case is relatively mild. I use various management strategies and may consider additional treatments like botulinum toxin injections or surgery if necessary. I’ve missed certain foods, but regaining my voice was worth the dietary sacrifice. I felt like I had almost lost my voice and found it again.

Understanding Laryngeal Dystonia

LD is a rare, chronic condition causing involuntary contractions of the larynx muscles. It’s linked to brain dysfunction affecting muscle movement, including the vocal cords. The affected muscles are functional, but the brain triggers uncontrollable spasms, impacting speech clarity and audibility. The exact cause is unknown, but research suggests brain signaling abnormalities. Stress may worsen symptoms but isn’t the root cause.

LD is more prevalent in women and typically develops between ages 30 and 50. Many cases go undiagnosed due to subtle, intermittent symptoms. Misdiagnosis as muscle tension, acid reflux, or anxiety is common. There are three types: adductor (vocal cords stiffen and close), abductor (vocal cords spasm open), and mixed (a combination).

Symptoms can appear suddenly and include hoarseness, vocal strain, and breathiness. While there’s no cure, botulinum toxin injections are a standard treatment, needing repeat injections. Surgery is another option. Speech therapy complements medical interventions.

Other Vocal Issues

Vocal difficulties warrant attention. Understanding vocal sound production—airflow, vocal cord vibration, and articulation—helps to diagnose issues. Various conditions can disrupt this system:

Vocal cord paralysis: Nerve damage causes vocal cord immobility. Treatment includes voice therapy and surgery.

Vocal polyps: Blister-like swellings on vocal cords, often from overuse. Smaller polyps may resolve with voice therapy; larger ones may require surgery.

Vocal nodules: Callus-like growths on vocal cords, typically treated with voice therapy.

Muscle tension dysphonia: Laryngeal tension causes vocal roughness. Voice therapy alleviates the tension.

Protecting Your Voice

Hydration, avoiding vocal strain, and smoking cessation are essential. Gentle humming warm-ups and vocal rest when hoarse are also recommended. Persisting vocal issues require an otolaryngologist consultation.