My Vocal Odyssey: Finding Answers and Regaining My Voice

Throughout my life, my voice has been integral to my work. From theatrical performances in high school and college to my radio, voice-over, and writing careers, my voice has always been a key element in my professional life. I even incorporated my voice into my writing, authoring books about national parks and presenting programs in various communities. I always valued my pleasant and confident speaking tone.

However, two years ago at age 68, I began experiencing unsettling vocal changes. During presentations, my voice would quiver unexpectedly. Words would get stuck, making my speech sound strained and jerky. Singing became challenging as well; pitch control faltered, and sustained notes would often cut short.

Initially, I dismissed these episodes as minor oddities. However, as they grew more frequent, my concern intensified. My mother had experienced similar vocal shakiness in her later years, making me wonder if I was facing a similar issue prematurely. I questioned if stress was a factor, or even if it was all in my head—my husband hadn’t noticed, though later he admitted he hadn’t been paying attention (attributing it to years of familiarity).

After several months, I mentioned my vocal problems to my brother. His immediate recognition of the issue confirmed my fears. This spurred me to seek medical attention.

An ENT doctor examined my vocal cords using a thin, lighted tube. To my surprise, he diagnosed me with acid reflux, the silent, laryngopharyngeal type. The upper esophageal muscle was permitting stomach acid to irritate my throat and vocal cords, likely due to age-related muscle weakening. He prescribed omeprazole to reduce stomach acid and recommended a low-fat, low-acid diet. While this dietary change was significant, I was determined to restore my voice.

But that wasn’t the end of the diagnosis. The doctor also identified laryngeal dystonia (LD), a condition I had never encountered. This explained the involuntary shuddering of my vocal cords. He suggested speech therapy.

After two months of medication and dietary adjustments, the irritation to my vocal cords subsided, reducing some of the quivering. Nevertheless, I recognized the need for additional support and scheduled a consultation with a speech therapist specializing in LD.

A series of tests followed; I read aloud, whispered vowels, blew bubbles, and performed other exercises. The therapist diagnosed me with adductor LD. This meant that sporadic muscle contractions were stiffening and closing my vocal cords. The therapist assured me that LD is a neurological condition, not a consequence of any action on my part.

Five weekly therapy sessions focused on modulating troublesome sounds (particularly “e”) and implementing techniques to mitigate their impact, such as vocal warm-ups and slower speech. Adequate hydration was also emphasized.

Today, my speaking engagements remain full. By consistently employing these techniques, my speech remains mostly strong. While occasional vocal hiccups persist, I’m grateful that my condition is relatively mild and manageable. I can utilize various strategies to control the tremors. (More extensive treatments are an option should the condition worsen.) I miss certain foods, but the desire for clear speech keeps me on track. I feel as if I nearly lost my voice—a crucial aspect of my life—but have successfully regained it.

Understanding Laryngeal Dystonia

LD is a chronic condition causing involuntary contractions of the larynx muscles. The disorder involves dysfunction in brain structures that control muscle movement, including the vocal cords. The affected muscle group remains intact; however, during activation, the brain produces uncontrollable spasms, affecting speech clarity and audibility.

The exact causes of LD remain unknown, though research suggests abnormalities in brain signaling. Stress may aggravate symptoms, but it’s typically a trigger, not the root cause. LD affects more women than men, typically between ages 30 and 50, and often goes undiagnosed. There are three types: adductor, abductor, and mixed.

Symptoms can appear suddenly and include hoarseness, vocal tightness or breaks, and breathiness.

While there’s no cure, botulinum toxin injections (Botox) are a standard treatment. Surgery is also an option. Voice therapy serves as a valuable supplementary approach.

Other Vocal Disorders

Vocal difficulties can stem from various conditions affecting the intricate process of sound production. The respiratory system, larynx, and articulatory structures work together under precise brain control. Disruptions in this system can lead to issues like vocal cord paralysis, vocal polyps, vocal nodules, and muscle tension dysphonia.

Vocal cord paralysis results from nerve damage affecting vocal cord movement. Vocal polyps and nodules are growths on the vocal cords, often stemming from overuse. Muscle tension dysphonia is characterized by excessive tension in or around the larynx.

Protecting Your Voice

Maintaining vocal health involves hydration, avoiding vocal strain, and abstaining from smoking. Gentle humming before speaking or singing, and resting the voice when hoarse, are recommended practices. Persistent vocal issues should prompt consultation with an ENT or otolaryngologist.