Blog, Pediatric Speech Therapy, Therapist's Corner

Understanding Our Voice

04 Sep

Does your child have difficulty or pain when trying to produce their voice? Perhaps their voice sounds hoarse, croaky, weak, or breathy. If so, your child may be experiencing a voice disorder. Before we can understand what causes voice difficulties and how they are treated, we must first discuss how the voice is produced.  

Three main steps occur: 

STEP 1: VOCAL FOLD VIBRATION

When we speak, our breath moves from our lungs through our larynx – also known as the ‘voice box’. Here, we find our vocal folds – two folds of muscle which rub together to make our voice. Our vocal folds rub together about 125 (for men) or 210 (for women) times each second! The more our vocal folds rub together, the higher pitch our voice will be. This movement creates sound energy – our voice. Our voices may sound raspy when we are sick because our vocal folds are swollen. When excited or stressed, our vocal folds may vibrate faster resulting in a higher pitch.

STEP 2: RESONANCE OF SOUND


The sound energy resonates in the pharynx (throat), oral cavity (mouth) and nasal cavity (nose) – meaning it reflects on these surfaces giving it a particular quality. When there is a balance of sound energy in the oral and nasal cavities, we hear a normal or typical resonance. When there is too much or too little sound energy in the nasal and/or oral cavity, we hear an atypical resonance. For more information about resonance disorders, ask an SLP!

STEP 3: SHAPING OF SOUND


Our tongue, lips, and facial muscles shape our voice into sounds and words. For example, try to make an ‘eee’ sound then an ‘ahh’ sound. In both cases, air passes from your lungs, to your larynx and vocal folds. The difference is how you move your face, tongue, and lips.  

In summary, our voice is produced by our vocal folds vibrating together. The sound energy resonates making your unique voice. Differences in our vocal folds and how the sound resonates makes our voices unique. 

What causes a voice disorder?

Voice disorders are typically related to the vocal folds. As a reminder, the vocal folds vibrate together for voice to occur. If there is something obstructing this vibration, it affects the voice. For example, vocal folds can become damaged or develop a growth (e.g., nodule, polyp, cyst) and have difficulty coming together. When the vocal folds do not come together easily, we may hear a strained, croaky, breathy, or weak voice.   

In children, voice disorders are most often caused by voice misuse causing small growths or vocal nodules to appear on the vocal folds. Vocal nodules should be addressed through therapy and/or surgery to avoid long term damage. 

Factors Affecting the Voice:

  • Severe stress 
  • Frequent loud shouting, crying, screaming causing over-exertion of the voice 
  • Medical conditions such as frequent throat infections, tonsillitis, coughs, reflux and dehydration 
  • Certain medications such as inhalers   
  • Injury to the larynx, a brain injury or intubation in hospital 

If your child experiences the following signs, they may be experiencing voice difficulties: 

  • Constant loss of voice 
  • Hoarse, strained, breathy, weak or croaky voice 
  • Recurrent sore throat 
  • Deterioration of voice through the day 
  • Uncontrolled changes in pitch 
  • Persistent need to clear throat 

Treatment:

Speech therapy is often used to address the root or underlying causes of voice difficulties. Sometimes, surgery is recommended to remove growths that cause the voice disorder. After surgery, ongoing upkeep of healthy voice habits is encouraged to avoid another growth. For many children, making changes to vocal habits through increased awareness and subtle reminders from adults will improve their voice quality.

Below are some strategies for healthy voice use:

  • Check a child’s hearing. A child may speak loudly due to hearing difficulties. 
  • Stay hydrated. Drinking water and avoiding caffeinated drinks helps your vocal folds vibrate more efficiently. If involved in activities with yelling/shouting (e.g., sports), remember to stay hydrated. 
  • Have good posture. Good posture makes it easier to breathe properly. 
  • Breathe from the diaphragm. Take deep breaths before you speak (instead of shallow breaths) and breathe from your diaphragm (instead of raising your shoulders). Do not talk till you run out of air.   
  • Decrease stress. The tension around the shoulders and neck can have an impact on the muscles around your larynx which in turn will have an impact on your voice. 
  • Avoid throat clearing/whispering. Instead of throat clearing, try a hard swallow or taking a sip of water. This is healthier for your voice. 
  • Stop or reduce smoking and exposure to smoke. Smoke irritates the vocal folds and can lead to breathing difficulties. 
  • Understand medications and medical conditions which may affect the voice. Stay hydrated to combat medications or medical conditions which may affect the voice. 

Many of these strategies are difficult for a child to remember and practice, especially if they have a temperament or personality leading them to shout or yell frequently. Adults in the child’s life play an important role in helping the child be aware of healthy voice habits and providing reminders throughout the day. For more support in understanding the voice and practicing healthy voice habits, talk with an SLP! 

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