will my voice come back?

Question

on saturday i went to the state fair, i went on alot of rides where i was screaming so they would make the ride so faster, yet i was being retarded and was screaming so loud, i wanted to know if my voice will come back? its been gone for about 2 days now.. (i dont know where to categorize this)

i need on clearing my throat, does that make it worse?

Answer 1

Do you feel like there is something in your throat? Like hard stuff stuck there?

If so, I recommend the following:
1. Boil water and pour some into a cup.
2. Add 2 Tbsp. cider vinegar (not regular vinegar)
3. If desired, add sugar and a bag of tea.
4. Sip this drink every few hours. The more often the better. It will soften up and dissolve the phlegm in your throat.

Of course, you should be careful to use your voice as little as possible till you have recovered.

As for clearing your throat: when the drink softens things up, you will be able to clear your throat better and get rid of the phlegm.
In the meantime, if the phlegm feels hard, do NOT clear your throat. If it feels soft, you can clear it gently.

Answer 2

1

Answer 3

Yes, your voice will come back in time, it may take a few days to a week. If it doesn't inprove within a week, see a doctor.

Answer 4

Rest is the key. Rest your throat and rest your voice.

Answer 5

yes of course it will, drink lots of fluids, try not to irritate your throat and suck on popsicles and cold stuff like ice cream
you'll be fine

Answer 6

well yea. is it gone comepletely or just real low and raspy? give itc some more time it will be ok

Answer 7

it will come back, you are so silly!! just give it a rest and don't try to talk. drink water......rest your voice noooooooo talking shhhhhhhhhhh

Answer 8

Functional Voice Disorders
Last Updated: June 28, 2006 Rate this Article
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Synonyms and related keywords: oropharynx, voice, larynx, dysphonia, conversion dysphonia, polyps, nodules, vocal cord nodules, Reinke edema, psychogenic voice disorder, vocal misuse, vocal abuse, falsetto, puberphonia, mutational falsetto, muscle tension dysphonia, tension-fatigue syndrome, dysphonia plicae ventricularis, false vocal fold phonation, ventricular dysphonia, spasmodic dysphonia, laryngeal dystonia, paradoxical vocal fold dysfunction, vocal cord dysfunction, factitious asthma, psychogenic asthma

AUTHOR INFORMATION Section 1 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography




Author: John Werning, MD, DMD, FACS, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Florida
Coauthor(s): Linda McAllister, MA, CCC-SLP, Director of the Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, Medical College of Ohio; Kim Antush, MEd, Consulting Staff, Department of Otolaryngology, Medical College of Ohio


John Werning, MD, DMD, FACS, is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and American Medical Association

Editor(s): John Schweinfurth, MD, Associate Professor, Department of Otolaryngology, University of Mississippi Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Stephen G Batuello, MD, Consulting Staff, Colorado ENT Specialists; Christopher L Slack, MD, Consulting Staff, Otolaryngology-Facial Plastic Surgery, Lawnwood Regional Medical Center; and Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

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INTRODUCTION Section 2 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography



Human voice production involves the synchronization of optimal glottic positioning and control of the airflow from the lungs to the oropharynx. Laryngeal function must be coordinated, efficient, and physiologically stable to produce a normal voice. Any imbalance in this delicate system affects vocal quality. When vocal quality deteriorates and both anatomic and neurologic etiologic factors are excluded, a functional voice disorder should be suspected.

Functional voice disorders account for at least 10% of the cases of dysphonia referred to multidisciplinary voice clinics. They occur predominantly in women, are frequently transient, and commonly develop after an upper respiratory infection. Functional voice disorders can be misdiagnosed because they can have variable presentations and multiple causative factors.

Psychosocial issues are frequently present in patients with functional voice disorders, and many patients have symptoms that fulfill the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) criteria for a mood disorder, an anxiety disorder, or an adjustment disorder. Patient response to these psychological stressors may result in a variety of voice disorders with different clinical manifestations. Furthermore, the role that psychogenic factors play in a particular voice disorder varies from patient to patient. This article provides an overview of the diagnosis and management of functional voice disorders.

For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education article Strep Throat.

Classification

Consensus is lacking regarding classification of functional voice disorders. Some authors classify polyps, nodules, and Reinke edema as functional voice disorders, while others classify them as anatomic or structural abnormalities secondary to vocal abuse. Furthermore, disagreement exists about the etiology of some functional voice disorders. Many voice disorders are recognized by different names, resulting in additional confusion. The authors have divided the functional voice disorders into 4 categories based on etiology:


Psychogenic - Caused by underlying psychological factors

Disorders of misuse or abuse- Caused by hyperfunction

Idiopathic - Underlying etiology not identified

Organic abnormalities resulting from misuse or abuse - Caused by hyperfunctioning that results in development of abnormalities such as vocal cord nodules.
CLINICAL EVALUATION Section 3 of 10
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History

A complete history must be taken, including characterization of the patients' specific vocal complaints and any precipitating factors. A recent upper respiratory infection may serve as a catalyst that forces an already stressed vocal tract into a more severely imbalanced state. Vocation (eg, singing, athletic coaching) and use or misuse of the voice in this vocation must be assessed. The patient's general health, including medications, should be reviewed.

Neurologic disorders such as generalized dystonia or myasthenia gravis should be excluded, and any history of laryngeal trauma or neural injury resulting from prior neck surgery or trauma should be obtained. A history of temporomandibular joint disorders, cervical myalgia, or muscular fatigue may be suggestive of hyperfunction. Other medical disorders, including gastroesophageal reflux and laryngopharyngeal reflux as well as endocrinopathies such as hypothyroidism, must be excluded.

Any psychiatric history or recent history of psychosocial stressors should be elicited. A complete social history must be obtained to evaluate for exposure to irritants such as tobacco smoke, alcohol, caffeine, dairy products, chocolate, mints and occupational irritants.

Clinical evaluation

Initial assessment of vocal quality for the range ease, volume, and quality of the voice occurs during the patient interview. All patients must undergo a complete ear, nose, and throat examination to assess nasal airway patency, pharyngeal function, and velopharyngeal competency and evaluate for xerostomia and dental wear suggestive of bruxism. Hearing loss also may result in voice strain because the patient may speak with greater volume.

Flexible fiberoptic laryngoscopy should be performed in addition to indirect laryngoscopy because it allows the examiner to observe the larynx in a more functional state.

If a functional voice disorder is suspected, the patient is usually referred to a speech-language pathologist to obtain measurements of acoustic, aerodynamic, and perceptual voice parameters. Laryngeal videostroboscopic assessment also may be performed to more closely visualize the vocal folds' vibratory patterns during selective speech tasks.

A functional voice disorder can be diagnosed only after a complete history, clinical examination, and voice assessment have been performed and no anatomic, neurologic, or other organic cause can be identified for the dysphonia. The diagnosis of a particular voice disorder is dependent on characterization of the patient's voice symptoms. PSYCHOGENIC VOICE DISORDERS Section 4 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography




Psychogenic voice disorders are maladaptive responses that result at least partially from psychological stressors and conditions in the patient. Psychological assessments of patients with functional voice disorders have been performed using the Minnesota Multiphasic Personality Inventory. These patients demonstrated elevated levels of anxiety, somatic complaints, introversion, and poor levels of adaptive functioning.

Conversion dysphonia

The development of conversion dysphonia, also called functional dysphonia/aphonia, may result from a temporally related psychologically or emotionally traumatic event. Conversion disorder is a somatoform disorder in which the symptoms are not intentionally produced or feigned by the patient. The patient's vocal quality is usually hypofunctional, or aphonic. Fiberoptic laryngoscopy may demonstrate a lack of vocal cord adduction during attempted phonation. However, coughing and throat clearing demonstrate normal vocal cord adduction. Treatment is voice therapy. Patients also may require psychotherapy to address the underlying psychological trauma.

Falsetto

Patients experiencing falsetto (also called puberphonia or mutational falsetto) present with a disorder of pitch control. The typical patient is a young male of pubertal age who is suffering emotional stress resulting from the psychosocial changes of adolescence. The adolescent's voice fails to descend to a normal adult pitch level at puberty. Falsetto is typically responsive to voice therapy. Occasionally, psychological counseling may be beneficial.
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DISORDERS OF MISUSE OR ABUSE Section 5 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography



Patients with disorders of misuse or abuse typically manifest hyperlaryngeal function, which may be secondary to increased muscle tension or vocal abuse resulting from behaviors such as frequent throat clearing or professional singing. Psychogenic factors may also play a role in their development.

Muscle tension dysphonia

In muscle tension dysphonia, excessive tension of the laryngeal or extralaryngeal muscle or both results in altered phonatory function. Numerous factors may contribute to the development of this disorder, including gastroesophageal reflux, stress, and excessive voice use and loudness. Patients with muscle tension dysphonia (also called tension-fatigue syndrome) frequently demonstrate significant emotional stress and manifest other symptoms of muscle tension such as neck and shoulder strain. Extended periods of voice use result in vocal effort and fatigue that intensifies over time. Patient subgroups who are at increased risk for muscle tension dysphonia include singers and speakers with extraordinary voice demands and patients with learned adaptations following an upper respiratory tract infection.

Treatment options include voice therapy and biofeedback that focus on muscle tension reduction. Such treatment modalities require identification of the reasons for hyperfunction. A technique known as manual laryngeal tension reduction, or circumlaryngeal massage, also may be beneficial in these patients.

Dysphonia plicae ventricularis

Typically, patients with dysphonia plicae ventricularis (also called false vocal fold phonation or ventricular dysphonia) demonstrate a low-pitched, coarse or rough, monotone voice. The voice may have a breathy quality. Usually, hyperadduction of both the true and false vocal folds is present. Because the ventricular folds have difficulty in making a good firm approximation along their entire length, severe hoarseness and breathiness often result. Vocal fold scarring may be mistaken for this disorder and must be ruled out.

This disorder is frequently responsive to voice therapy that focuses on gestures such as gargling and sighing, which relax supraglottic muscles and isolate true vocal fold adduction from false vocal fold adduction. IDIOPATHIC DISORDERS Section 6 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography




Spasmodic dysphonia

A significant number of authorities purport that spasmodic dysphonia, or laryngeal dystonia, is a neurologic disorder described as a focal action dystonia in which volitional activation of speech results in involuntary adduction or abduction of the vocal cords, resulting in abnormal speech production. Other focal dystonias include blepharospasm, oromandibular dystonia, and torticollis. This disorder may be precipitated or exacerbated by an upper respiratory tract infection, excessive voice use, or psychological stress. However, dystonias are often incorrectly attributed to psychological causes, and the rate of psychopathology in patients who have spasmodic dysphonia is much lower than in those patients who have been diagnosed with other forms of functional dysphonia. Schweinfurth and colleagues have documented an association between childhood measles or mumps and subsequent spasmodic dysphonia. Some researchers believe that spasmodic dysphonia should be considered an idiopathic disorder until the underlying neurologic cause for spasmodic dysphonia has been identified.

Blitzer et al published a series of 901 patients with spasmodic dysphonia. Of these patients, 63% were female, and their average age of onset was 39 years. Adductor spasmodic dysphonia was diagnosed in 83% of the patients, while 17% were diagnosed with the abductor type. Adductor spasmodic dysphonia demonstrates hyperadduction of the vocal folds, producing an irregular, interrupted, effortful, strangled, strained, staccato voice. Abductor spasmodic dysphonia demonstrates a voice that is abruptly interrupted by a breathy hypophonic voice, causing aphonic or whispered segments of speech. In addition, a mixed adductor-abductor form of spasmodic dysphonia exists.

The following 3 main treatment modalities exist:


Voice therapy to address any exacerbating factors of misuse or abuse: Usually, voice therapy by itself is inadequate.

Recurrent laryngeal nerve destruction: Several different types of intentional nerve injury have been described, including transection, segmental avulsion, or crushing the nerve. Selective transection of the branch to the thyroarytenoid muscle has also been performed. These procedures have produced mixed results.

Neuromuscular blockade using botulinum neurotoxin: Botulinum toxin inhibits the release of acetylcholine from cholinergic terminals and is typically administered via an electromyographically guided intramuscular injection into either the thyroarytenoid muscle or the posterior cricoarytenoid muscle. Use of botulinum toxin injections by Blitzer et al demonstrated an average benefit of 90% of normal function in patients with adductor spasmodic dysphonia and an average benefit of 66.7% of normal function in patients with abductor type. Courey and colleagues from Vanderbilt have documented significant improvements in the patients' perception of their functional, physical, and emotional voice handicap, as well as improvements in mental health and social functioning following botulinum injection. Thus, botulinum toxin therapy with concomitant voice therapy is now the treatment of choice in most patients with spasmodic dysphonia.
Paradoxical vocal fold dysfunction

The etiology of paradoxical vocal fold dysfunction may be psychogenic in some patients and associated with gastroesophageal reflux in others. Increasing evidence suggests that a relationship between chronic cough and paradoxical vocal fold dysfunction exists. This disorder is more common in females and teenagers. Paradoxical vocal fold dysfunction is also known as vocal cord dysfunction, factitious asthma, episodic laryngeal dyskinesia, and psychogenic stridor.

Patients experiencing paradoxical vocal fold dysfunction present with sudden difficulty in breathing, which is often diagnosed as difficult to control asthma that is not responsive to treatment. Episodes may be exercise-induced. Laryngeal stridor may be present. Most patients have no dysphonia, but some are significantly dysphonic. The paradoxical nature of this disorder involves the adduction of vocal folds during inhalation when they should abduct, resulting in stridor. Laryngoscopy, however, demonstrates no laryngeal structural abnormalities.

Paradoxical vocal fold dysfunction is usually responsive to voice therapy and, when indicated, psychological counseling. Significant dyspnea may require the use of botulinum toxin or anxiolytics. ORGANIC ABNORMALITIES RESULTING FROM MISUSE OR ABUSE Section 7 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography




Anatomic abnormalities such as vocal cord nodules, polyps, intracordal cysts, edema, laryngitis, and sulcus vocalis, as well as other abnormalities may result from a functional voice disorder (vocal misuse). However, poor vocal hygiene (abuse) is the most common cause of these organic findings. VOCAL REHABILITATION Section 8 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography




Vocal hygiene

All voice rehabilitation should include the elimination of vocally abusive behaviors such as throat clearing, habitual yelling or screaming, habitual breath holding or improper glottic valving during exercise. In addition, caffeine and alcohol intake should be eliminated, and irritative inhalants such as tobacco and toxic chemicals should be avoided. Furthermore, medications with drying potential should be minimized, and gastroesophageal reflux should be controlled. Increased fluid intake to optimize laryngeal hydration is crucial to proper vocal hygiene.

Voice therapy

Stemple has classified the different treatment philosophies of voice therapy into the following 5 categories.


Symptomatic voice therapy addresses the identification and elimination of vocally abusive behaviors through facilitating approaches. These techniques facilitate a target or a more optimal vocal response by the patient. Examples include auditory feedback, head positioning, laryngeal massage, and relaxation. Disorders of misuse or abuse would benefit from this treatment philosophy.

Psychogenic voice therapy addresses the underlying emotional and psychosocial issues that are causing the dysphonia. Patients with conversion dysphonia would benefit from this approach.

Etiological voice therapy focuses on recognition and elimination of the cause of the voice disorder, which may be multifaceted. Muscle tension dysphonia may benefit from this approach.

Physiologic voice therapy, a type of biofeedback, involves the use of acoustic and aerodynamic analysis to direct the patient's vocal function back to objectively normative physiologic voice function. Physiologic voice therapy may be useful on a patient with falsetto.

Eclectic voice therapy management of voice disorders uses a combination of therapeutic approaches. Examples include spasmodic dysphonia, which frequently improves from a combination of speech therapy and botulinum injection, and paradoxical vocal fold dysfunction, which frequently improves when voice therapy and psychotherapy are combined.
In reality, voice disorders are usually treated by combining a number of therapeutic modalities. A multimodal approach is frequently essential, since many of these voice disorders have psychogenic overlay. PICTURES Section 9 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography




Caption: Picture 1. Case study 1: Conversion aphonia. A 27-year-old woman presented to the voice clinic with a complaint of loss of voice for a 4-month period. Patient reported that she experienced strep throat with resulting laryngitis on her honeymoon. Within 1 month of her return home from the honeymoon, her mother suffered a stroke, requiring placement in long term care, and her maternal grandmother died suddenly. Following these events, the patient was diagnosed with a dysphonia and a conversion voice disorder. She was consequently placed on a voice therapy program.


Picture Type: Movie
Caption: Picture 2. Case study 1: Conversion aphonia. Following therapy, her vocal quality improved markedly.


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Caption: Picture 3. Case study 2: Plica ventricularis. A 66-year-old patient experienced a right vocal cord paralysis after undergoing carotid endarterectomy. The patient subsequently developed a compensating hyperfunctional voice component and presented to the voice clinic for evaluation. Laryngoscopy and stroboscopic analysis demonstrated severe anteroposterior and mediolateral compression of the supraglottic musculature with phonation produced by the false vocal folds.


Picture Type: Movie
Caption: Picture 4. Case study 2: Plica ventricularis. Following 8 sessions of voice therapy that focused on the reduction of supraglottic muscle tension, the patient now demonstrates improved glottic closure in the absence of false vocal fold adduction.


Picture Type: Movie
Caption: Picture 5. Case study 3: Puberphonia. A 6'2" tall, 20-year-old man presented to the voice clinic experiencing a harsh, hoarse voice that "cut out" on him intermittently. Clinical evaluation revealed a high, female-pitch of approximately 196 Hz (average male pitch 120 Hz). The young man also reported that he occasionally tries to speak with a "lower voice," but uses it on a limited basis because of negative feedback from his peers.


Picture Type: Movie
Caption: Picture 6. Case study 3: Puberphonia. Patient received voice therapy focusing on counseling and biofeedback to help patient adjust to use of his more appropriate male voice.


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Caption: Picture 7. Case study 4: Muscle tension dysphonia. A 59-year-old woman with a history of asthma was seen for voice evaluation due to a harsh, strident voice with intermittent voice loss. The patient reported extreme familial stress and the sole responsibility of caring for her elderly parents. Her voice quality reportedly deteriorated suddenly after an upper respiratory infection. Testing revealed a habitual pitch of approximately 280 Hz, which is excessively high for a 59-year-old female (norm is 200 Hz). Vocal characteristics were suggestive of severe hyperfunctioning of the supraglottic and glottic musculature secondary to psychogenic factors. She was placed on a voice therapy program, which included progressive relaxation and lowering pitch using biofeedback. After an intensive 2-month voice therapy program, habitual pitch was reduced to 220 Hz and voice was functional.


Picture Type: Movie
Caption: Picture 8. Case study 5: Nodules. A 26-year-old woman complained of hoarseness and vocal fatigue. She is employed in an executive position and is exposed to high stress on a daily basis. She is also a smoker. Laryngeal stroboscopy demonstrates bilateral excrescences on the glottic edges, most likely as a result of vocal abuse and misuse. The patient used a low habitual pitch to maintain an authoritative speaking style. She was counseled to quit smoking and was educated about vocal abuse, misuse, and vocal hygiene.


Picture Type: Movie
BIBLIOGRAPHY Section 10 of 10
Author Information Introduction Clinical Evaluation Psychogenic Voice Disorders Disorders Of Misuse Or Abuse Idiopathic Disorders Organic Abnormalities Resulting From Misuse Or Abuse Vocal Rehabilitation Pictures Bibliography





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Sataloff RT: Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego: Singular Publishing Group; 1997.
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Stemple JC: Voice Therapy: Clinical Studies. St Louis: Mosby-Year Book; 1993.
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NOTE:
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER


Functional Voice Disorders excerpt


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