American Idol Finalists: Protect Your Voice


In the United States, voice disorders affect approximately 25 million people, yet there are less than 80,000 who visit a specialist for care. Anyone who uses his or her voice excessively is at a greater risk for vocal overuse and abuse, especially young singers. A voice problem left untreated in these individuals could be career-threatening.

Voice is produced by the vibration of the vocal folds, which are two bands of smooth muscle tissue that lie opposite each other in the larynx, or voice box. The larynx is positioned between the base of the tongue and the top of the trachea (windpipe). During rest, the vocal folds are open to allow for breathing. To create voice, the folds close, air from the lungs passes through them, causing vibration and thus making sound.

Young women are at a greater risk for developing voice problems because the vocal folds are more delicate. The most common vocal disorders are laryngitis, vocal nodules, vocal polyps and contact ulcers.

Laryngitis is the inflammation or swelling of vocal folds caused by excessive use of the voice, bacterial or viral infections, or by irritants such as inhaled chemicals. It may also be caused by a condition known as laryngopharyngeal reflux (LPR), the backflow of gastric (stomach) contents into the throat. The voice will often sound raspy, breathy, and hoarse.


Vocal nodules are small, benign growths on the vocal cords that are a frequent problem among professional singers. Nodules usually form in pairs, one on each vocal fold, and develop from damage caused by repeated pressure on the area. The voice of a person who has vocal nodules usually sounds hoarse, low-pitched, and slightly breathy.

A vocal polyp is a benign growth similar to a vocal nodule, but softer, and it usually only forms on one vocal cord. This type of growth is more often associated with long-term cigarette smoking, but is also linked to hypothyroidism, gastroesophageal reflux (GERD), or chronic vocal misuse. A vocal polyp may also be called Reinke’s edema or polypoid degeneration.

Contact ulcers are a less common disorder of vocal abuse. They occur in people who use too much force when speaking, which causes ulcerated sores on or near the cartilages of the larynx. These ulcers are also common in people with GERD. Symptoms include a tiring of the voice and pain in the throat, especially when talking.

Most vocal disorders are reversible. The best treatment is to identify and eliminate the behavior that created the injury. Vocal conservation techniques, or voice rest, may be used, particularly if the patient has had vocal fold surgery to remove growths. Voice therapy or rehabilitation can also be beneficial, particularly for those who need to eliminate behaviors such as forceful voicing.

Anyone who experiences vocal change or hoarseness for more than 2 weeks should be examined by a physician, preferably an otolaryngologist – a physician that specializes in diseases of the ears, nose, throat, and head and neck. Although hoarseness is usually due to vocal abuse or misuse, it can also be an early sign of cancer of the larynx.

The Voice Institute of New York
The Lions Voice Clinic at the University of Minnesota
National Institute on Deafness and Communication Disorders