VOICE INDEX

Introduction / The Voice Team

Photo Library

Normal Voice

Raspy Voice

Normal Speech, but Upper Range Loss

• Breathy or Lost Voice

Voice That Catches/Spasms (Spasmodic Dysphonia)

"Noisy Breathing"

Nasal Sounding Speech

Laryngitis

Miscellaneous

Treatment?

get quicktime

The Breathy or "Lost" Voice
by Christopher Chang, MD • Last Modified 1/29/2007

This section will go over a variety of lesions that leads to a voice with poor volume with a breathy or airy quality. Often, the patient is unable to talk more than a few words at a time. Treatment depends on the cause of the breathy voice. Depending on the cause, surgical interventions and/or voice exercises are available to restore/improve the voice.

Vocal Cord ParalysisBowed Vocal CordsCOPDMuscle Tension Aphonia

NOTE: Please allow sufficient time for the audio and movie files to upload. All files are around 1-2 megabytes in size. If you are unable to see the movies, then you may not have the QuickTime plugin. You will need to download and install ActiveX and QuickTime to view these video and audio clips. The plugin is available for free download at Apple. QuickTime and the QuickTime Logo are trademarks of Apple Computer, Inc., registered in the U.S. and other countries.

Click here for audio & video of what normal looks like.
Photos displaying abnormalities can be found in the Photo Library.


Example 1: Vocal Cord Paralysis, Cancer

Audio - Standard Passage

Click here to view video.

Note that the LEFT vocal cord (your right), does not move where as the right vocal cord does. Notice the gap between the vocal cords which is the root cause of the breathy voice quality. In this case, the vocal cord is paralyzed due to a large thyroid cancer that invaded the nerve responsible for left vocal cord movement.

Click here to view video.
You must have QuickTime plugin installed to view video.


Example 2: Bowed Vocal Cords (Presbylaryngeus)

Audio - Standard Passage

Click here to view video.

Note that both vocal cords have a curve to them which prevent a tight closure resulting in air escape. Normal vocal cords are straight and come together tightly to prevent any air escape. This condition is initially treated with voice strengthening exercises. If the vocal exercises fail to produce adequate improvement, surgical options are available.

Example provided courtesy of Dr. James Thomas.

 

Click here to view video.
You must have QuickTime plugin installed to view video.


Example 3: Severe COPD (lung disease)

Audio - Standard Passage

Click here to view video.

This patient has a breathy voice, not due to anything wrong with her voicebox, but because the patient has severe lung problems. So severe, in fact, that she barely has any breath to power her voice. The lungs are what gives power to a voice. Weak lungs = weak voice. Imagine taking a breath in and than completely exhaling. Now try yelling out loud WITHOUT taking a breath in first. Very hard... For this patient, as the lungs get stronger, the voice will improve.

In the video, you may notice that the false vocal cords come together. This is compensatory, but obviously fails as the brain erroneously attempts to get more power by trying ever harder to squeeze the vocal cords together.

 

Click here to view video.
You must have QuickTime plugin installed to view video.

 


Example 4: Muscle Tension Aphonia (Mixed Lateral and AP Squeeze)

Audio - Standard Passage

Click here to view video.

Another example of muscle tension dysphonia to the point of no voice (aphonia). This patient's aphonia started after a viral upper respiratory infection. In the video, note that the anatomy is all normal. However, on phonation, there is a very tight squeeze of the false vocal cords which completely blocks the true vocal cords from being seen. Also note that the front and back of the voicebox comes close together as well (AP squeeze). The muscular squeeze on the true vocal cords is so strong that the vibration that creates the voice is literally smothered.

This patient regained her voice after 15 minutes of speech therapy focused on relaxation of the neck muscles and focussing on pitches where her voice became most audible and clear (upper register). The following is the same patient after self-directed speech therapy for one week:

Audio - Standard Passage after Speech Therapy

Click here to view video.

Note in the second video the complete resolution of the lateral and AP squeeze. Whereas before, one was unable to see her vocal cords, they are now easily visible. The colors appear different between the 2 videos due to different light sources used (first video used halogen light, second video used a xenon light source).

Click here to read more about muscle tension dysphonia.

 

Click here to view video.
You must have QuickTime plugin installed to view video.


The video below is after 1 week of self-directed speech therapy.

Click here to view video.
You must have QuickTime plugin installed to view video.

 

 

Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.