The Raspy Voice

by , last modified on 6/2/16
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This section will go over a variety of lesions that leads to a "raspy voice". Please note that examples given under "Normal Speech, but Upper Range Loss" and "Laryngitis" also may exhibit raspy voice. Treatment depends on the cause of the raspy voice and may include surgery and/or voice therapy.

Smoker's PolypsVocal Cord NodulesLarge Vocal Cord Polyp
Muscle Tension DysphoniaTumorCancer
Vocal Cord Varicosity and Mucosal BridgeBilateral Thyroarytenoid Muscle Paralysis
DehydrationPapillomasPediatric Vocal Cord Nodules

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

How Were These Images/Videos Obtained??? By a Procedure Called Fiberoptic Trans-Nasal Endoscopy...



Example 1: Smoker's Polyps (Both Female Patients)

Note that video #1 is provided courtesy of Dr. James Thomas

Audio - Standard Passage (Female patient from Video #2 Sample)

Both videos were taken from a middle-aged FEMALE! Note the limited vocal range. The vocal cords themselves are thick resulting in loss of upper range and an overall deepening of the vocal pitch. This situation is analogous to violin strings where a thicker string has a deeper pitch compared to a thinner string.

After surgery in video #1 (yes, it's the same patient), note the normal voice quality and markedly increased vocal range.

This condition is generally limited to females who smoke (a lot) and talk (a lot). Yet another reason to quit smoking!

Typically before surgery is performed to remove the excessive polyps from the vocal cords, extensive voice therapy is required along with smoking elimination.

Read more about vocal cord polyps here.

 

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polyp


polyp


Example 2: Vocal Cord Nodules

Audio - Standard Passage

Audio - Ascending /e/ Pitches

The raspy voice is due to nodules in this patient. The patient clearly has impairment throughout her restricted vocal range, but especially at the upper range where there is a prominent pitch break. Note the right greater than left large bump on the true vocal cords. This patient was successfully treated with voice therapy and surgical removal.

Here is an example of a 5 years old child with vocal cord nodules.

Read more about vocal cord nodules here.

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nodule


Example 3: Large Vocal Cord Polyp

Audio - Standard Passage

The raspy voice is due to a large polyp on his right true vocal cord. The patient has impairment evenly throughout his entire vocal range. Towards the end of the video, a maneuver called an inspiratory phonation was performed which causes the polyp to flip in and out. Treatment was with complete excision.

Sometimes, the polyp can get so large that it actually causes problems with breathing. Click here for an example of a large ball-valving polyp.

Read more about vocal cord polyps here.

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polyp


Example 4: Muscle Tension Dysphonia (Lateral Squeeze)

Audio - Standard Passage

Note how raspy the voice is. In the video, see how there is a significant lateral-lateral squeeze (muscular tension) of the false vocal cords to the point they touch in the speech frequencies (plicae ventricularis). However, at higher pitches, the voice clears up and the false vocal cord muscular tension also disappears. This finding provides the basis for how to begin voice therapy to help her "find" her normal speech voice again. Of note, this disorder is often confused with (but should not be mistaken for) tonic or ADductor spasmodic dysphonia. Sometimes, the tension is so strong that the person does not have a voice at all (muscle tension aphonia)!

Audio - With Voice Therapy

Note that at the upper pitches, the patient's voice is clear. However, as the pitch decreases, the voice becomes raspy. The basis of voice therapy will be to start where the voice is clear and figure out a way for the patient to bring that clarity to the lower pitches. Click here to read more about muscle tension dysphonia.

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mtd


Example 5: Tumor

Audio - Standard Passage

There is a right vocal cord bulging mass. The raspy voice is understandably due to this mass.

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cancer


Example 6: Cancer

Audio - Standard Passage

There is a thickening of predominantly the left vocal cord as well as the anterior half of the right vocal cord. This thickening was surgically excised and found to be cancer (squamous cell carcinoma). The patient was successfully treated with radiation therapy.

Risk of cancer increases if you smoke, drink alcohol, suffer from reflux, etc. More info on risk factors here.

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cancer


Example 7: Vocal Cord with Enlarged Blood Vessel and Mucosal Bridge

Audio - Standard Passage

Her voice, even at normal speech pitch levels contain onset delays and pitch breaks. The video reveals several abnormalities involving her left true vocal cord. There is a blood vessel varicosity near the free edge of the left vocal cord. Some amount of vocal cord is sweling around the varix. It was thought that there may have been a cyst also present, but none was found at time of surgery. Given the large size of the abnormality, she has a raspy voice throughout her vocal range. At the upper range, her voice becomes diplophonic where the anterior vocal cords (in front of the mass) vibrates at a different frequency than the back. Treatment is excision.

At time of surgical excision, a mucosal bridge was found on the opposite right true vocal cord which was unanticipated. Picture is shown where an instrument was placed through the mucosal bridge.

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varix

bridge
No video with this image. Note instrument passing through the mucosal bridge at time of surgery.


Example 8: Thyroarytenoid Muscle Paralysis (Partial Vocal Cord Paralysis)

Audio - Standard Passage

If you listen to this patient's voice (49 year old male), it is quite breathy with a harsh quality to it. Apparently, his hoarseness started during a viral upper respiratory infection a few weeks before this visit. The strobe video exam revealed that he had bowing of both the true vocal cords with laxity on phonation. Note that the vocal cords are flopping around without any smooth symmetric vibration indicating a partial vocal cord paralysis (specifically, the thyroarytenoid muscle). They do move together and apart so it is not a complete paralysis. Given the tremendous effort he was using to talk, mild traumatic laryngitis (swelling and redness) was present from effortful vocalization.

He was treated with a prednisone burst and taper and instructed to limit his voice use. After 2 weeks, his voice completely resolved with normal vocal cord appearance and functioning.

Paralysis could effect only one side completely resulting in lack of movement and a breathy voice. Here is an example of that.

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paralysis


Example 9: Dehydration

Audio - Standard Passage

This patient presented with a persistent slight rasp to his voice due to dehydration. He rarely drank water and drank copious amounts of coffee. In the video, note how dry the lining of the voicebox and vocal cords are. In fact, one can see dried up crusts of mucus throughout including the vocal cords themselves (looks like pieces of dust). The mucosal wave is nearly absent. Treatment is eliminating caffiene (which contributes to cellular dehydration) and markedly increasing water intake (to at least 6 large glasses a day).

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dry


Example 10: Vocal Cord Papillomas

Audio - Standard Passage

Clearly, both vocal cords are diffusely involved with papillomas. On the video, one may note the epiglottis has a single papilloma mass. Given the diffuse involvement of the vocal cords, not surprising that the vocal quality is quite raspy.

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papilloma


Example 11: Pediatric Vocal Cord Nodules

5 years old male who presented with a several year history of a hoarse voice. On the video, one can see that the child has prominent vocal cord nodules. Treatment is voice therapy with a pediatric voice therapist.

Read more about vocal cord nodules here.

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nodule

 

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