Phonotraumatic behaviors and voice disorders

By: Angela Duan, Clare Larochelle, and Valeria Canizares

When patients come to a speech-language pathologist (SLP) complaining of a “hoarse voice”, they are sometimes surprised to learn that personal behaviors may have contributed to their dysphonia. Phonotrauma is defined as “trauma to the laryngeal mechanism (vocal folds) as the result of vocal behaviors that include yelling, screaming, and throat-clearing” (Middendorf, 2007). Phonotrauma can also result from factors such as poor diet/health, hearing loss, and excessive laryngeal muscle tension when speaking or singing. Individuals who use their voice frequently in their everyday lives (teachers, lawyers, singers, actresses, etc.) are at a higher risk of developing certain voice disorders (Akst, 2020). Educating patients on the effects of their own contributing behaviors and subsequently modifying those behaviors are essential steps in successfully treating the associated voice disorder.

What types of vocal pathologies can recurrent phonotrauma cause? Phonotrauma can cause a variety of benign epithelial and lamina propria abnormalities, including vocal nodules, vocal polyps, and vocal cysts. Vocal nodules are lesions on the vocal fold that are “typically bilaterally symmetrical” and are “among the most common vocal fold pathologies” caused by vocal misuse (Bohlender, 2013). Vocal polyps are a fluid-filled lesion which can result from “repetitive trauma” of the voice and require surgery and voice therapy (Bohlender, 2013). When vocal cysts are acquired, typically through phonotraumatic behaviors, they are found “within the lamina propria” and commonly seen in “occupational groups with a high vocal stress” (Bohlender, 2013). These vocal pathologies and others caused by phonotraumatic behavior can have detrimental effects on a person’s voice.

In a study conducted in Belgium, researchers found that in those who use their voice intensely in their profession, 41% acquired functional dysphonia, 15% acquired vocal nodules, and 11% acquired laryngo-pharyngeal reflux (Van Houtte et al., 2009). Besides occupation, the risks of developing voice disorders can also vary depending on age and gender. The older a person gets, the more susceptible they are to developing a voice disorder, and vocal pathologies are more common in females than males, with 63.8% of those who have voice diagnoses being female and 36.2% male (Van Houtte et al., 2009).

In terms of treatment, it can vary depending on the severity and type of voice disorder, and treatment can range from vocal rest to surgery. Management of these diagnoses can include vocal hygiene, behavior management, and direct intervention (Middendorf, 2007). Some management approaches are education regarding the voice disorder, identifying and eliminating vocal traumatic behaviors, improving hydration, decreasing signal to noise ratio, promoting an appropriate diet to avoid reflux, and doing direct voice therapy (Middendorf, 2007). Most importantly, education is necessary to invoke prevention of voice disorders due to phonotraumatic behaviors as opposed to treatment once diagnosed.


Akst, L. (2020). Phonotrauma. Retrieved November 01, 2020, from

Bohlender, J. (2013, December 13). Diagnostic and therapeutic pitfalls in benign vocal fold diseases. Retrieved November 02, 2020 from

Middendorf, J. H. (2007). Phonotrauma in Children: Management and Treatment. The ASHA Leader, 12(15). doi:

Van Houtte, E., Van Lierde, K., D’haeseleer, E., & Claeys, S. (2010). The prevalence of laryngeal pathology in a treatment‐seeking population with dysphonia. The Laryngoscope, 120(2), 306-312.