Voice Disorders

What are the vocal cords (or folds)?

Two small muscles located within the larynx (voice box) that are responsible for voice production.

How is voice/speech produced?

During speech, the vocal cords come together and produce sound by vibrating. Movement of the lips and tongue change this sound to create individual speech sounds.

What are vocal nodules?

Callous-like bumps on the vocal cords. They can form on one or both of the cords.

If nodules are present, the cords cannot close completely. Therefore, extra air escapes and the voice sounds hoarse and breathy as a result. Unless the causes of the vocal cord nodules are eliminated, the vocal cord nodules will most likely return no matter how often they are surgically removed.

Most common causes of vocal nodules in children include:

  • Excessive talking, shouting, screaming, crying etc.
  • Strained vocalizations (for example, sounds used to imitate animal noises or motors)
  • Hard vocal attacks (starting words abruptly)
  • Excessive coughing or throat clearing caused by chronic allergies or reflux


  1. Voice Therapy
  2. Surgery
Resonance Disorders

What is a resonance disorder?

Resonance refers to the way airflow for speech is shaped as it passes through the oral (mouth) and nasal (nose) cavities. During speech, the goal is to have good airflow through the mouth for all speech sounds except m, n, and ng. To direct air through the mouth, the soft palate (back part of the roof of the mouth) lifts and moves toward the back of the throat. This movement closes the velopharyngeal valve (opening between the mouth and the nose). A resonance disorder occurs when there is an opening, inconsistent movement, or obstruction that changes the way the air flows through the system.

What are the signs of a resonance disorder?

Signs of a resonance disorder due to incomplete or inconsistent closure of the velopharyngeal
valve may include:

  • Hypernasality: too much sound coming from the nose during speech.
  • Nasal Air Emission: air leaks through the nose while trying to build up pressure for consonant sounds.
  • Weak or omitted consonants.
  • Short utterance length due to loss of air through the nose.
  • Compensatory speech errors.
  • Phoneme-Specific Nasal Emission of Air: audible nasal air loss on only a few sounds (usually s and z). This is a result of velopharyngeal mislearning, not a structural issue.

What causes a resonance disorder?

The most common cause of a resonance disorder is cleft palate but children with a submucous cleft palate, childhood apraxia of speech, enlarged adenoids and/or neurological disorders may also have a resonance disorder.

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