Trouble Speaking: Common Causes & When to See a Doctor
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Trouble speaking symptoms
Your manner of speech is unique to you and one of the primary ways others identify you. If speaking becomes difficult, different, or impossible, it will likely require you to approach your day with hesitancy and concern. However, most conditions that cause trouble speaking can be managed or cured. Trouble speaking is also called aphonia or dysphonia.
Common characteristics and other symptoms of trouble speaking
Involuntary tension in the muscles within or surrounding the voice box can cause trouble speaking. It's also possible the vocal cords are involuntarily forced closed or forced open, are paralyzed, and impossible to use. Trouble speaking can be described by:
- Pain or tightness in your neck or throat
- A straining feeling
- A high-pitched voice that has to be forced out
- A weak, breathy, whispery voice
- You are unable to sing
- Constantly clearing the throat: However, you may feel there is something caught in your throat.
- Choking on food or liquids
- Difficulty breathing
Who is most often affected?
People who are most likely to experience trouble speaking include the following.
- Women nearing 50 years old
- Anyone who is required to spend many hours a day speaking or singing
- Anyone who frequently strains their voice with yelling or screaming
Is trouble speaking serious?
The severity of trouble speaking varies based on the cause.
- Not serious: Laryngitis usually resolves with voice rest and fluids, even if you are unable to speak at all for a few days.
- Moderately serious: If you find it impossible to speak for no clear reason and have no other symptoms, it may be due to muscle spasms of the larynx or anxiety . Both muscle spasms and anxiety are treatable.
- Serious: Persistent hoarseness is a symptom of some types of throat or laryngeal cancer. Hoarseness should be treated if it lasts longer than two weeks.
Trouble speaking causes and conditions
The following details may help you better understand your symptoms, what common cause may be at work, and if and when you need to see a physician.
Laryngitis is inflammation of the vocal cords that due to one of the following.
- Viral infections are the most common cause
- Fungal infections are more rare
- Bacterial infections
- Allergies, irritants, or chemicals
- An injury
- Gastroesophageal reflux disease (GERD)
Involuntary muscle spasms of the larynx
Muscle spasms can be due to the following.
- Neurological disorders: These disorders include multiple sclerosis (MS), Parkinson's, or, more rarely, Spasmodic Dysphonia.
- Inherited traits
- Other issues: These issues include aftereffects of illness or stress or excess stomach acid caused by gastroesophageal reflux disease (GERD)/heartburn.
Injuries to the nerves or muscles of the neck may include the following.
- Physical injury: An injury may occur from a car accident, a fall, or a collision in sports.
- Surgical injury: This type of injury can occur from surgery to your thyroid, larynx, or if you have a tracheotomy.
Severe social anxiety can cause you to feel like you can't breathe and your throat is closing up. This phenomenon can alter the voice and make it difficult to speak at all.
Rare and unusual causes
Rare and unusual causes may include the following.
- Vocal cord paralysis: Paralysis of the vocal cords may result from surgical injury, viral infections, or some forms of cancer.
- Laryngeal cancer: Tumors in an around the voice box may make speech difficult or impossible.
- Psychological disorder: The physical structure of the voice box may be normal, but you may experience a psychological block, greater than simple social anxiety, against speaking at all.
3 possible trouble speaking conditions
Stroke or tia (transient ischemic attack)
Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.
Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.
Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.
A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.
Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.
Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck
Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness
Urgency: Emergency medical servic
A carotid artery dissection is a tear in a layer of the wall of a blood vessel called a carotid artery, one of two such arteries found in the neck. Blood vessel walls normally have three layers, and a tear in any of these can allow blood to flow into the result..
Brain tumor or mass
In medical terms, "mass" and "tumor" mean the same thing: the unexplained, out-of-place growth of tissue anywhere in the body, including the brain.
The cause of any sort of brain tumor is unknown. Some originate in the brain, while others spread from cancers growing in other parts of the body.
Symptoms may include increasing headaches; nausea and vomiting; blurred or double vision; loss of sensation in an arm or leg; loss of balance; confusion; speech difficulties; or seizures.
If symptoms persist, it is important to see a medical provider so that any treatment can begin as soon as possible.
Diagnosis is made through neurological examination, CT scan, and/or MRI.
If the mass or tumor is found to be benign, that means it is not cancer and not harmful. It may or may not be treated.
If it is malignant, that means it is cancer and must be treated. This will involve some combination of surgery, radiation therapy, and chemotherapy, followed by specialized therapy to help with recovery.
Top Symptoms: fatigue, headache, nausea, loss of appetite, irritability
Symptoms that always occur with brain tumor or mass: focal neurological symptoms
Urgency: In-person visit
Trouble speaking treatments and relief
If your symptoms are not severe, treatment can begin at home. However, if your symptoms persist and you do not find relief, you should consult your physician.
Treatment can begin at home with the following methods.
- Conserve your voice: To protect your voice from overuse, practice 10 minutes of silence for every 90 minutes of speaking or singing.
- Avoid whispering: This can strain the voice more than just normal speech.
- Stay hydrated: Drink plenty of water and keep the air around you moist, using a humidifier if necessary.
- Do not use decongestants: These are very drying to the tissues of the throat.
When to see a doctor
Seeing a doctor is necessary for an inability to speak at all above a whisper, especially if you have pain when attempting to speak. Your doctor may also recommend the following.
- Surgery: This may be needed if other medical treatment alone cannot resolve the problem.
- Referral for voice therapy: This can often resolve, or at least help, a speech problem.
- Referral for counseling: This can help with the social issues of anxiety, or of having limited speech or no speech at all.
When it is an emergency
Along with the inability to speak, these symptoms below indicate an emergency.
FAQs about trouble speaking
Can constant screaming, as in singing loudly or coaching a sports team, cause permanent voice loss?
Your voice may not be entirely lost, but you can cause permanent damage, especially if you smoke. Irregular nodules can form on the vocal cords or cause a hemorrhage. Damage can reside with voice rest, voice therapy, and, sometimes, surgery.
Can anxiety or stress cause a complete loss of voice?
Anxiety or stress may cause you to lose your voice entirely. However, these are not physical causes. Severe social anxiety causes muscle spasms in the throat in many cases. In rare cases, a mental block can make you stay silent even if you want to speak.
What is the best treatment for a severe case of laryngitis?
You should rest your voice, especially if you cannot speak at all. Forcing your speech with laryngitis may cause severe and permanent damage to the vocal cords. Instead, keep silent, communicate with notes, and drink plenty of water. See a physician if laryngitis has not improved after a few days.
What is the difference between voice therapy and speech therapy?
"Voice" is the basic sound produced by the voice box and vocal cords. "Speech" is the refinement of the voice into words with the lips, tongue, and throat. A voice therapist works with voice problems created by the vocal apparatus, while a speech therapist works with speech problems and the parts of the body that create them.
Can Botox help with a loss of voice?
In some cases, yes. At the site of injection, Botox blocks the signals that the nerves send to the muscles and leaves the muscles in a state of relaxation for days or weeks . If your loss of voice is caused by muscle spasms in the voice box or the surrounding muscles, relaxation will allow speech to return.
Questions your doctor may ask about trouble speaking
- How would you describe your speech difficulty?
- Are you having any difficulty walking?
- Did you just suffer from a high impact injury (e.g., a fall, collision, accident or sports trauma)?
- Have you noticed a change in your hearing?
- Vorvick LJ. Laryngitis. U.S. National Library of Medicine: MedlinePlus. Updated October 1, 2018. MedlinePlus Link
- Chronic Laryngitis. Harvard Medical School: Harvard Health Publishing. Published May 2015. Harvard Health Publishing Link
- National Institute on Deafness and Other Communication Disorders (NIDCD). Updated March 6, 2017. NIDCD Link
- Voice Disorders. American Speech-Language-Hearing Association. ASHA Link
- Shelat AM. Dysarthria. U.S. National Library of Medicine: MedlinePlus. Updated October 1, 2018. MedlinePlus Link
- Vocal Cord Disorders. Harvard Medical School: Harvard Health Publishing. Published January 2015. Harvard Health Publishing Link
- Adler CH, Bansberg SF, Hentz JG, et al. Botulinum Toxin Type A for Treating Voice Tremor. Arch Neurol. 2004;61(9):1416-1420. JAMA Network Link