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Trouble Speaking: Common Causes & When to See a Doctor

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Last updated March 10, 2021

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Take a quiz to find out what's causing your trouble speaking.

Understand trouble speaking symptoms, including 3 causes & common questions.

Trouble speaking quiz

Take a quiz to find out what's causing your trouble speaking.

Take trouble speaking quiz

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
  • Smokers

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 [2]. 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.

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.

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.

Rarity: Common

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

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Neck injury

Neck sprain, sometimes called "whiplash," means that the ligaments – the tough, fibrous bands that connect bones together – in the neck have been torn or overstretched.

It is caused by a sudden impact that causes the head to whip back and forth very suddenly, most commonly from an automobile accident or riding a fast amusement park ride. A sports injury may force the neck to overstretch, spraining the ligaments.

Symptoms include pain and stiffness in the neck, shoulders, and upper back; dizziness; ringing in the ears; and sometimes spots of numbness in the hands and arms.

It is important to see a medical provider about these symptoms, to rule out any damage to the spinal cord. Paralysis, difficulty walking, or loss of control over bladder and bowels indicate a medical emergency. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through physical examination, tests of reflexes, and sometimes x-ray, CT scan, or MRI.

Treatment includes rest and over-the-counter nonsteroidal anti-inflammatory drugs to ease pain and reduce inflammation. Muscle relaxants may be prescribed.

Laryngitis

Laryngitis an inflammation of the larynx, or voice box. This causes the vocal cords to swell and leads to a hoarse, raspy voice.

A viral infection, such as the common cold or influenza, is nearly always the cause of laryngitis. These infections are spread through casual contact, as when someone sneezes and the droplets are inhaled from the air.

Most at risk are people whose immune systems are already weakened by illness, medication, or chemotherapy.

Symptoms include hoarseness; sore, irritated throat; difficulty speaking; coughing; and sometimes fever.

Forcing speech during laryngitis can cause permanent damage to the vocal cords. Hoarseness that never really clears up should be seen by a medical provider, as it can be a symptom of a more serious condition.

Diagnosis is made through throat swab and sometimes blood tests.

Treatment involves rest and drinking plenty of fluids until the virus has run its course, and resting the voice so the swelling can subside on its own. Antibiotics are not effective against a viral illness.

Carotid artery dissection

A carotid artery dissection is the tearing of the walls of the carotid arteries, which deliver blood to the brain from the aorta. This is a medical emergency.

Call 911 immediately. Diagnosis is done by CT or MRI, and treatment involves anti-clotting medication for at least 3-6 months. Surgery may be necessary for those who can't get this medication.

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.

Rarity: Rare

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

Anxiety

Anxiety causes intense worry or fear, and can also cause physical symptoms like a racing heart. Treatments can help reduce anxiety, and differ depending on whether you have generalized anxiety, panic attacks, phobia, or another type of anxiety.

Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis is also called ALS or Lou Gehrig's Disease. It is a degenerative disease that destroys nerve cells, which eventually leads to loss of control over muscle function.

The cause of ALS is not known. It may be inherited and/or due to a chemical imbalance, faulty autoimmune response, or exposure to toxic environmental agents.

Symptoms include weakness; difficulty with speaking, swallowing, walking, or using the hands; and muscle cramps. The muscles of the arms, hands, legs, and feet are most involved at first. It does not affect the senses or a person's mental ability.

ALS is progressive, meaning it worsens over time. There is no cure, but supportive care can keep the patient comfortable and improve quality of life.

Diagnosis is made through several tests including blood tests; urine tests; MRI; electromyography (EMG) to measure muscle activity; nerve conduction studies; and sometimes muscle biopsy or spinal tap (lumbar puncture.)

Treatment involves medications to both slow the progression of the disease and ease the symptoms; respiratory therapy; physical therapy; occupational therapy; and psychological support.

Acid reflux disease (GERD)

Gastroesophageal reflux disease is also called GERD, acid reflux disease, and heartburn. It is caused by a weakening in the muscle at the end of esophagus. This allows stomach acid to flow backward, or reflux, up into the esophagus.

Risks factors for GERD include obesity, smoking, diabetes, hiatal hernia, and pregnancy.

Symptoms include a painful burning sensation in the chest and throat, and sometimes difficulty swallowing.

If heartburn occurs more than twice a week, a doctor should be consulted. If symptoms are accompanied by jaw or arm pain, and/or shortness of breath, these may be signs of a heart attack and constitute a medical emergency.

Repeated exposure to stomach acid damages the lining of the esophagus, causing bleeding, pain, and scar tissue.

Diagnosis is made by patient history and sometimes by x-ray, upper endoscopy, or other tests to measure refluxed acid.

Treatment begins with over-the-counter antacids and lifestyle changes. Medication may be used to reduce stomach acid, and surgery may be done to strengthen the sphincter muscle at the lower end of the esophagus.

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

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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.

At-home treatments

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.

  • Choking or difficulty breathing
  • Signs of stroke: These include a loss of use of one side of the body or muscle weakness, facial drooping, vision changes, or confusion.

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 [7]. 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?
Share your story
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

  1. Vorvick LJ. Laryngitis. U.S. National Library of Medicine: MedlinePlus. Updated October 1, 2018. MedlinePlus Link
  2. Chronic Laryngitis. Harvard Medical School: Harvard Health Publishing. Published May 2015. Harvard Health Publishing Link
  3. National Institute on Deafness and Other Communication Disorders (NIDCD). Updated March 6, 2017. NIDCD Link
  4. Voice Disorders. American Speech-Language-Hearing Association. ASHA Link
  5. Shelat AM. Dysarthria. U.S. National Library of Medicine: MedlinePlus. Updated October 1, 2018. MedlinePlus Link
  6. Vocal Cord Disorders. Harvard Medical School: Harvard Health Publishing. Published January 2015. Harvard Health Publishing Link
  7. 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