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Underuse or a weak voice has an effect on the vocal muscles. This causes weak curved vocal chords.


Do you have a rough voice quality "(false vocal voice speech)" or are you easily tired when speaking in a noisy environment? Do you sometimes hear from others that you are whispering when you speak? Does it often escape air or do you breathe faster when you speak? Do you have a rough voice quality or do you sometimes feel light-headed after having spoken in a noisy environment? Do you fade your voice or do you become hoarse after a long talk?


If so, we advise you to consult a doctor. The above characteristics are symptoms of a weak voice and can have various causes.


  • Aging - As you grow older, the vocal cords lose strength, elasticity and mass and the voice becomes weaker.

  • Insufficient speech or insufficient vocal power may play a role. For example, a person may have an unusually taciturn personality or, for example, someone who lives and / or works alone. These people are also called "underdoers". On a self-assessment scale of talkativeness, they score below 4.

  • Vocal paralysis - This can occur after neck or thorax (chest) surgery but can also occur spontaneously, after colds or by unknown causes.

  • Injuries and scars - These can occur after a breathing tube has been necessary for a prolonged period. Also an operation on the vocal cords can leave scars that make the vocal cords stiff.

  • Congenital - One may be born with or genetically determined to have or develop relatively thin vocal folds. Just like there are all types of bodies, there are all sizes of vocal cords.



Seniors, people who have just undergone thyroid, neck or chest surgery or long-term artificial respiration, or those with a weak voice have a higher risk of being an 'underdoer'.


The voice organ and its function are examined by an ENT doctor and a speech therapist. The voice has 3 functions: breathing, protecting the airway while swallowing and speaking. Every person is dependent on these 3 functions every moment of the day.

In addition to a thorough survey and a clinical examination of the neck, an inspection of the vocal cords (laryngoscopy) takes place at rest and during vocalization. This is supplemented by a stroboscopy, research in which through short flashes of light, the vibration pattern of the vocal cords is delayed and thus displayed in more detail.

Then, the voice and voice capacity is listened to. One can often hear the nature of the voice problem while speaking. Sliding, softer or louder voices, soft singing can help to find the right cause of the weak or painful voice.

In addition, a voice examination usually takes place, including aerodynamic parameters (the maximum phonation time), acoustically perceptual parameters (e.g. habitual speech pitch, voice quality in function of the change intensity and pitch) and the vocal range (intensity and frequency dynamics).

If the cause or complete diagnosis is not yet clear, additional studies may be appropriate. Percutaneous electromyography (E.M.G.) can provide additional information about muscle activity and innervation of laryngeal muscles. Radiological examinations (e.g. RX of the lungs or CT neck) can demonstrate a local cause of vocal cord paralysis.

Left vocal cord paralysis - preoperatively



It goes without saying that a correct diagnosis is paramount for a successful treatment. The treatments can be very diverse. When a weak voice or underuse is at the origin, a speech therapy treatment will often be proposed. This includes a voice-building program, whether or not under the supervision of a speech therapist, where the strength and flexibility of the voice is trained. Practice 3 times a day for first 5, then 10 minutes. Speak with a bearable voice as if you were speaking in front of a room with 100 people. Do not call. Practice your full vocal range to both high and low tones. Robust 'oe' sounds are useful as well as voicing when breathing in especially when there are scars on the vocal cords. After disciplined tracking of this voice therapy for at least three weeks, one can evolve if your voice quality improves. You are therefore advised to check with your doctor to evaluate your claim. If you notice an improvement, it is recommended to continue the therapy until there is no further improvement.


The results of the voice-building program are very encouraging with both a stronger voice, better endurance and voice elasticity (for example, vibration) as a result. Do these voice exercises as long as you make progress. When the maximum improvement is achieved, you can maintain the voice improvement with regular voice exercises as a sports athlete has to maintain his muscle activities.


If you are dissatisfied with the result of the voice building therapy, there are often other options such as injections or surgical procedures that can improve your voice.


Rarely, a drug treatment can offer the solution as when reflux of acidic stomach contents lies at the basis of irritation of the vocal cords. Surgical treatments, whether or not in combination with speech therapy, may be appropriate for vocal swelling, small malignant tumors (laser excision) or, for example, vocal cord polyps in smokers. Even when one or both vocal chords are paralyzed, resulting in severe hoarseness and often swallowing problems, effective treatment can be provided. ('Thyroplasty')

Left vocal cord paralysis - audio postoperatively

Left vocal cord paralysis - 6 weeks postoperatively

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