Vocal Abuse and Misuse

These terms have long been subject to disagreement and dispute by voice professionals, and other labels have been proposed, including "phonotrauma," and "repetitive strain injury." The essential components of vocal abuse and misuse are prolonged, effortful, and maladaptive vocal behaviors, usually based on excessively loud or aggressive voice production, sharp glottal attack (voice onset), inappropriate technique for voice or singing, and aggressive laryngeal vegetative maneuvers, including throat clearing, coughing, or grunting. Some forms of abuse and misuse rise from at-risk situations or environments, including the need to talk above loud ambient noise, the need to talk for long periods of time, or unhealthy vocal demands placed on persons through external occupational demands. Vocal abuse and misuse often result from poor or ineffective training in vocal technique, including insufficient respiratory support, excessive laryngeal tension during phonation, and failure to achieve proper oral resonant focus. Across time, the aggregate effect of these poor vocal behaviors, whether produced knowingly or unknowingly, is traumatic injury to the vocal fold cover, sometimes to the extent that benign lesions will be formed.