Voice Changes

Author: Marisa Healy, BSN, RN
Last Reviewed: March 27, 2023

Some types of cancers and/or their treatments can cause changes to your voice. Voice changes can be caused by:

  • A tumor on or near your vocal cords.
  • A tumor in your oral cavity (mouth).
  • Cancer treatment near your throat/mouth/neck.
  • A tumor in your brain that affects your speech.

This article will focus on the effect of head and neck cancers and their treatments on your vocal cords.

What causes voice changes?

Your vocal cords, also called vocal folds, are bands of smooth muscle. They are found in the larynx (voice box) on top of your trachea (windpipe). As air passes from the lungs, your vocal cords vibrate (move). This makes the sound of your voice.

When there is a tumor on your vocal cords or close to them, it can affect how these cords work. Your voice may sound weak, quiet, stressed, hoarse, breathy, raspy, or you may feel like you need to clear your throat often. You may have changes in the pitch and intensity of your voice.

A tumor touching your vocal cords can cause changes to your voice. Treatments for head and neck cancers, like surgery and radiation, can damage the vocal cords and lead to voice changes. Ask your provider if your cancer or treatments may lead to voice changes.

How are voice changes treated?

Multidisciplinary treatment is very important in head and neck cancers. This means you will have providers from many different specialties involved in your care.

An important member of your team is a speech language pathologist (SLP). An SLP will test and help treat voice changes and any swallowing problems before, during, and/or after treatment. An SLP can give you exercises to help your swallowing and how you use your voice. The SLP may show you other ways to communicate. SLPs can be accessed at any time in a survivor's life for new concerns or to explore newer technologies for speech.

If you have new or worsening changes to your voice that last about 2 weeks or longer, call your primary care provider.

Changes to your voice can cause many feelings and can affect your quality of life. Talk with your provider about any concerns you or your caretaker may have.

For more information on swallowing problems, nutrition issues, and other side effects, check out our Head and Neck cancer section.

Aggarwal P, Hutcheson KA, Garden AS, et al. Association of Risk Factors With Patient-Reported Voice and Speech Symptoms Among Long-term Survivors of Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg. 2021;147(7):615–623. doi:10.1001/jamaoto.2021.0698

American Cancer Society. (2021). Signs and Symptoms of Laryngeal and Hypopharyngeal Cancers. Taken from https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/detection-diagnosis-staging/signs-symptoms.html#:~:text=Hoarseness%20or%20voice%20changes,health%20care%20provider%20right%20away

Bressmann, Tim. Speech Disorders Related to Head and Neck Cancer. Chichester, U.K. ; Malden, Mass. :: Wiley-Blackwell, 2010. Web.

CHEN, Shu-Ching. Oral Dysfunction in Patients With Head and Neck Cancer: A Systematic Review. Journal of Nursing Research 27(6):p e58, December 2019. | DOI: 10.1097/jnr.0000000000000363

Johns, M.M., Kolachala, V., Berg, E., Muller, S., Creighton, F.X. and Branski, R.C. (2012), Radiation fibrosis of the vocal fold: From man to mouse. The Laryngoscope, 122: SS107-SS125. https://doi-org.proxy.library.upenn.edu/10.1002/lary.23735

Müller, Nicole. The Handbook of Language and Speech Disorders, edited by Jack S. Damico, et al., John Wiley & Sons, Incorporated, 2010. ProQuest Ebook Central, https://ebookcentral-proquest-com.proxy.library.upenn.edu/lib/upenn-ebooks/detail.action?docID=792626.

Zebralla V, Wichmann G, Pirlich M, Hammermüller C, Berger T, Zimmermann K, Neumuth T, Mehnert-Theuerkauf A, Dietz A, Hinz A, Wiegand S. Dysphagia, voice problems, and pain in head and neck cancer patients. Eur Arch Otorhinolaryngol. 2021 Oct;278(10):3985-3994. doi: 10.1007/s00405-020-06584-6. Epub 2021 Jan 16. PMID: 33452920; PMCID: PMC8382612.

Zhang M. J., Mu J. W., Chen X. R., Zhang X., & Feng C. (2018). Effect of voice rehabilitation training on the patients with laryngeal cancer after radiotherapy. Medicine (Baltimore), 97(26), e11268. https://doi.org/10.1097/MD.0000000000011268

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