Frequently Asked Questions

1. Why is my voice hoarse? What causes a voice to become
hoarse?
Voice hoarseness can be caused by the following:
■ Secondary to a viral or bacterial infection causing the
laryngeal mucosa to swell
■ Acid reflux (laryngopharyngeal reflux)
■ Secondary to mass lesion/s on the vocal cords
■ Secondary to a complication after a neck surgery (e.g.
thyroidectomy)
■ Secondary to cardiac or pulmonary conditions that might
impinge the recurrent laryngeal nerve as it courses through
the aorta and pulmonary artery to the larynx. This
impingement might cause left sided vocal fold paralysis or
paresis (weakness)

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2. Why does my voice shake when I talk? I feel that my voice
seems strangulated.
You may be suffering from spasmodic dysphonia, specifically
adductor spasmodic dysphonia (ADSD). ADSD is characterized
by uncontrollable spasms of the vocal fold muscles. These
sudden, involuntary movements interfere with the proper
vibration of the vocal folds.

A shaky voice (sometimes described as a voice with tremors) can
also be caused by muscle tension dystonia (MTD). This disorder
causes the muscles around the larynx to tighten, causing it to
work inefficiently. This results in a voice that sounds strangulated.
Muscle tension dystonia is prevalent among 40-50-year old
women

3. Why does my voice sound weak and breathy?
A weak or breathy voice may be caused by spasmodic
dysphonia, specifically abductor spasmodic dysphonia (ABSD).
This form of spasmodic dysphonia is less common, the spasm

causes your vocal folds to remain open, resulting in a weak and
breathy voice. Some patients may describe this as a murmured or
whispery voice.

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4. Why does my voice suddenly sound high/low-pitched?
This can also be caused by adductor spasmodic dysphonia, please
refer to FAQ#1 for the possible causes.

5. Why does my voice cut out when I talk?
This can also be caused by adductor spasmodic dysphonia, please
refer to FAQ#2 for the possible causes.
6. Why does my voice crack? Is it normal for a voice to crack even
for females?

A voice can crack due to the reasons enumerated in #1. This can
also be caused by spasmodic dysphonia, please refer to #s 2 and 3.

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7. Is having a sore throat serious? Is it a symptom of COVID?
Yes, it is one of the common symptoms of COVID 19. But it doesn’t
mean that if your throat is sore, you already have COVID.

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8. What kind of doctor treats spasmodic dysphonia?
If you feel that you may have spasmodic dysphonia, it is best to
consult with an ENT-HNS doctor, specifically a laryngologist who is
trained to assess/diagnose spasmodic dysphonia.
Not all ENT-HNS specialists are aware of spasmodic dysphonia or
trained to identify this condition. As a result, SD patients can be
misdiagnosed if not seen by an ENT or laryngologist who have hands-
on experience in correcting this condition.

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9. What should I expect when I visit a voice doctor for spasmodic
dysphonia?
You would expect a thorough history-taking and physical examination
by the laryngologist. Additional procedures such as videostroboscopy
will be performed for anatomical assessment. Videostroboscopy is a
technique wherein the doctor gently inserts a thin flexible tube
attached to a video camera through the nose and into the back of the
patient’s mouth to visualize your vocal cords.

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10. How is SD diagnosed? What are the possible treatments?
SD is diagnosed by a trained ear. It should be taken into consideration
that not all ENT-HNS are exposed to this condition since cases are
limited or at least overlooked, hence there is a large margin that is
misdiagnosed.
There are some videostroboscopic findings which suggest SD that can
lead to a high index of suspicion for the diagnosis.

11. What are the possible treatments of spasmodic dysphonia?
Currently, these are the available treatments for spasmodic dysphonia
in the Philippines:

■ Temporary – Botox (ADSD)
■ Permanent – Type 2 thyroplasty (ADSD) or lateralization
■ For ABSD (difficult to treat, we might do further
assessment)

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12. How much does surgery for spasmodic dysphonia in the
Philippines cost?
Cost of spasmodic dysphonia thyroplasty in the Philippines varies due
to a number of factors. Please call 0917 637 5588 for further information

or you can fill up our form.

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13. I am a transgender, can a doctor make my voice sound more
female/male?

Technically yes, we just have to assess your voice first (voice analysis) to
know if the said range that you are aiming for is feasible.

14. What is the procedure for a voice change? Is this available in the
Philippines?
Voice change procedure from female to male is known as Type 3
thyroplasty. Voice change procedure from male to female is Type 4
thyroplasty. Both voice change procedures can be performed at IMVC
Manila.

15. How much does voice feminization/ voice masculinization cost in
the Philippines?
Cost of voice feminization or voice masculinization in the Philippines
varies due to a number of factors. Please call 0917 637 5588 for further
information or you can fill up our form.

16. My voice became permanently hoarse after my thyroidectomy.
Can you fix it?
Yes. There is a big possibility that your laryngeal nerve was severed
during the procedure. This caused your true vocal cords to be
paralyzed. This can be corrected with medialization or Thyroplasty type
1.