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Whether your voice is rasping, strained or altered in pitch, Barbara Myers and Dr Ruth Epstein, a specialist in voice disorders at London鈥檚 Royal National Throat, Nose & Ear Hospital, answer your questions.

The voice is produced by vibrations of the vocal cords or folds, the two bands of muscle tissue in the larynx or voice box. At rest, the folds are open and when they close, air passes through them causing them to vibrate and make a sound.

Having a problem with your voice can be very inconvenient if it strikes when you鈥檙e about to go on stage or defend someone in court.

If you suffer from bouts of hoarseness, find out what you can do to prevent them.

Laryngitis, characterised by a raspy breathy voice, occurs when the vocal folds are swollen. It can arise when the voice is overused, and exposing the vocal folds to infection or irritants can also be a trigger.

Nodules on the vocal folds can cause hoarseness, most commonly among professional singers. A nodule forms on each vocal fold, in the area which is under most pressure when the folds come together to vibrate.

In rare cases, and particularly in smokers, hoarseness can indicate cancer of the larynx.

Spasmodic (or laryngeal) dysphonia is a distressing condition that causes the voice to break or have a strained or strangled quality. Sudden spasms cause the vocal folds to slam together and stiffen. There鈥檚 no cure, but botox injections into the vocal folds can help to stop the spasms and improve voice quality for a few months.

Many voice problems can be reversed by voice therapy, which helps the patient eliminate the voice behaviour that created the disorder in the first place, like proper breath support for speech and eliminate forceful voicing. Other treatments include medication and surgery.

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