From hoarseness to speaking more slowly, how voice changes can signal an underlying health condition

Everyone gets the occasional frog in their throat that makes their voice sound different temporarily. Sometimes a cold or seasonal allergies are to blame, especially when you have that post-nasal drip. Aging can also cause changes in how you speak. But in some cases, these voice changes can linger and serve as a sign of a more serious underlying chronic condition — one that warrants a doctor’s attention.

Experts share a few conditions that may affect how you speak and sound and what to look out for.

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease, aka GERD, is a digestive condition in which stomach acid and sometimes bile move up the esophagus, irritating the lining of the food pipe.

“GERD can irritate the vocal cords, which can cause hoarseness, especially earlier in the day,” Dr. Alexa Mieses Malchuk, a family physician based in Cary, N.C., tells Yahoo Life. “A person with GERD may also cough or clear their throat frequently — a result of stomach acid refluxing up.”

Throat irritation and frequent coughing or throat-clearing can change how a person sounds.

“Anyone with a persistent cough over time, not explained by an infection, should be evaluated for GERD and post-nasal drip, in addition to other etiologies,” or causes, Malchuk says. “GERD is very common and if untreated over time can lead to serious health issues.”

Malchuk adds that being overly concerned about subtle voice changes can cause undue anxiety, but if you do notice changes, talk with your doctor.

Parkinson’s disease

Parkinson’s disease is a progressive movement disorder that causes shaking, stiffness and difficulty with balance and coordination. Voice changes can also happen.

A 2020 study found that evidence suggests voice dysfunction is the earliest sign of motor impairment in PD. The researchers stated that “the complexity and fine motor control involved in vocalization may result in dysfunction here before the limbs.”

However, this is still an emerging area of study. Although voice changes aren’t necessarily predictive of developing the condition, says Dr. Ariane Park, associate professor of neurology and co-director of the Center for Parkinson’s Disease and Other Movement Disorders at the Ohio State University Wexner Medical Center, they are common in those with Parkinson's.

“Speech requires multiple cognitive domains that involve processing what you’ve heard, organizing your thoughts and then producing words [or] language,” Park tells Yahoo Life. “PD can affect the networks that coordinate these various functions.”

Parkinson's can affect the voice in several ways, including speech that’s softer or has a breathy or hoarse-like quality, speaking in a monotone, mumbling, slurring and a faster or slower speaking rate. Adds Park: “Some patients know what they want to say but have a hard time getting the words out.”

It’s important to point out that many neurological disorders can affect speech, so Park says if a patient notices a change in their voice along with other neurological changes or concerns, they should see a neurologist.

“Having a diagnosis helps patients get connected with the best treatment options,” she says. “This can include medications, dedicated speech therapy programs and/or communication devices.”

Alzheimer’s disease

Alzheimer’s disease is a degenerative disorder that causes severe changes to the brain, resulting in disorientation, confusion, memory loss, behavior changes and difficulty finding the right words.

Language dysfunction often occurs in people with Alzheimer's. According to a 2022 study, “The first signs that communication is being affected are the difficulties on finding words, especially when it comes to naming familiar people or objects. Words are replaced by wrong and meaningless words and pauses during speech are increased as well.”

Technology may help diagnose cases earlier. Researchers are investigating using computer-assisted and artificial intelligence analysis of speech in people with Alzheimer's to help detect the condition in its early stages.

ALS

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord. Speech problems occur with ALS when nerve cells that deliver messages from the brain to the muscles that move the lips, tongue, soft palate, jaw and vocal cords are damaged, causing the muscles they control to become weaker and tighter. Respiratory muscles that control breathing can also become weak. When this happens, speech can become slow, slurred and breathy, according to the ALS Association.

“About 50% of people who live with ALS have a slow cognitive decline, so speech analysis can actually give a window into how that is progressing,” Emily Baxi, program director at BD2 and a director at Milken Institute, tells Yahoo Life. She believes precision medicine with machine-assisted speech analysis can help understand aspects of disorders like ALS and lead to targeted therapeutics.

Bipolar disorder

Bipolar disorder is a chronic mental health condition that causes a person to experience extreme shifts in mood from depressive lows to manic highs. How the voice rises and falls often shifts with mood, says Dr. Victor Fornari, a psychiatrist at Northwell Health.

“In bipolar disorder, during a manic or hypomanic episode, the voice can be pressured and elevated,” he tells Yahoo Life, adding that the content of the speech can be grandiose, or highly exaggerated. “Individuals in a manic phase are often loud, overly talkative and can be intrusive,” he says.

During the depressed phase, however, the person’s voice can be soft and slow in pace and they use few words, says Fornari.

This happens because symptoms of mood fluctuations are mediated by changes in neurotransmitter functioning, explains Dr. Serra Akyar, a psychiatrist at Northwell Health. “These changes impact mood, thoughts, decisions and speech,” she tells Yahoo Life.

Voice pattern changes are linked to other mental health conditions too. For example, with obsessive-compulsive disorder, the person may repeat certain words or phrases, says Akyar.

“What I think is intriguing is that you can take one to two minutes of a person’s natural speech and without knowing anything else, run an analysis and be able to say if someone is likely to have schizophrenia, anxiety, depression, psychosis,” Baxi says. “Now obviously that comes as a helpful tool and not a clear diagnostic.”

Fornari points out that providers often observe a patient’s appearance, behavior, speech and judgment when evaluating their mental health status. “The voice is often a window into the person’s emotional state,” he says. “When someone is concerned about the speech or voice pattern of a person, including changes in characteristics, it may be a sign of a mental health concern, including bipolar disorder.”