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This can lower the pitch and induce some hoarseness as well. In such cases, the fundamental frequency of the speaker varies randomly. If the vocal folds approximate too loosely, breathiness will be the dominant feature. Voice that is both harsh and breathy is called hoarse. The individual may be taught to initiate voice softly and gently and thus this helps eliminate harshness. Voice therapy is effective in eliminating harshness caused by some of the structural problems that are due to vocal abuse. In some individuals, harshness may be a matter of how the person has learned to produce voice with hard glottal attacks and abrupt initiations of voice. Other causes of harshness include any kind of structural alternation of vocal folds that changes its mass and elasticity, such as changes caused by nodules or cancerous growths. In patients with spastic dysarthria, harshness is also accompanied by strained or strangled voice, low pitch, and pitch breaks. Harshness is a voice symptom associated with spastic dysarthria, a neurological disorder often caused by a single-brainstem stroke or multiple cerebral hemisphere strokes. Harshness may be present in loud or soft voice, although it often is associated with weak voice of low pitch. A lowered level of estrogen and progesterone before the menses can cause a thickening of the vocal folds. The vocal fold vibrations are not periodic but aperiodic across the spectrum. Habitual breathiness can be treated with behavioral techniques. A harsh voice is variously described as unpleasant, rough, strident, metallic, grating, and gravelly sounding. If breathiness is due to vocal nodules that are typically caused by such vocally abusive behaviors as routine screaming and yelling, the clinician may modify those behaviors. In addition, the individual may initiate voice abruptly and exhibit hard glottal attacks. The pitch of a hoarse voice is typically low. If they approximate too tightly, harshness will be dominant feature. Hoarseness can signal a serious laryngeal pathology, although it often accompanies the common cold. The client may be trained to better approximate the folds to reduce breathy vocal quality. Voice therapy also can effectively modify such faulty vocal behaviors as hard glottal attacks and abrupt voice initiations. Voice therapy can reduce the size of nodules or eliminate them completely and normal voice quality will then return. Generally tensed larynx and pharynx may be a part of this learned behavioral pattern. It is associated with excessive muscular tension and effort. Causes of harsh voice include neurological neurological diseases that affect the neural control of vocal folds. The predominant component of hoarseness may be breathiness in some individuals and harshness in others. The vocal folds are pressed together too tightly, and the air is then released too abruptly. Hoarseness results from irregular vocal fold vibrations. The resulting voice sounds harsh and unpleasant. The causes of hoarseness include all those that produce both breathiness and harshness of voice.
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