I think the differentiation between 'voice' and 'speech' needs to be clarified here.
My 'voice' was the very first thing to be affected, along with breathing. My speech was good then, and still not that bad now.
Most bulbar ALSers when they say they've lost their voice, they mean they've lost their ability to speak clearly because their articulation is affected.
Magpuff, I can say a sentence or two before my voice disappears. Or, for a long sentence, I can start out being audible, and my voice trails off to nothing by time I finish it. It continues to weaken, but, as everything else for me, the progression is slow.
I went through a bunch of testing that showed vocal cord (fold) bowing and paresis. Before we knew it was a motor neuron problem, I underwent a procedure to plump up my vocal cords with a filler, kind of like restylane used for cosmetic wrinkle filling. It was not at all successful. It did indeed help close the gap, but it did nothing to improve my voice.
Sometimes when people have the opposite problem, instead of thin, weak, bowing vocal cords, their vocal cords are too tight (which could be seen in pseudo bulbar palsy) botox injections are helpful.
I would guess that about 18 months into knowing I had a problem with my voice—in other words, before I had a diagnosis—I had lost almost all tonal range. Especially low notes. I do not think my voice is monotone, but the amount of inflection I can show is extremely limited. It is also very very soft. I cannot project it. The percentage of how much of my voice loss is due to vocal cord paralysis, and how much is due to inability to force the air out, no one seems to really know.
I did create a voice with Model Talker. I don't use it that often. I used a voice amplifier for a while, but in a short length of time managed to kill two microphones, so I gave up on that. I mostly just don't talk unless its absolutely necessary.
Here is a good article on the voice. * Source is the American Academy of Otolaryngology Head and Neck Surgery:
The main parts of voice production:
• The Power Source: Your Lungs
• The Vibrator: Your Voice Box
• The Resonator: Your Throat, Nose, Mouth, and Sinuses
The Power Source: The power for your voice comes from air that you exhale. When we inhale, the diaphragm lowers and the rib cage expands, drawing air into the lungs. As we exhale, the process reverses and air exits the lungs, creating an airstream in the trachea. This airstream provides the energy for the vocal folds in the voice box to produce sound. The stronger the airstream, the stronger the voice. Give your voice good breath support to create a steady strong airstream that helps you make clear sounds.
The Vibrator: The larynx (or voice box) sits on top of the windpipe. It contains two vocal folds (also known as vocal cords) that open during breathing and close during swallowing and voice production. When we produce voice, the airstream passes between the two vocal folds that have come together. These folds are soft and are set into vibration by the passing airstream. They vibrate very fast – from 100 to 1000 times per second, depending on the pitch of the sound we make. Pitch is determined by the length and tension of the vocal folds, which are controlled by muscles in the larynx.
The Resonator: By themselves, the vocal folds produce a noise that sounds like simple buzzing, much like the mouthpiece on a trumpet. All of the structure above the folds, including the throat, nose, and mouth, are part of the resonator system. We can compare these structures to those of a horn or trumpet. The buzzing sound created by vocal fold vibration is changed by the shape of the resonator tract to produce our unique human sound.
