I felt like my mind was losing control of my voice. I later learned that was exactly what was happening.

A few months after the onset of my strange symptoms, I was diagnosed with spasmodic dysphonia, a rare neurological disorder that causes muscle spasms in the vocal cords and affects one to four people in 100,000, according to the National Institutes of Health. The result is choppy, unstable speech quality. I was told there was no cure but treatment was available in the form of voice therapy and shots of botulinum toxin, or Botox, directly into the vocal cords. But even with treatment, my doctor told me that my voice would never be the same again.

I had lost my voice.

Like other physical characteristics such as height, weight, and hair color, our voices help identify us. The sound of our voice influences how other people perceive us—possibly even more than the words we actually say.

“Our voice is our ambassador to the rest of the world,” says Dr. Norman Hogikyan, director of the University of Michigan Health System Vocal Health Center. “Often a first impression is based upon a person’s voice.”

For people with voice disorders, a part of our identity is stripped away. Our weak voices can be unfairly associated with emotional sensitivity, a lack of confidence, lower intelligence, and sometimes, physical illness.

In the 1990s, Hogikyan developed the voice-related quality of life, or V-RQOL, test along with his colleagues at the University of Michigan Health System after realizing how interconnected the voice was with patients’ confidence and self-perception. The test is similar to the quality of life measure that psychologists use to gauge the overall well-being of patients. The V-RQOL is meant to assess the collective emotional, social, and physical functioning issues related to the voice in people with voice disorders.

“What I realized was we didn’t have a good way to really understand what a voice problem meant to an individual,” Hogikyan says.

Some patients—like me—who have the “adductor” type of spasmodic dysphonia, in which the vocal cords slam together respond well to Botox treatment. (In “abductor” spasmodic dysphonia, the vocal cords spread too far apart.) Hogikyan measures these patients’ voice-related quality of life before and after treatment with Botox. On average, patients rate their voice-related quality of life around 30 on a 100-point scale before treatment. After Botox treatment, patients rate their voices around 80 on average.

Botox works by essentially paralyzing the vocal cords, stopping the spasms and temporarily restoring the voice. But the benefits only last three to four months at most, and along with the treatment comes physical, emotional, and social side effects. For the first week or two after the injection, my voice is soft and I’m unable to project loudly. Speaking requires a lot of physical effort. I actively avoid bars and parties during this time period. In college, when I found myself in noisy atmospheres, I told people that I was getting over a cold and I had lost my voice. I still say that sometimes.