Voice Topics on this Page  

• What is Voice?
• What are Voice Disorders?
• What causes a voice problem?
• How are voice disorders diagnosed?
• How are voice disorders treated?
• Tips for improving a hoarse voice
• GERD/LPR Instructions

 

 

Voice

What is voice and how is it produced?

The sound of the human voice is created by vibrations of the vocal cords as air passes outward from the lungs and through the larynx (the “voice box”). The "Adam's apple," seen most prominently on men, forms the front of the larynx. When the speaker presses the vocal cords together like a valve, the air passes gently between them, causing them to vibrate and producing sound. The sound is then modified and enhanced by the throat, cheeks, tongue, lips, soft palate and sinuses, all of which participate in the creation of human speech.

It is important to know that the prime purpose of the vocal cords is to protect the airway from the entry of food and drink during swallowing. During the course of evolution animals have evolved the ability to use the larynx as an organ of communication. But if we did not have a larynx, we would have to deal with repeated episodes of aspiration (entry of food and liquids into the trachea, or windpipe) that lead to pneumonia, lung scarring and eventually death from asphyxiation.

What are voice disorders?

A normal voice is judged according to whether the pitch, loudness, and quality are adequate for communication and suit a particular person. A person may use a pitch which is too high or too deep, intensity that is too loud or too soft, or voice quality may be too hoarse, breathy, or nasal. Sometimes a voice may seem inappropriate for an individual, such as a high-pitched voice in an adult male.

Voice is a problem when the pitch, loudness, or quality calls attention to itself rather than to what the speaker is saying. It is also a problem if the speaker experiences pain or discomfort when speaking or singing. Some common signs of a voice disorder include:

• Hoarseness
• Vocal fatigue
• Breathy voice quality
• Change in pitch range of the voice
• Excessive coughing
• Excessive throat clearing
• Change in voice after a cold or flu

What causes a voice problem?

There are a variety of causes of voice problems. People can become hoarse temporarily by cheering too loudly at a football game or using a pitch level that is too high or too low. Other misuses of the voice, such as an improper breathing pattern or excessive smoking, can also result in a voice problem. Some prescription, over-the-counter, and herbal medications including can affect the function of your voice.

Voice changes sometimes follow an upper respiratory infection or cold due to swelling of the vocal cords and changes in their vibration pattern. Reduced voice use (voice rest) typically improves the voice after an upper respiratory infection, cold, or bronchitis. If voice does not return to its normal characteristics and capabilities within two to four weeks after a cold, a medical evaluation is recommended. A throat examination after a change in the voice lasting longer than one month is especially important for smokers because of the possibility of cancer as a cause of the hoarseness. Other causes of voice change are vocal cord weakness or paralysis (stroke, lung cancer, neuropathy), vocal cord polyps or nodules, gastroesophageal reflux disease, thyroid disease, allergy, inhalations of irritating substances or medications, endotracheal intubation during surgery, neurological disorders (spasmodic dysphonia, multiple sclerosis) and external neck trauma.

How are voice disorders diagnosed?

Dr. Damask will begin her evaluation with a thorough medical history and description of the events leading up to your visit. She will thoroughly review your medical history to determine whether any of the factors that cause voice disturbances are present.

Next she will perform a comprehensive examination of the head and neck. This will include and endoscopic procedure to observe the vocal tract structures. The vocal cords will be observed for the detection of muscular weakness or paralysis, deformity, inflammation, polyps, tumors, nodules, granulomas and infection.

In addition to the examination Dr. Damask may order additional testing, such as:

• Imaging studies (CT scan, MRI scan) to detect structural abnormalities in the larynx, soft tissues of the neck, thyroid gland and airway)
• Videostroboscopy to delineate the vibratory characteristics of the vocal cords
• Direct laryngoscopy, an operative procedure under general anesthesia, to obtain tissue for analysis of tumors, inflammation or infection. Tissue removal is accomplished under the guidance of a microscope using microinstuments or lasers.
• Vocal assessment by a Speech and Language Specialist. Formerly known as “Speech Pathologists,” these highly trained professionals are experts at voice analysis and rehabilitation. They use advanced testing, such as acoustic analysis, aerodynamic evaluation and voice therapy to diagnose and treat abnormal function of the vocal tract.

How are voice disorders treated?

Depending on the cause Dr. Damask has a number of options available:

• Gastroesophageal reflux disease is treated with diet modification, proton pump inhibitors to stop acid production and lifestlye modification (elevation of head during sleep, no late night meals, etc.)
• Vocal cord polyps may require operative intervention and smoking cessation.
• Vocal cord cancer is treated with surgery and/or radiation therapy and chemotherapy.
• Functional voice problems (vocal misuse and abuse, derangements of pitch and breath control and others) require the assistance of a speech and language specialist.
• Neurological disorders, such as paralysis or spasmodic dysphonia, may require surgery and/or medications.
• Vocal hygiene includes following a daily regimen to achieve and maintain a healthy voice including maintaining adequate hydration (6-8 glasses of water per day), minimizing exposure to noxious chemicals, no smoking of cigarettes, and the avoiding of excessive shouting, screaming or other loud voice use.

Tips of improving a hoarse voice?

• Break the throat-clearing habit by taking sips of water regularly throughout the day.
• Break up the mucus from "postnasal drip" and nasal congestion with a non-prescription expectorant (e.g. Robitussin).
• Quit smoking and avoid smoke-filled environments.
• Use a properly working humidifier during the heating season.
• Don't use your voice non-stop at work. Organize your schedule to include regular periods of voice rest.
• Keep the volume down. In conversation, don't scream or try to talk over loud noises. Avoid noisy environments such as nightclubs and sporting events.
• Find the right volume for your voice and avoid strain. Take a deep breath and use your abdominal and chest muscles (diaphragm) to produce a forceful, but unstrained voice level.
• When speaking in public, maintain an erect but relaxed posture; speak with your normal pitch range, and use a microphone or megaphone for amplification, rather than trying to shout.

GERD/LPR Instructions

Reflux of stomach juices up the esophagus into the throat can cause or aggravate a variety of throat symptoms, including

• chronic sore throat
• chronic cough
• chronic laryngitis
• postnasal drip
• snesation of a lump in the throat
• vocal cord polyps
• difficulty swallowing

Treatment for this condition can often be accomplished without additional medication. The following guidelines should be observed:

• nothing to eat or drink within 3 hours of bedtime
• avoid overeating
• avoid fatty and fried foods
• avoid chocolate and mints
• avoid foods with tomatoes or tomato sauce
• avoid all carbonated beverages, caffeine and alcohol (no herb tea)
• discontinue smoking
• consider weight loss
• avoid tight-fitting clothing

If following these guidelines does not relieve your symptoms, using an antacid may help to neutralize the stomach acid reflux. Take two tablespoons of a liquid antacid (Mylanta or Maalox) or two antacid tablets (Tums or Rolaids) afer each meal. Mylanta lozenges work especially well. You can also try over-the-counter "acid-blockers" such as Pepcid AC or Tagamet HB as directed. Gargling with PeptoBismol also seems to work well.

Many Drugs and medications can aggrevate reflux. These include:

• ACE-inhibitors (some blood pressure medications)
• calcium-channel blockers (some heart and blood pressure medicines)
• theophylline preparations (asthma medicine)
• antihistamines/decongestants (cold remedies)
• sedatives (e.g. Valium)
• birth control pills

You should avoid these medications if possible. If you have any questions about whether your medicines fit into these categories, please ask the doctor. Before discontinuing any medicine, discuss the matter with your primary care physician. Do not stop any of the medicines your normally take with discussing it with your doctor.

If this conservative approach is not successful, you may be prescribed medication to reduce the amount of acid in the stomach and medication to tighten the muscular 'valve' between the stomach and the esophagus. These medications should be taken every day, not on an "as-needed" basis. You may not see an improvement for several weeks.