Voice care: Sorting fact from fiction


Lesley Childs, M.D., Cory Atkinson, M.A., CCC-SLP, Amy Hamilton, M.A., CCC-SLP, Laura Toles, M.S., CCC-SLP, Janis Deane, M.E.D., CCC-SLP, and Ted Mau, M.D., Ph.D

At the UT Southwestern Voice Center, we enjoy gearing up for World Voice Day, April 16, by answering your questions about how the voice works and how to care for it. We also can help dispel some common myths about your vocal cords, and suggest some easy therapies and exercises to keep your voice in tip-top shape.

Q: Who should think about voice health?

A: Anyone who uses their voice! It’s not just singers and actors who should give their vocal cords special care. We only get one set of vocal cords, so it’s crucial to take good care of them.

Q: Are the vocal cords muscles?

A: The vocal cords themselves are made up of a mucosal cover and a muscular body. These structures vibrate, which is what produces our sound.

Q: Does whispering save your voice?

A: Whispering is OK in principle, but most people do not whisper in a way that is good for the voice. When most people whisper, they want to be heard, so they strain to produce sound. It can be as bad for your voice as shouting. There is a type of whispering, called an “open throat whisper,” which is fine, but the problem is no one will hear you! If you are trying to rest your voice, we recommend you not talk, not even in a whisper.

Q: Which foods and drinks can help heal your voice? Which can damage your voice?

A: The most important thing we can consume to improve vocal health is water. Staying hydrated helps your body produce thin, watery mucus. Your vocal cords vibrate more than 100 times a second when you speak, and they need that mucus to help them stay lubricated.

We recommend drinking 64 ounces of water each day. If you enjoy a caffeinated or alcoholic drink, you need to add more water to your daily consumption. So, if you drink 64 ounces of water, and then you have a 16-ounce coffee, you need to drink 16 more ounces of water.

It’s a myth that what you eat or drink comes into direct contact with your vocal cords. Drinking honey or tea, or gargling salt water or apple cider vinegar can definitely be soothing for your throat, but they aren’t washing off the vocal cords. If you do use cough drops, we recommend using glycerin-based products and to avoid menthol. Prolonged use of menthol can further irritate your throat.

Some supplements in excess can potentially irritate your vocal cords. For example, too much vitamin C can be very drying. Others, including large amounts of ginger, gingko, and garlic can thin the blood, putting you at risk of a vocal hemorrhage.

If spicy foods cause you acid reflux, you may want to order something else off the menu to help avoid vocal damage over time when reflux occurs.

Q: How can I prevent damage to my voice?

A: The five main tips we give to avoid damaging your voice are:

  • Warm up your voice before extensive use, just like you would warm up your muscles before exercise.
  • Do not use your voice when you are hoarse or have laryngitis.
  • Rest your voice when it feels strained or tired.
  • Drink 64 ounces of water a day.
  • See a laryngologist (a type of Otolaryngologist (ENT) who specializes in the vocal cords and care of the voice) if you have been hoarse for two weeks or longer.

Q: Do your vocal cords age?

A: Yes, your vocal cord tissues change with age just like the rest of the body. Your vocal cord muscles also can atrophy over time, causing your voice to change in pitch or volume, or to sound thin, breathy, or weak. However, you don’t necessarily have to accept your voice changing as you age. As the population ages, we are seeing more patients who want to know what they can do to make their voices sound more robust. Depending on your situation, we may recommend voice therapy to optimize your voice or injecting fillers or placing implants to enlarge or bulk up your vocal cords.

Q: My mom’s voice doesn’t sound thin, but it sounds shaky. Why is this?

A: This may be a sign of a vocal tremor. While there is no cure for a vocal tremor, if diagnosed, a laryngologist can offer treatment options to help decrease the severity of the tremor, such as injecting BOTOX (botulinum toxin) into the vocal cord muscles.

Q: What are some home remedies to heal a lost or hoarse voice?

A: The best home remedies are very simple: Drink water and rest your voice. Steam inhalation also is great for the voice. When you drink water, it doesn’t actually touch the vocal cords, but instead hydrates the entire body. However, inhaling steam does bring the water into more direct contact with the vocal cords.

Q: Can you help transgender patients change their voice?

A: Yes. Gender perception of the voice can be modified through voice therapy or, in some cases, surgery.

Q: How can I ensure that my voice comes through clear and strong when singing and speaking in public?

A: Using good breath support and forward resonance helps. Forward resonance refers to allowing the sound to resonate in the front of the face, which results in a more focused sound.

Q: How can sleep or lack of sleep improve or hamper our voice?

A: Lack of sleep and fatigue reduces our breath support and negatively affects the mechanics of voice production, which causes our muscles to work harder than they need to when vocalizing.

Q: I have a naturally raspy voice and I worry about making sure it doesn't get any lower. Any tips?

A: You should be evaluated by an ENT doctor to determine what is causing the raspiness and determine a plan of action from there.

Q: Why do I get a headache when I sing or hear loud sounds?

A: It’s not normal to feel pain when you’re using your voice. There can be many reasons for getting a headache from loud sounds. We recommend seeing an ear, nose, and throat specialist for both issues.

Q: Sometimes when I wake up, it’s hard to swallow and I’ve lost my voice. What is the fastest way for me to get back to normal?

A: Drink plenty of water and inhale steam.

Q: Are there seasonal or environmental concerns regarding the voice?

A: Allergy season can cause your vocal cords to become irritated due to all the coughing and throat clearing. In the winter, we see patients struggle with thick mucus because the heating systems in their homes are drying. Using a humidifier can help during those times. Smoke can irritate the vocal cords and airways, so try to avoid exposure to secondhand smoke.

Q: What are vocal cord nodules and polyps? How are they treated?

A: Vocal cord nodules and polyps are examples of wear and tear injuries. Nodules are a thickening of the vocal cord lining and usually occur on both vocal cords. Polyps are growths that usually develop on one vocal cord. We initially treat nodules and polyps with therapy, although surgery sometimes is needed to remove a polyp.

Q: Can acid reflux damage my vocal cords?

A: Yes, acid reflux can affect the vocal cords if it is coming all the way up into the voice box. A laryngologist may be able to see some telltale signs of acid erosion during an exam. To prevent damage, we often recommend weight loss, dietary changes (such as avoiding spicy food), and other behavioral changes such as not eating or drinking within two hours of going to sleep. If these interventions do not work, medication may be prescribed.

Q: I have struggled with laryngitis for years. Seeing a speech therapist helped, but what else can I do?

A: There are many therapy approaches, so you may want to ask your therapist about different exercises. If it continues to be a problem, you may want to get a repeat vocal cord exam.

Q: My child’s ENT who put in his ear tubes said he doesn’t work with voice problems? Who should I see instead?

A: Look for a fellowship-trained laryngologist with special training in voice care. A laryngologist is an ENT doctor who has received extra training on caring for those with voice, airway and swallowing disorders. A laryngologist also can recommend a voice therapist. Did you know that fewer than 5 percent of speech therapists in the nation specialize in voice therapy, specifically?

Q: My child loses her voice often. Is this more common for some people?

A: Some people do lose their voice more often than others. Certain behaviors, such as frequent yelling or cheering can cause you to lose your voice. If it’s happening often, see an ENT.

Q: Why do we feel the need to “clear our throat”?

A: We do this because we have the sensation that there is mucus on the vocal cords that we need to clear off. However, it sets off a vicious cycle. Basically, it pushes the mucus over a little bit, but doesn’t get rid of it, so we keep doing it. Meanwhile, it causes our vocal cords to grind together. It’s actually more vocally healthy to cough once than clear your throat multiple times.

We usually feel the need to clear our throat when we’re not adequately hydrated. If we’re not hydrated, the mucus we produce is thick, and we’ll notice it more. But if we’re adequately hydrated, our mucus is thin and watery, and we don’t notice it as it lubricates our vocal cords.

If you have further questions or are experiencing voice problems, request an appointment here or call 214-645-8898.

UTSW Voice Care Center

The Voice Center at UT Southwestern provides state-of-the-art care for patients with voice disorders and other conditions affecting the larynx (voice box), airways, and swallowing function. Patients include professionals who rely on their voices – singers, actors, public speakers, broadcasters, lawyers, clergy, and teachers – as well as seniors or anyone experiencing vocal problems.

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