Seven ways to protect              

                                your voice from injury

By Dr Kevin Soh

Visiting Consultant Ear, Nose & Throat Surgeon, Mount Alvernia Hospital

Most of us would have experienced hoarseness at least once in our lives.  It is common because there are so many factors that can injure the voice box.  Most cases of acute hoarseness (less than 2 weeks) will have only one cause.  But several factors are usually identified in patients with chronic hoarseness (more than 2 weeks).

Trouble-shooting a patient with hoarseness will involve a very detailed and pain-staking scrutiny of a patient’s life-style, habits and behavior.

A Typical Example

Mr. Tan, 30 years old, consulted me because he was worried about hoarseness that had persisted for 6 months.  The hoarseness was associated with an aching sensation in his throat that made him cough frequently.  He also suffered from blocked nose that had been troubling him as a child.  He was forced to breathe through his mouth because his nose would block completely, especially when he was lying down to sleep at night.  Mr Tan tried many different medications including antibiotics but did not find any relief.

Mr Tan’s voice was worse in the mornings when he first got out of bed, but improved as he used his voice during the day.  However the voice never actually got back to normal even though he rested his voice in the evenings or weekends.  He also experienced a chronic throat irritation that woke him up at night.  He worried that his problems may be due to cancer as his mother had recently died of breast cancer.

Clues from Occupation, Lifestyle & Leisure Activities

Mr Tan worked as a head-hunter.  He had been in the industry for 2 years.  The job is hectic.  He puts in long hours in order to head-hunt prime candidates for his corporate clients.  He worked in a noisy office without partitions and has to be on the phone most of the time.  His job involved a great deal of talking.  In the evenings, Mr Tan entertained his business partners at expensive night spots to build relationships and discuss business.  Most of these places tend to be smoky and noisy, and they normally had to raise their voices above the din of background noise in order to make themselves heard.  He also indulges in smoking and alcohol. In order to stay awake, Mr Tan has resorted to the habit of coffee drinking.

Because of his hectic lifestyle, he seldom has time to cook or ear at home. He eats out most of the time, and his favorite dishes are those that are spicy and deep-fried. Recently to relieve stress, he has also picked up a new hobby – karaoke.

Vocal Cord Nodules

I told Mr Tan that he has vocal cord nodules.  This is a diagnosis that is made using a fiberoptic nasoendoscope to visualize the vocal cords. Vocal cord nodules are also known as Singer’s nodules or Screamer’s nodules as they tend to affect people who overuse or abuse their voices. They are commonly seen in people who have to use their voice professionally e.g. singers, teachers, speakers or children who scream as a habit.

How To Customize and Tailor the Treatment?

It is easy to make a diagnosis of vocal nodules and to attribute it to vocal abuse.  The difficult part is to scrutinize and identify what factors, habits or behaviors are at play in causing and perpetuating the nodules.  Even more challenging is to recommend feasible solutions that are practical from the patient’s point of view.  It is not enough to tell patients to ‘rest their voice’. The treatment and behavioral adjustments would therefore have to be tailored and customized for Mr Tan’s specific situation.

How I Solved the Problem?

  • I reassured Mr Tan that he does not have a cancer. I also advised him that vocal nodules will not deteriorate to become cancers.
  • I explained to Mr Tan that antibiotics are not going to help as his problem is caused by irritative and behavioral factors, and is not caused by an infection.
  • I started Mr Tan on an anti-smoking program.
  • I advised him to avoid alcohol and coffee as they tend to dry the vocal cords and increase irritation.
  • Mr Tan was unable to change the nature of his daytime work. However a lot could be done for his night-time activities. I advised him to bring his associates to quiet, non-smoky places so that they do not have to raise their voices during conversation.
  • He should refrain from cold drinks and spicy, deep-fried foods.
  • I treated his nose to restore nasal patency, thus reducing the need to mouth-breathe. With time, the throat irritation and dryness improved. He began to cough and clear his throat less frequently.
  • With continued encouragement and support, Mr. Tan was able to persist with the behavioral modification therapy. Mr Tan’s voice improved, but he also benefited in terms of relief from blocked nose, throat irritation, disturbed sleep, and general improvement in perception of health.

How to Defend Your Voice against Injury?

To protect your voice from injury, do the following:

  1. Avoid smoking, people who smoke, and dusty places
  2. Avoid shouting and screaming at sporting events
  3. Avoid discussing important matters in a noisy club or bar
  4. Avoid excessive coughing or throat clearing
  5. Avoid singing or talking loudly if you have acute laryngitis
  6. Drink lots of water to protect your vocal cords from dehydration
  7. Get your sinusitis and allergies treated. Chronic mouth breathing and postnasal drip can irritate your throat, make you cough and injure your vocal cords.

Hoarseness – Is It Serious?

Sometimes hoarseness can be a manifestation of throat cancer, lung cancer, thyroid cancer, tuberculosis or vocal cord paralysis. It is therefore important to exclude these important causes of hoarseness before assuming it is due to the common vocal cord nodule. It is important to have your throat examined by an Ear Nose and Throat Surgeon if the following situations exist:

  • If hoarseness last longer than 2 weeks
  • If the hoarseness is associated with coughing out blood
  • If the hoarseness is associated with difficulty swallowing
  • If you have a lump in your neck.