World Voice Day: Doctor shares why you need alertness to voice problems (and tips to protect your voice)

April 16 is celebrated internationally as World Voice Day. This has been instituted from the year 1999, having started as a national initiative in Brazil. The intention has been to increase public awareness of the importance of voice and alertness to voice problems.

Voice forms part of human identity. Any problem with it results in multi-dimensional handicap for the patient. Prevention, thorough analysis, investigation, and relevant correction are all needed to address this problem.

A change in one’s voice, if persisting beyond a few days, can have many consequences. These range from basic communication getting affected, apprehension about the cause of the voice change, social awkwardness, professional incompetence and even a possible loss of work and income. Nowadays, the importance given by the patient and his/her social environment to the change in voice is considerable. However, the important aspects of prevention and precautions are often not understood, or sometimes, ignored.

The larynx, or ‘voice-box’, situated in our throat is the primary organ of phonation, or voice production. Its primary component is a pair of vocal cords, which vibrate in that air-stream, during phonation. However, other structures also are involved in voice production.

The first step in our voice production begins with the intake of air, which we do as part of breathing. Our lungs fill with air. Next, as we prepare to speak, we breathe out and this air collects under the closed vocal cords, increasing the pressure there. Then, at a certain pressure, the air bursts through the cords. This leads to the release of sound energy. At the same time, the vocal cords vibrate. This leads to voice production. All these steps are common for all of us human beings. This voice then undergoes resonance and articulation as the sound waves move up from the voice box towards our lips. These form our individual voice patterns and speech, thus marking our identities.

Anything that hampers the above structures or their functioning in any way can lead to the symptom of hoarseness (perceived change in voice). The single biggest factor here is the extent of individual voice usage. This is in contrast to most diseases were infection, tumour or some form of injury would be the cause.

Voice abuse and consequent voice strain are the main culprits for the symptom of hoarseness. One’s profession has a major role to play in this. Hence, voice strain and voice change issues are common in teachers, lawyers, businessmen with excessive mobile phone use, public speakers etc. Singers, especially those taking part in realty shows, form a special category. There are also the habitual voice abusers who tend to speak more or very loudly. Personality too plays a part here. One’s diet and lifestyle can also predispose to voice problems. Many neurological diseases also can lead to voice and speech disorders. Last, but not the least, any growth in the voice-box, especially in smokers, can present as hoarseness – possibly the earliest warning sign of malignancy.

Many of the voice problems, especially in professional voice users, can be prevented. These warrant an awareness of the Dos and Don’ts in one’s daily lifestyle and voice use.

Smoking can harm the voice in many ways, most importantly by its association with malignant changes in the voice box or lungs. So, complete cessation of smoking is an absolute must in voice protection. The other general guidelines would be to avoid over-spicy and over-starchy diet, control obesity and to lead a healthy lifestyle. One should take prompt treatment for allergies, respiratory infections as well as acid reflux.

It is said that the only ‘medicines’ for the voice box are air and water. Deep full breaths and plenty of oral fluids – these ensure smooth function of the vocal cords and clear voice.

Now, comes the most important part, which is avoiding abuse of one’s voice. This consists of the spectrum of misuse, overuse, and abuse. So, the mantra here is “everything in moderation”. One should consciously reduce the duration, intensity, and frequency of one’s speaking. This becomes all the more relevant in the case of the above-mentioned voice professionals, especially teachers. They must learn to continue using their voice in the correct way, thus maintaining both job and voice health.

This is a concept to be stressed on World Voice Day. Vocal hygiene comprises all the good habits that help to keep all the structures that produce our voice healthy, and thus prevent development of a voice problem.

Hydration is the golden rule here. Ensure intake of at least 8 - 10 glasses of water a day and take care to include juicy fruits as snack items. One must also avoid dehydration – reduce intake of tea, coffee, and alcohol, and be wary of unnecessary ‘anti-cold’ medications, as they have the side effect of dehydration. For the voice, humid atmosphere is preferable to dry or dusty type.

A common bad habit that can damage the vocal cords is throat clearing. This is mostly done to ‘clear sputum’, but it leads to abnormal friction between the vocal cords. The safer option is to cough gently followed by a swallow.

At the cost of repetition, it must be stressed that the cornerstone of vocal hygiene is careful, controlled use of one’s voice - avoiding speaking too loudly, too much, or too rapidly.

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If you are recovering from hoarseness, then do take care to avoid lengthy phone conversations, whispering or shouting, talking in noisy environment. Remember to talk face to face, choose words carefully, whenever possible, try non-verbal means to ‘call out’ and to take adequate rest in case of inevitable lengthy talk

And, for the voice users, especially teachers, always ensure adequate hydration during and between classes, along with easy relaxed breathing. For performers, do remember to plan in advance of performances with reasonable [singing] practice schedules.

A speech Language Pathologist(SLP) is the one who provides the needed voice therapy and required long term follow up. Voice therapy is highly individualised depending on the cause of the problem. What is offered as therapy is based on the factors that were identified at the time of evaluation. It could be a change in the structures of the Larynx due to misuse or abuse of voice or any other neurogenic causes. Or it could be a pre-existing condition like allergic cough or reflux. Sometimes a wrong pattern of breathing and posture also can affect voice especially singers.

Once the causative factors are identified, therapy is initiated. Sometimes, merely eliminating these factors solves the issue. But for some a systematic way of management is required. Voice therapy is aimed at improving the way it functions so that optimum voice is produced with ease. It is important to consult a Speech Language Pathologist at the beginning stage itself so that worsening of the voice can be avoided.

Wishing everyone a clear and strain-free voice on this World Voice Day!

By: Dr. Unnikrishanan. K. Menon, Professor, Department of ENT, Amrita Hospital, Kochi