Everyone has heard of the importance of brushing your teeth to prevent cavities, or stretching before exercising to prevent injuries, but have you heard of caring for your voice to prevent damage to your vocal folds? Did you know that your voice (vocal folds) can get damaged? Prior to graduate school, I had never thought twice about how my voice was produced or taking care of my voice! Like most people, I have experienced sore throats after a long day of talking or after trying to carry a conversation over a loud crowd, but I never considered that my sore throat could have lasting consequences.
When I am doing voice therapy with clients with voice disorders I often hear, "I wish I knew this before I got vocal nodules!" or "Why doesn't everyone know this?" So, today I am going to give you an introduction to your voice and some strategies to prevent vocal fold damage.
WOW! I bet you didn't know...
Did you know that about 16% of the population will develop a voice disorder at some time in their life? If you are a teacher or you rely heavily on your voice, you are more likely to develop a voice disorder. A study conducted by Luce, Teggi, et al. (2014) revealed that more than 50% of the teachers they sampled had a voice disorder at some time during teaching.
Where is my voice?
Say "zzzzz" and place your fingers on the top of your neck. Can you feel buzzing? That buzzing is your voice! Your vocal folds are protected behind thyroid cartilage. They vibrate to produce noise but they also play an important role in protecting your airway from liquids/foods (along with your epiglottis). Your vocal folds allow you to breathe by opening. That's not all! When your vocal folds are closed, they allow you to build intrathoracic pressure so that you can lift weights or have a bowel movement. (I bet you never thought your vocal folds played a role in your use of the washroom!)
You can feel your vocal folds close by pushing down really hard with both hands into your chair. When your vocal folds are closed they act like a cap on a pop bottle. When the bottle is closed it is stiff and more difficult to crush/squeeze. When the cap is taken off of the bottle all of the pressure escapes through the top and it is much easier to squeeze the bottle. Similarly, when you close your vocal folds you create extra stability in your core.
How is sound produced?
Sound is produced by the "Bernoulli Effect." As you breath in you fill up your lungs and your diaphragm with air. When you breath out the air pressure moves up through your trachea and vibrates your vocal folds to create sound. Your articulators (lips, tongue, etc.) then shape the sound to create different speech sounds, just like a musical instrument creates different notes.
Your vocal folds are responsible for the pitch of your voice. The muscles in your larynx control the length and tension of the vocal folds. Think of a double bass versus a guitar - the strings are very long on a double bass whereas the strings on a guitar are shorter. When length is increased the pitch is decreased. When your vocal folds are short and tense, they produce a higher pitch. The speed of the vibration also contributes to the pitch. Did you know that your vocal folds can vibrate more than 1000Hz per second (although your normal speaking voice vibrates slower than this)?!
How can I damage my vocal folds?
When your throat feels sore it is usually the first sign that your vocal folds are irritated. I often think of vocal fold irritation like a blister from running or breaking in new shoes. Like a blister, if you rest the area it will usually recover on its own with no lasting damage. If you are a runner who has a blister that doesn't want to take a break in their training schedule, the blister will often form a callus. The same concept is true for your voice. If you don't rest your voice when it is irritated, you can develop a vocal fold nodule (a small bump). A bump on your vocal fold will distort your voice and it may sound more raspy or hoarse.
The following list can contribute to vocal fold damage:
GERD: Reflux can cause acid to irritate your vocal folds.
Raising your voice: When you raise your voice you exert extra pressure on your voice. Rather than your vocal folds gently vibrating and lightly touching, they slam together.
Grunting: Like raising your voice, grunting results from closing your vocal folds forcefully.
Coughing and Throat Clearing: When you cough or clear your throat you exert a great deal of pressure on your vocal folds. When this happens chronically, damage can occur.
Overuse: When your voice is used for long periods of time, you do not allow your voice time to recover.
Whispering: You would probably think this would be easier on your voice. In fact, it is much harder on you vocal folds to whisper!
How can I care for my voice and prevent vocal fold damage?
Drink more water to keep vocal folds lubricated and moving effectively.
Consume less caffeine as this can be a diuretic.
Avoid talking in situations with loud background noise. When you feel your voice straining to speak above background noise, try to find a quieter area to speak or wait until their is a time where you can speak without straining your voice.
Rest your voice: When your voice feels sore, it is telling you it needs a break. Regular vocal rest can help prevent long-term damage of your vocal folds.
Use amplification: If you need to speak to a crowd of people, over background noise, or in a large space, amplification can help you maintain your normal volume and pitch.
Use nonverbal communication: Sometimes it is possible to communicate your message without using your voice. For example, at times an email may be used instead of a phone call to communicate the same message. For teachers, you could also use clapping, flipping the light switch, or a raised hand to communicate to a room full of people.
What if I already have vocal fold damage?
If you often feel like you often have a sore throat, sound like you have a cold (but don't), or feel like your voice sounds rough, low, or unusual, it is time to see a medical professional. An ENT (ear, nose, and throat doctor) can visualize your vocal folds and determine whether a voice disorder is present. Typically, a referral from your family doctor is needed to see an ENT. Your family doctor can also determine whether GERD or other medical conditions are contributing to your voice changes.
If an ENT determines you have a voice disorder, you would benefit from voice therapy. Speech-Language Pathologists are uniquely qualified to treat voice disorders. Many voice disorders are treatable but rely on creating new voice habits. If voice disorders are left untreated, surgery is often required, however surgery will not resolve the underlying habits that are damaging your vocal folds and therefore vocal nodules often come back after surgery without voice therapy.
If you are noticing frequent voice changes, act now and talk to your family doctor. Remember, you only have one voice... take care of it now!
LIRA LUCE F, TEGGI R, RAMELLA B, et al. Voice disorders in primary school teachers. Acta Otorhinolaryngologica Italica. 2014;34(6):412-418.