Apr 17, 2013 4:00 PM

Author: Katherine Kendall, MD, FACS


Talking is something we humans do without putting much thought into it. We do it automatically and don’t have to think consciously about how to do it. That is, until something goes wrong with our ability to talk. Hoarseness, or a deterioration of vocal quality, typically is the sign of some kind of injury to the vocal folds. Interestingly, when the margins of the vocal folds are injured, there is usually very little pain associated with the injury. Individuals with injury to the vocal folds will experience a change in vocal quality and may have an increased sense of effort when they speak. Especially when chronic hoarseness is a problem, patients need to recognize any change in vocal quality or change in the effort required to speak as a sign of further injury signaling the need for voice rest.

The most common situation leading to hoarseness is a bout of laryngitis that comes along with a cold or flu. The voice change in that situation is due to swelling and inflammation of the vocal folds from the viral infection. Even though viral laryngitis typically goes away on its own in a few days, it is important to recognize that the vocal folds are suffering from injury during that time and it is important to rest them by minimizing voice use until the voice change goes away.

There is no need to wait for a vocal fold injury to employ good vocal habits and to optimize vocal health, however. In order to keep vocal folds healthy, it is important to minimize excessive vocal demands such as talking over background noise or talking for long periods of time. Try not to talk on the phone in the car (traffic background noise) and don’t call to family members in another room. A good rule of thumb is to try to get close to the person you wish to speak to. Professional voice users, such as teachers, should use amplification systems in the classroom in order to avoid voice fatigue. And again, it is important to rest the voice if vocal deterioration is noted.

Certain non-verbal vocal behaviors such as chronic throat clearing or coughing are also very hard on the vocal folds and can lead to irritation and injury. Most people with this problem report that they feel a sensation of mucus or a tickle leading them to clear their throat. The throat clear improves the feeling for a short while and then the feeling comes back. In reality, what is happening is a vicious cycle. The throat clear or cough causes as much irritation as it relieves and, in the end, the more one clears their throat, the more one is likely to feel like the need to again. Strategies to help avoid chronic throat clearing include sipping water, using lozenges (avoid menthol or eucalyptus), chewing gum, a rapid exhalation, or a dry swallow. None of these strategies feel as good as a throat clear but they help, and the more one is able to resist that next throat clear, the closer one is to no longer feeling the need to.

Good hydration is very important for optimal vocal health. Movement of mucus out of the trachea and over the vocal folds clears irritants that are resting on the surface. The mucus moves faster with better hydration so irritants don’t sit on the vocal folds for a long period of time. A good estimate of individual water intake needs is about half one’s body weight in ounces per day. So, for example, a man who weighs 170 lbs. should drink 85 ounces of water per day. Keep in mind that other beverages that have caffeine or alcohol in them act as diuretics and will cause more fluid loss that needs to be made up by drinking more water.

Lastly, it is very important not to ignore a change in vocal quality that persists beyond a couple of weeks. Although chronic hoarseness is most likely due to a benign process, it is also the most common sign of an early laryngeal cancer. An examination by an otolaryngologist (ENT doc) is warranted to determine the cause in any individual suffering from chronic hoarseness.

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