• Reference Number: HEY-352/2024
• Departments: Speech and Language
• Last Updated: 31 January 2024

Introduction

This leaflet has been produced to give you general information about how your voice is produced, how it may be damaged and recommendations on how to look after it.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your Speech and Language Therapist (SLT), but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with your SLT.

How is your voice produced?

Respiration

As we speak we breathe out. Air travels from the lungs, up the windpipe (trachea), through the voice-box (larynx) and out through the mouth.

Phonation

As the air passes through the voice box, it presses on the resting vocal folds and parts them, the vocal folds separate in a wave-like fashion. The rapid opening and closing creates a vibration changing the air pressure into sound waves.

Resonance

Voiced sound is made louder and modified by the vocal tract resonators. These are the throat, mouth and nasal spaces. The resonators produce a recognizable voice individual to each person.

Articulation

The vocal tract articulators (the tongue, soft palate, and lips) modify the resonated voiced sound and produce recognizable words.

Damage to any of the areas or the muscles in the vocal tract may result in voice problems.

How does a voice disorder develop?

Our voices may reflect how we are feeling physically or emotionally and can also be affected by the environment around us.  The following conditions may bring about a voice disorder:

• Stress and/or anxiety
• Gastric reflux or silent reflux
• Asthma/COPD
• Arthritis or other conditions affecting posture

Often we misuse or abuse our voices by:

• Shouting or overusing our voices especially during or after a throat infection
• Continual coughing or throat clearing
• Untrained singing
• Smoking and/or alcohol

Note: It is often a combination of these (and other) factors that interfere with the normal workings of the voice box.

Voice Therapy is Holistic – Tips on how you can look after your voice and why:

Give up smoking

Smoking causes the throat and vocal cords to become dry and swollen from the smoke therefore smoking and passive smoking can worsen your voice quality.

There are many benefits to giving up smoking. If you would like any advice or help on giving up smoking you can access the Smoking Cessation Service by going to www.readytostopsmoking.co.uk  or by ringing 08003247 111 or text QUIT to 61825.

Drink plenty of fluids

Dehydration badly affects the function of the vocal folds and as a result, voice production. To keep your vocal cords healthy, your body needs enough fluid.  General opinion is that for good systemic hydration (fluids you drink) 2 litres a day is about right. The best fluids for the body are water, dilute squash, herbal/fruit teas and juices. (Do however ask advice from your GP if you are on water tablets). Drinking water is important but so is ‘superficial hydration’ such as steam inhalation. Hydration is especially important if you are suffering from a throat infection or take medication that may dry your mucus membranes or if you suffer with nasal congestion at night as this can also dry the membranes in your larynx. Your Speech and Language Therapist can direct you further on this.

Avoid excess caffeine

Fluids such as tea, coffee, and some fizzy drinks can contain caffeine, which act as a diuretic (make you go to the toilet). Small amounts is fine for the voice but it is better to stick to water/ dilute squash as above.

Avoid alcohol

Alcohol causes the vocal cords to become dry and inflamed as well as having a dehydrating effect. Alcohol may also aggravate reflux, which is not good for your voice.

Foods

Research shows that indigestion/acid reflux can cause voice problems. Some people find that certain foods and drinks can give them symptoms of acid reflux ie fatty and spicy foods. Avoid eating just before going to bed (allow 2 to 3 hours between your last meal and bedtime). Raise the head of the bed so that the angle will assist downward flow of acid. For more information on acid reflux and managing symptoms please ask your Speech and Language Therapist.

Throat clearing/coughing

When you cough or clear your throat your vocal cords come together with force. If this happens repeatedly you can cause them to become sore and swollen, causing voice changes and producing more mucus. This can often develop into a habit.  instead of coughing or clearing your throat, drink water, swallow hard, yawn, or suck a sugar free sweet instead.  This will help you to break the habit.

Shouting/raising voice/voice rest

When shouting or raising your voice your vocal cords come together with force and you increase the muscular tension in your neck.  Constant shouting and raising your voice can cause vocal strain. This in turn may increase the likelihood of developing changes to your vocal cords and as a result, affect the sound of your voice. If you are a professional voice user and have laryngitis, ideally cancel any immediate engagements and begin voice rest. Laryngitis makes singers more prone to injury so do not risk it.

Whispering

Often people feel that whispering can help by giving the voice a rest; however, whilst you are not using your voice it can still cause damage to your voice box. Most people use more pressure and strain the muscles more when they are whispering than when they are talking. Try to speak in a gentle voice instead to reduce muscular effort.  Once you start whispering it can be a difficult habit to break.

Wellbeing

Keeping your body and mind healthy can have huge benefits for your vocal health. Sleep really matters, the average person needs 6 to 9 hours of sleep. Lack of sleep can lead to greater fatigue and have a negative impact on your mental health. If your body feels tired then your voice will be too. Mental wellness is important for vocal wellness. Do what you need to do to reset at the end of the day. This might be taking a walk, doing some stretches, having a hot bath or reading a good book. Any tension in the body can be transmitted to the voice.  This means that the ability to relax is very important for your voice and for your general well being.  True relaxation involves the mind and body and can be taught.  Relaxation often starts with optimal breathing.

Breathing

Having a good breathing technique is essential for optimal voice. Start to observe how you breathe. Paying attention and observation is essential for learning, guidance can be found at: Self Help – Physiotherapy for breathing pattern disorders (physiotherapyforbpd.org.uk)

Positioning

Any imbalance in posture or positioning can cause muscle tension in the body.  To achieve the best from your voice it is advised that you position yourself in an open, relaxed position e.g. uncrossed legs and arms, and sitting upright.  If you spend a lot of time talking with your neck twisted, or tilted you will be using your muscles unevenly e.g. when using the telephone, or talking to someone over your shoulder.  Especially consider your volume and the position of your head/neck while on the telephone.

Chemicals/sprays

Avoid air fresheners, plug-ins, and aerosols (e.g. spray deodorant, perfumes, hairsprays). These release chemicals into the air which are inhaled when you breathe. This can irritate the lining of your throat and vocal cords. If you decide to continue to use aerosols, do so in a well-ventilated room.

Dry air (central heating/air conditioning)

Breathing in dry or dusty air can dry out and irritate the mucous linings of your throat and vocal folds.  Centrally heated or air-conditioned environments can cause the air you breathe to become dry. If you spend large amounts of time in these environments, increase your fluid intake to ensure your body is hydrated.

In a centrally heated environment, try placing water near a heat source e.g. under or near a radiator, as this will add moisture to the air. Alternatively use an air humidifier. If your throat feels dry, you could try inhaling steam.  Do not put any scents, especially not menthol/Olbas oil into the water, as these products are designed to dry out the mucosa lining in the body. In some circumstances vocal nebulizers can be beneficial – ask your therapist for more advice.

Background noise

We tend to talk louder if our surroundings are noisy e.g. home, work, in the car, pubs/clubs, sports events etc. Often we are not aware of raising our voices even slightly e.g. in response to continuous sounds such as air conditioning.

Avoid speaking for long periods in noisy environments and wherever possible remove or reduce unnecessary noise e.g. by turning the television off or down whilst speaking.

Managing colds/infections

• Keep your nose and throat warm and wet.
• Saline nasal sprays or rinses are soothing. They thin down mucus and wash away any inhaled irritants while the salt has a mildly antiseptic effect.
• Drink plenty of water and keep well hydrated. Mucus is predominantly made of water. If you do not drink enough, mucus will thicken and dry. You know you are properly hydrated when urine is almost colourless (‘pee pale’).
• Steam is your friend. It gets water safely to thick, dry mucus in the nose and chest, thinning it and making it easier to clear. It soothes irritation and reduces swelling of the mucous membranes. Turn off air conditioning and reduce air convection heating. Keep the atmosphere more humid (open a window, keep leafy plants around, spray some water into the room or keep a wet towel over the radiator).
• Beware decongestant medicines. Decongestants temporarily shrink the nasal membranes by constricting blood vessels in the nose. The nose feels clearer for a short time before the constricted blood vessels dilate again and the nose re-blocks. Persistent use of these medications can create a vicious circle. If you really need them, follow the manufacturer’s instructions carefully and do not use them for more than 7 days
• Sleep as much as possible and eat healthily – plenty of fruit and vegetables.

Listen caringly to your voice. If you do experience a voice issue, help is available.

Should you require any further advices on the issues contained in this leaflet, please do not hesitate to contact the Speech and Language Therapy Department on telephone number: 01482604331.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.