Why has my voice changed?
Our voice connects us to other people and is an integral part of the human experience. It is distinct to who we are and an identifiable characteristic that we are known by.
In general, our voice is a part of who we are that we don’t really think about very much until something is wrong. Whether you are a singer, public speaker, teacher, politician, doctor, student, parent, you name it, we all have a voice that allows us to engage with one another. Toddlers use their voice to communicate basic wants and needs through cries or babbling, singers use their voice to entertain their audience, teachers need their voice to educate their students. The bottom line is that we use our voice on a daily basis for a variety of purposes and it is essential to functioning in the most simple tasks to the most complex activities. Over the course of our lives, we will experience changes to our voice as a result of seasonal allergies, cheering at a basketball game, the common cold or strep throat. This is because the vocal folds, which are key players in the production of voice, are very delicate and easily affected by how we use them. A topic for another day is how the voice is impacted after a medical diagnosis such as laryngeal cancer or after intubation post a hospital stay. These are more complex conversations that can have a different course for treatment. So, let’s get into it!
As I mentioned before, changes to vocal quality, pitch and loudness happens at the level of the vocal folds and depends on the coordination of the respiratory, phonation and resonation systems (ASHA, 2023). It’s an incredibly complex system that works together dynamically without conscious thought.The vocal folds are made up of very delicate tissue that adducts (move inward) and abducts (move outward) to create a vibration which is perceived as sound. When something changes in the anatomy or structure, the function of the voice is impacted.
Ok, without getting too technical about anatomy and physiology, the first term I’m going to introduce is hyperadduction. When the vocal folds come together with increased force, it is called hyperadduction. This is a common cause of vocal fold injury and can be due to excessive misuse of one or more of the subsystems. Imagine clapping your hands together. When you clap your hands, you are using more than just your hands. Your hands are guided by your forearm, upper arm and even some back muscles. The wrists allow for the flexibility needed to complete the motion. Coordination and balance of all moving parts actively regulate the loudness and impact. Now, I am not a physical therapist. So, I won’t pretend to understand the complex fine and gross motor skills that occur when clapping your hands together. However, I use this example to illustrate the complexity of the movement of clapping that mirrors the opening and closing of the vocal folds.
Hyperadduction can result in temporary changes in voice, temporary loss of voice, vocal lesions and/or long term damages. Unfortunately, many people unknowingly rely on hyperadduction to increase voice volume, or intensity. Continued misuse of the voice in this way may lead to reduced stiffness and increased thickness of the vocal folds (Zhang, 2021). Zhaoyan Zhang is the department head of neck surgery at the University of California in Los Angeles. In Acoust Today, Zhang goes on to say that tightly compressed vocal folds could result in irregular vocal fold vibration and cause a rough quality of voice. Continued hyperadduction and misuse of the voice, can lead to nodules, polyps, ulcers or permanent changes in vocal quality (Zhang, 2021). If speech therapy is not implemented for rehabilitation, surgical courses of treatment may then be required.
Now that we’ve reviewed what hyperadduction is, let’s talk about day to day uses of voice where hyperadduction is commonly relied on. Cheering, screaming and shouting are the most common occurrences where you might wake up with a raspy or sore voice in the days that follow. Most often, this subsides on its own with vocal rest and hydration because it is a result of an isolated situation (i.e., a sports event, concert, etc). However, continued use of voice in this way may result in more significant damage and/or changes to the structures of voice production. Professions at risk include, but are not limited to: coaches, teachers, referees, singers, public speakers.
Another daily misuse of voice is excessive coughing or throat clearing which can be brought about by the common cold, seasonal allergies or GERD. This is another common form of hyperadduction of the vocal folds that occurs regularly and left untreated can have damaging effects in the long run. I am one of those people who frequently clears my throat because I live in Texas and experience allergies year round. That tickle in the throat that causes the sensation of needing to clear the throat is the culprit. However, there are other ways to relieve that annoying feeling without clearing your throat. One healthy habit to develop is to take a sip of water and say “mhmm.” This is a much gentler way to move any mucus that may be triggering that need to cough and supports hydration.
I am also a regular coffee drinker. Anyone else need to start their day with a nice hot/cold cup of liquid energy? Unfortunately, caffeine is a diuretic which can contribute to dehydration and, therefore, negatively impacts healthy vocal fold vibration. When you hear about hydration of the vocal folds, it does not come from simply sipping water while actively using your voice. It actually means ensuring that continuous hydration is occurring in order to properly support vocal fold function.
Speech therapy provides intervention for all types of voice disorders that include but are not limited to: raspy voice, loss of voice, dysphonia, rehabilitation of vocal lesions, post-surgery recovery, etc. With all of this being said, please converse with a medical professional or a speech language pathologist if you have questions or concerns. This information is not meant to be a substitute for individualized assessment and treatment.
In summary, take care of your voice because you only realize how much you need it when it is gone.
To book a consult or schedule an evaluation, contact kerena@thebalancedslp.org or call 210-651-2186.
Resources:
Zhang, Z. Jan 13.The Physical Aspects of Vocal Health. Published in final edited form as:Acoust Today. 2021 Fall; 17(3): 60–68. doi: 10.1121/at.2021.17.3.60
Georgalas, V., Kalantzi, N., Harpur, I., and Kenny, C. (March 2021). The Effects of Caffeine on Voice: A Systematic Review. Journal of Voice. https://doi.org/10.1016/j.jvoice.2021.02.025
Voice Disorders. ASHA, 2023. https://www.asha.org/practice-portal/clinical-topics/voice-disorders/#collapse_3
