This information is not intended to replace an evaluation by a physician or a speech pathologist. Because of privacy and other concerns, we can not address patient specific questions. These must be addressed in person.

What causes voice problems?

The voice is produced by vibrations of the vocal cords or folds within the larynx (voice box). Anything that interferes with this normal vibration may cause hoarseness. Although voice problems are quite common, many are self-limited and most respond to treatment.

Acute laryngitis and its resultant sore throat and hoarseness often accompany viral upper respiratory infections. Smoking and overuse are frequent causes of voice difficulty. Allergies and sinus problems with postnasal drip can affect voice quality as may bronchitis and lung infections. A cause, relatively common but sometimes hard to prove, is reflux (or leakage) of stomach acid into the throat. This may occur without symptoms such as heartburn or belching. Rarely, a vocal cord may become weak or paralyzed. Benign (noncancerous) and malignant (cancerous) growths which occur in the larynx will interfere with vibration of the vocal cords resulting in hoarseness. Lastly, some voice changes occur naturally such as those associated with aging.  Voice problems can also be caused by vocal overuse or misuse.

Most respond to treatment of the underlying cause. For example, acute laryngitis improves as the virus resolves. Voice rest, fluids and mild cough suppressants such as Robitussin DM or an equivalent are helpful also.  In other cases, treatment is more complex. For the patient with longstanding sinus infection, antibiotics and sometimes even surgery are needed to correct the underlying problem and resultant hoarseness. If the voice disorder does not respond to medical treatment, then voice therapy may be recommended by the doctor.  So, the first step in treating a voice problem is making the correct diagnosis. 

One who is hoarse after yelling at a football game or who has caught a cold may not need to see a doctor at all. If the voice does not return quickly or other symptoms are present (such as a bad cough with yellow sputum), a call or visit to your personal physician would be wise.  If hoarseness lasts more than a couple of weeks, or the treatment prescribed by your doctor does not seem to be working, a visit to an otolaryngologist (ear, nose & throat specialist) is usually the next step.

Can reflux/heartburn affect my voice?

Yes. Reflux means that stomach contents and acid rise up to the throat and can irritate the vocal cords causing voice problems.  This problem can often be reduced by changes in eating habits such as when, what, and how much one eats. It is also recommended that you avoid alcohol, caffeine, chocolate, and fried and spicy foods.

What are vocal nodules?

Vocal nodules are small calluses of the vocal cords. They occur in both boys and girls and predominately in women. Nodules come from abuse to the vocal cords associated with yelling, screaming, or an unnatural pitch or singing style. Vocal nodules are frequently found in cheerleaders, aerobic instructors; they rarely occur in librarians. Vocal nodules can be treated quite easily and successfully with voice therapy. This condition rarely requires surgery, almost never in children.

I have heard that drinking water is good for my voice, is this true? And how much?

Yes. The vocal cords are two small muscles that vibrate in order to produce voice. The more flexible the vocal cords are the better they vibrate.  Drinking 6-8 glasses of water and avoiding caffeinated drinks (cola, tea, and coffee) will improve the flexiblity of the vocal cords.  Adequate water intake makes it easier to speak with less effort. A general guideline is to "pee pale and speak clear." In other words, drink enough fluids to keep your urine very dilute or pale.

 What is voice therapy?

Voice therapy is used to improve the voice.  Therapy includes voice education to improve understanding of how the voice works, voice conservation to improve the voice, and vocal exercises to improve the balance of breathing, vocal cord vibration and voice production. This often involves the proper use of your breathing muscles for the best breath control and voice use. Voice therapy is typically done once a week and may vary from 3 to 12 sessions.    

Does smoking affect my voice?

Yes. Smoking and exposure to smoke irritates and dries the lining of the voice box. This decreases voice quality, promotes reflux laryngitis, and increases the need for throat clearing. Long term smoking also destroys lung function, and without good lung power, singing is impossible.

 What can be done for a paralyzed vocal cord?

There are several treatments for a paralyzed vocal cord and they frequently can result in the restoration of near-normal speaking voice quality. Voice therapy is helpful in the treatment of a paralyzed vocal cord to maximize the voice and to compensate for the immobile vocal cord. Surgery to push the paralyzed vocal cord to the midline by injection or placement of an externally placed implant is often done in conjunction with voice therapy. This type of surgery is usually performed as same-day surgery

My voice is weak. Can something be done to make it stronger?

Yes. A weak voice and a voice that tires easily (vocal fatigue) can be caused by many things. Aging and neurologic disorder may do this. A weak voice often can be strengthened with voice therapy. Alternatively, surgery on the vocal cords to make them stronger (vocal fold augmentation) can be done to correct a weak voice or a voice that tires easily.

To schedule an appointment with the Voice Disorders Center please call (205) 933-5068.  We are located at St. Vincent's Hospital, Building One, Suite 201 in Birmingham, Alabama 35205