• Reference Number: HEY-352/2016
• Departments: Speech and Language
• Last Updated: 1 August 2016

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, i.e. the glottis, it presses on the resting vocal cords and parts them, the cords separate in a wave-like fashion. The rapid opening and closing of the vocal cords creates a vibration changing the air pressure into sound waves.

Resonance

We use muscles to modify the space within the chest, throat, mouth and nose. This is specific to each person and therefore gives us our own unique and individual voice.

Articulation

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

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

How does a voice disorder develop?

Our voices may reflect how we are feeling physically or emotionally. The following conditions may bring about a voice disorder:

• Stress and / or anxiety.
• Gastric 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.
• Excess smoking or alcohol.

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

How can I look after my voice?

What to do and why:

Give up smoking

Smoking causes the throat and vocal cords to become inflamed and swollen from the dryness, heat and tar from the tobacco smoke. Smoking (including passive smoking) may therefore 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 0800 3 327 111.

Drink plenty of fluids

To keep your vocal cords healthy, your body needs enough fluid. General opinion is that 8 glasses (around 2 litres) a day is about right. The best fluids for the body are water, squash, herbal teas and juices. (Do however ask advice from your GP if you are on water tablets).

Avoid caffeine

Fluids such as tea, coffee, and fizzy drinks contain caffeine which can dehydrate your body. Caffeine also has a drying effect on the vocal cords.

Avoid alcohol

Alcohol causes the vocal cords to become dry and inflamed as well as having a dehydrating effect. Alcohol may also aggravate heartburn 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 i.e. fatty and spicy foods. Avoid eating just before going to bed (allow 2-3 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, causing voice changes and producing more mucus. This can also cause voice changes. This may have developed 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 (making it work much harder and requiring much more effort). This in turn may increase the likelihood of developing changes to your vocal cords and as a result affecting the sound of your voice.

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 soft voice instead to reduce effort. Once you start whispering it can be a difficult habit to break.

Relaxation

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. Please ask your Speech and Language Therapist. The following should set you up ready for any further breathing exercises that your SLT may prescribe:

Engaging the abdominal muscles using the Alexander Technique:

This technique is designed to restore body symmetry, help you identify body tensions and develop your awareness of breathing while lying down.

• Lie on the floor or mat (or a firm bed if you have major back problems or difficulty getting up off the floor). Place a couple of books or a pillow under your head and bend your legs with feet flat on the floor or bed (this is to relieve your back). Look at the ceiling and try to centre yourself in line with a beam or a light fitting.
• Your head needs to rest on enough books (or a small, firm cushion) to stop your chin dropping into your chest. Use this position to help lengthen your neck slightly but comfortably.
• Check your legs are in line and parallel, knees in line with your hips and feet.
• Either place a small book on your tummy (preferable to start with) or place your thumbs on your navel, hands spread over your abdomen and elbows resting on the floor. Check that your shoulder blades are relaxed. Lengthen your spine comfortably and check that there is a small space between your waist and the floor / bed.
• Breathe in and then blow the air out gently through pursed lips. Blow gently but comfortably to the end of the breath, relax and wait for the next breath to surge in again on its own.
• Check to see whether your abdomen rises as you breathe in – if not, this is where a light book on your abdomen will help. Push it up gently as you breathe in.
• As you finish breathing out, let the abdomen relax (the book will drop down). Wait for the in-breath to start again on its own.
• If you feel breathless then slow your rate of breathing right down. Allow your body to decide how much oxygen it needs. Try to relax into it otherwise body tension may make you feel out of breath.
• Get into a slow, gentle rhythm of breathing. (A very slowly ticking metronome may help if you have one or could borrow one.)
• Repeat this exercise a few times. Up to five minutes twice a day will prepare you for any breathing therapy your therapist may prescribe.

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 the mucous linings of your throat and vocal cords. 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 fully.

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.

If your throat feels dry, you could try inhaling steam.

Do not put any scents, especially not menthol products into the water, as these products are designed to dry out the mucosa lining in the body.

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.

Should you require any further advice on the issues contained in this leaflet, please do not hesitate to contact the Speech and Language Therapy Department on telephone number (01482) 604331.

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.