Your voice and how to look after it

About your voicebox

The voice box has two vocal cords which move and close to produce our voice.

What is causing the problems with my voice? 

Many different things can cause discomfort or changes in your voice quality. These include: 

• a recent cold or infection 
• damage to the voice box from injury 
• the way in which the voice is used, such as shouting or screaming 
• lung conditions, such as asthma, can reduce the airflow needed to form your voice 
• imbalance in the voice box’s muscle tone 
• stress and worry
• excess acid refluxing into the voice box 
• smoking 

If your voice problems persist, you may need an examination of your vocal cords using a thin camera. This is to look for any problems, such as swelling, growths or minor bleeding. The examination will also look for signs of irritation of your voice box. These could be from acid reflux, allergies, smoking or vaping. 

How can my voice problems be treated?

There are several different ways of treating voice problems:

• voice therapy
• medications
• surgery
• or a combination of these

Your GP may refer you on to an ENT specialist or a Speech Therapist to treat your problem. Some referrals for persisting problems are classed as routine. Others may be urgent to rule out a possible cancer, in which case you will be seen quickly.

If they have recommended surgery or medication, you will be given more information about this. There are many things you can do to help your voice in the meantime. These are outlined in this leaflet.

How to look after your voice

For your voice to improve, you will need to follow this advice.

Do…

• Reduce background noise, such as, televisions and radios when you are speaking.
• Think about your posture, drop your shoulders, open up your chest, ‘unfurl’ your neck – grow tall!
• Try to relax when speaking, especially your shoulders and head and neck region, so you can feel the breath support coming from your stomach muscles.
• Take another breath if you feel you are running out of breath while speaking. If you run out of breath, you run out of voice!
• Aim to drink two litres of non-caffeinated, non-alcoholic fluid every day (avoid fizzy drinks and citrus fruit juices due to their acidity). It is best to take sips throughout the day to help lubricate your vocal cords. Steam inhalation is another good way of keeping your voicebox moist.
• Suck a sugar-free sweet or chew sugar-free gum if your mouth or throat feels dry and if you cannot get a drink.
• Rest your voice if it feels ‘tired’ or sounds husky for any reason, including when you have a cold. This means not speaking unless it is necessary. When you do speak, use a quiet voice rather than a whisper. Whispering uses a lot of energy and force on the vocal cords.
• Pace your voice use. If you will need to speak a lot, try to avoid going out to a noisy event the evening before, and try to use emails and texts rather than a phone call or meeting.
• Facing someone who has hearing problems and using slow, clear speech at normal conversational volume is likely to be more effective than shouting.

Avoid...

• Smoking, as this involves inhaling smoke past the vocal cords. This dries them out and may cause irritation and inflammation. Smoking also greatly increases your risk of developing cancers of the mouth, lung or voicebox.
• Vaping - we do not know the full impact on the throat as this is relatively new. Therefore, we suggest avoiding vaping.
• Screaming, shouting, yelling, or doing anything with your voice that makes it go husky or feel sore.
• Clearing your throat – use alternatives such as doing a strong swallow after taking a sip of water or doing a quick, strong sniff followed by a swallow.
• Speaking over background noise, particularly loud, amplified music.
• Shouting to make yourself heard by people who are deaf or hard of hearing.
• Singing at a pitch or volume that makes your throat hurt or your voice husky.

Some more tips to keep your voice healthy

• If you are overweight, try to lose some weight as this will help to reduce reflux. Speak to your doctor if you need advice or help.
• Acid reflux is when acids from your stomach cause irritation by flowing up from the stomach into your food pipe. If you are aware that you suffer from reflux, discuss with your doctor whether medication might be helpful.
• Avoid acid reflux by eating regular meals and avoid eating late at night. Leave at least two or three hours between your last meal and going to bed. This reduces the risk of acid reflux when you lie down at night. When you are lying flat, acid may spill over into your windpipe and cause irritation and swelling of your vocal cords.
• Do not force yourself to speak if you have laryngitis (you have lost your voice, or it is very hoarse). Using your voice should always feel easy!
• Avoid stress. Stress causes muscle tension, which interferes with breathing. As breathing and breath support is vital for voice production, stress may be a major cause of voice problems.
• Relax. Use any form of relaxation that feels appropriate in your case. This may include attending relaxation classes and/or take regular physical exercise, e.g. yoga or swimming.

Disclaimer: This publication is designed for the information of patients. Whilst every effort has been made to ensure accuracy, the information contained may not be comprehensive and patients should not act upon it without seeking professional advice.