HEALTHWATCH
Voice at risk
Dr. P. S. N. MURTHY
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Man developed speech as a by-product of evolution. It is up to us to maintain a healthy voice.
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VOICE is the sound produced by the inward movement of vocal cords when the air from lungs passes through and brings the vocal cords together. The voice box or larynx is a unique organ responsible for producing sounds. This sound or `voice' is modulated and modified by structures like the lips, tongue and palate to produce decipherable speech. Voice and speech are invaluable resources for communication, social interaction and occupation.
Changes in voice can be very subtle but are noticeable early. Hoarseness is a general term, which describes abnormal voice changes. The voice may sound breathy, raspy, strained and rough in quality. People with voice problems often complain of or notice changes in the pitch or the volume, loss of voice or endurance and sometimes a sharp or dull pain or change in singing ability. Coughing or spitting blood or mucus along with breathlessness denotes a more serious problem.
Common causes
Voice problems arise from a variety of causes including abuse or misuse of voice, infections, injury and cancer. The changes in the voice are due to disorders related to the structure and movements of the vocal cords. Swellings and nodules over the medial margins of the vocal cords prevent them coming together resulting in changes in the quality, volume and pitch. Weakness of the laryngeal muscles leads to restriction or paralysis of the vocal cords. Cancers of the upper aero digestive tract can cause hoarseness either due to mass lesions preventing complete adduction of vocal cords or fixing the vocal cords by local infiltration or both.
The most common cause of hoarseness of voice is acute laryngitis, which usually follows an upper respiratory tract viral infection resulting in the swelling and oedema of vocal cords. Another reason could be excessive usage of voice while having a "cold". It is very important to be conscious about using voice during an episode of laryngitis as it may cause sub mucosal haemorrhages due to injury to the vessels traversing the vocal cords and then lead to permanent damage.
Vocal cord lesions comprises benign, non-cancerous vocal cord growths, which are usually caused by excessive use, abuse or misuse of the voice. Vocal cord cyst and polyps are also mucosal lesions occurring on one vocal cord. These affect both the structure and vibration of the vocal cords and causes chronic changes in the quality of voice.
Speaking at an abnormal or uncomfortable pitch can lead to hoarse voice. Young women, speaking at a lower than appropriate pitch, are usually at risk. Whispering is an example of this poor technique. Speaking too loudly, focusing and stressing certain syllables can result in injury or trauma to the vocal cords and muscles causing vocal fatigue.
Other factors that affect voice and speech are poor breathing techniques that cause increased tension in the throat and neck muscles. Pain and fatigue associated with talking are the usual symptoms in addition to hoarseness of voice.
Talking on a mobile phone with the instrument cradled to one's shoulder causes excessive tension in the neck and laryngeal muscles and changes the speaking technique leading to a voice problem. These are usually seen in professional voice users like teachers and politicians.
Acid reflux into the larynx and the irritation of vocal cords is being increasingly understood now. LPRD is difficult to diagnose, as the patients do not have classical symptoms of heartburn.
In patients with reflux-related voice problems, the voice is worse in the morning and improves during the day. They have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat and throat irritation.
Coughing or throat clearing injures vocal cords and should be minimised and treated accordingly. Primary causes such as Acid Reflux Laryngitis, allergy should be identified and treated.
Vocal cord paralysis occurs because of the involvement of superior and recurrent laryngeal nerves that regulate the muscles of the vocal cords.
Trauma, Thyroid surgery and viral neuronitis are the frequent causes of vocal cord paralysis. Vocal cord paralysis could also point to a major problem in the chest or neck such as cancerous lesions of lungs or food passage. The immobile or paralysed vocal cord typically causes a soft, breathy, weak voice due to inefficient closure and air escape during phonation.
Persistent hoarseness or change in the voice for longer than two to four weeks in a smoker should prompt a detailed ENT evaluation to rule out malignancy. Changes in the quality of voice may be the earliest or the only symptoms of the laryngeal cancers. Upper aero digestive tract cancers can cause hoarseness either by involving the laryngeal muscles or infiltrating the larynx. Patients may also complain of difficulty or pain while swallowing and difficulty in breathing with or without swelling in the neck. These lymph nodes indicate extensive nature of cancer coming into the tissues of the neck.
Smoking, allergies, thyroid dysfunction, neurological disorders and trauma to the neck can also cause hoarse voice.
Treatment
Consult a qualified Otolaryngologist (ENT surgeon) and speech or voice therapist. Most with mild hoarseness due to laryngitis will be all right with rest. Avoid smoking. Adequate fluid intake and mucolytic agents will help.
The role of an ENT surgeon is to identify the lesions, which require surgical excision. Larger nodules, polyps and cysts need to be removed with phono-Micro surgical techniques that remove only the lesions without damaging the underlying structures.
A biopsy of suspected laryngeal or pharyngeal cancers may be required. The non-medical treatment by speech and language pathologists and speech therapists will help patients in behaviour and lifestyle modification.
Do you have a problem?
Check the following questions:
* Is your voice hoarse, raspy, breathy or rough?
* Does your throat often feel raw or strained?
* Do you need to make an extra effort to talk?
* Do you clear your throat often?
* Do people regularly ask you if you have a cold when you don't?
* Have you lost your ability to hit high notes while singing?
Tips for a good voice
* Adequate hydration of the body through water consumption optimises the throat's mucus production and vocal cord lubrication.
* Avoid alcohol and caffeinated beverages that can cause dehydration.
* Avoid active and passive smoking.
* Avoid abuse or misuse of voice, habitual yelling, screaming and cheering.
* Avoid noisy environments.
* Stop talking if throat feels dry and tired.
* Use non-vocal or visual cues to attract attention.
* Use a microphone, if needed.
* Stop speaking in unnatural pitch.
* Minimise throat clearing.
* Moderate voice use when sick.
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