Voice problems
Talking is an integral great part of our everyday lives. When we talk, air from our lungs is pushed between two elastic structures called vocal folds or vocal cords, found in the larynx (voice box). Sufficient pressure causes them to vibrate, thus producing sound.
However, there are times when we experience voice problems. Most often, these are temporary and our voice is restored to normal within a couple of days. But for some people, the problems are prolonged.
A voice disorder is defined as a problem involving abnormal pitch, loudness or quality of sound produced by the larynx. Hoarseness is the most common symptom. This maybe secondary to a lot of conditions: an upper airway infection (common colds and cough may produce vocal fold edema leading to laryngitis); voice abuse and misuse leading to the development of vocal fold nodules, cysts, and polyps; certain viral infections causing formation of vocal fold papilloma; underlying medical conditions, such as Laryngopharyngeal Reflux (LPR) or Gastroesophageal Reflux Disease (GERD); vocal fold motion impairment typically seen in patients with vocal fold weakness or even paralysis.
Hoarseness may also be caused by chronic irritation due to smoking, excessive alcohol intake, allergies, or nasal obstruction. This is prevalent among a growing number of voice professionals like singers, performers, newscasters, teachers, and call center agents. Hoarseness is most often due to voice abuse and misuse. Vocal abuse occurs when we do the following: habitual shouting or screaming, talking for long periods without rest, speaking in a stentorian manner (i.e. loud and powerful), constant coughing and throat clearing. Vocal misuse, on the other hand, happens when we speak without the proper breath support, talking on an unnatural pitch, and exerting too much effort.
Most of the conditions mentioned above maybe benign. However, not all voice problems are due to a benign cause.
A recent report from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) states that, “almost half of adults are not aware that persistent hoarseness may be a symptom of cancer.” The report also noted that among people who were eventually diagnosed with throat cancer, only 52% thought their hoarseness was harmless and delayed seeing a doctor. (Brouha, et al 2005)
Laryngeal cancer is the second most common head and neck cancer. Voice change often happens early and can help diagnose early stage cancer, thereby improving prognosis. Similarly, treatment options are based on the extent of disease.
Often, we neglect seeking proper medical advice. A lot of the good old traditional medications (i.e. herbal) may provide relief, but a proper evaluation and diagnosis should be emphasized. Still, a good number of the population is bereft of the right information. Prevention is the key. Taking an active role in proper voice care or vocal hygiene is important.
Adopting healthy daily habits can easily prevent voice disorders caused by vocal abuse and misuse. Adequate hydration (e.g. drinking plenty of water, steam inhalation, and humidification) to keep the vocal folds moist while talking is important. Do not strain your voice. Rest your voice, if you must. Try to avoid frequent throat clearing. Instead, swallow hard or take sips of water. Proper warm up and cool down of the voice is advisable. Furthermore, try to modify contributing environmental factors such as proper amplification when talking to a large audience in a full-sized area and when speaking above background noise. Reduction and elimination of vocal abuse and misuse behaviors are recommended. Most of the time, speech rehabilitation or therapy proves to be very helpful.
Reflux Laryngitis maybe prevented by correcting bad eating habits (i.e. lying down immediately after eating, eating too much, or skipping meals) and diet modifications. Avoiding too much intake of caffeinated drinks, alcohol, smoking, and spicy food may also help prevent acid reflux. Certain medications, such as antihistamines (antiallergy), may also have a dehydrating effect. So, it’s a must to hydrate more.
Above all, it is always best to consult your Otolaryngologist (Ear, Nose, and Throat doctor) should there be persistent hoarseness or change in the voice for longer than four weeks or for any other symptoms in your throat. As mentioned earlier, prompt attention to voice changes can help facilitate early diagnosis and subsequent early treatment of voice problems.
St. Luke’s Medical Center takes pride in the Voice, Swallowing, and Sinus Center, which is the country’s most modern and fully-equipped integrated unit created for the diagnosis, management, and rehabilitation of patients with upper aerodigestive tract disorders. Using state-ofthe-art technology, it specializes in the evaluation and treatment of patients with voice-speech, laryngeal disorders, swallowing problems, and diseases of the nose, paranasal sinuses, and oropharyngeal areas. The Center is equipped with Digital Videolaryngostroboscopy with a laryngeal microphone system and Computerized Speech Laboratory to assess patients with voice problems. It also has a Swallowing Workstation Unit with digital video recording system for the evaluation of patients with Laryngopharyngeal Reflux and other swallowing disorders.
St. Luke’s Voice, Swallowing, and Sinus Center specializes in the care of an increasing number of Filipinos who rely on their voice to perform their job. For more information, please call the St. Luke’s Voice, Swallowing, and Sinus Center at 7230101/0301 ext. 4715/4716 (Quezon City) or 789-7700 ext. 2055/2056 (Global City).
Dr. EMMA B. GUEVARA is a Fellow of the Philippine Society of OtolaryngologyHead and Neck Surgery and a Fellow of the Philippine College of Surgeons. She is an Active Consultant of the Department of Otolaryngology-Head and Neck Surgery of St. Luke’s Medical Center - Quezon City and a Clinical Instructor/SGD Facilitator at St. Luke’s College of Medicine - William H. Quasha Memorial.