10 April 2019
Many of us have experienced ‘losing’ our voice at some point, usually because of a cold or cheering too loud for our favourite sports team, and so we understand the frustration that comes with it. Most voice problems last only a short time, but others can last longer. Our Consultant ENT Surgeon, Mr Abir Bhattacharyya, discusses the different voice disorders, how to avoid them and also how to treat the symptoms.
What is a voice disorder?
Voice disorders covers a wide variety of conditions that affect the voice box (larynx) that can manifest with a change in voice, such as the below:
- Infection of the larynx
- Swelling of the larynx
- An abnormality in the structure
- Trauma to the larynx
- Lumps in the larynx
- Neurological (such as Parkinson’s disease or multiple sclerosis)
- Autoimmune disease
The management involves a thorough understanding of the function of the larynx, diagnostic evaluation with attention to detail and a multidisciplinary team approach in treatment.
How common are voice disorders and which groups of individuals are generally affected?
It is estimated that between 3 – 10% of the general population are affected by voice disorders. This is of particular concern in ‘voice professionals’, the term used to designate those individuals who depend on their voice for their profession like teachers, singers, lecturers and even doctors. The main symptom in people with voice disorders is hoarseness or dysphonia, which describes an alteration in voice quality.
How are voice disorders diagnosed?
The evaluation and assessment of a patient with a voice disorder is carried out by an ENT Consultant, who may seek an opinion from a Speech therapist. A thorough assessment is carried out by Diagnostic and Physical evaluation by the Consultant using specialist equipment for Laryngeal evaluation, including rigid and flexible laryngoscopes (an instrument used to examine the larynx) and video stroboscopy (an examination of the vocal fold using a strobe of light). On occasions the accurate diagnosis is established after Perceptual evaluation (a clinical voice assessment) and specific imaging and blood tests.
How are voice disorders treated?
There are three general approaches to the management of voice problems: medical, surgical, and behavioural including speech therapy. It is often the case however, that optimal treatment requires the use of a combination of treatment types.
The medical approach to the treatment of voice disorders refers to non-invasive techniques. Problems in which the vocal cords demonstrate redness, swelling or irritation (e.g. laryngopharyngeal reflux) can be medically treated. Proton pump inhibitors used to control and treat acid reflux play an important role.
Surgical management (Phonosurgery)
A thorough understanding of the structure of the vocal cord is important for effective management. Vocal fold cysts, polyps, swelling (oedema) and other benign, precancerous and malignant conditions are treated surgically.
Speech therapy and behavioural management
The behavioural approach consists of voice therapy, which aims at restoring the best voice possible within the patient’s anatomical, physiological and psychological capacity.
Look after your voice
Below is some basic advice that can help keep your voice in good health. Not all of them will relate to you, so read carefully, and decide some goals for your voice.
Drink more water
Aim to drink 2 litres of water each day. If you don’t like plain water, you could have water with some squash or diluted fruit juice. If you like hot drinks, try a mug of hot water or herbal tea. Avoid fizzy water as this can encourage burping.
We all know that smoking is bad for our health, but did you know smoking is bad for your voice too? Talk to your GP about how to give up – or phone the NHS smoking helpline on 0800 169 0169.
Daily steam inhalations
Take a bowl or basin of hot water. Lean over the basin with a towel over your head and breathe the steam in through your nose and out through your mouth, to prevent coughing. Do this as many times as you need to during the day, but avoid doing this before any strenuous voice use or voice exercises. Do it every day for one week and see if it helps to improve your throat/voice. If it helps, make steaming part of your daily routine.
Stop clearing your throat
If you find yourself frequently clearing your throat out of habit, try very hard to stop doing this. Each time you feel the urge to clear your throat, stop and have a sip of water. Swallow a couple of times and see if the feeling goes away without you needing to clear your throat. Allergies/asthma/asthma inhalers can be potential contributing factors.
Be aware of reflux
Acid reflux is a very common occurrence. Sometimes all we notice is an irritation in our throat or a change in our voice. It can help to follow these basic rules:
- Do not go to bed on a full stomach; wait at least 3 hours before lying down
- Avoid spicy food or oily/greasy foods
- Avoid fizzy drinks, alcohol and caffeinated tea/coffee
- Sleep with the head of your bed propped up with books/blocks so that your feet are lower than your head.
Cut down on caffeine and alcohol
Caffeine and alcohol can both dehydrate your throat and cause reflux. Drinking lots of caffeine and/or alcohol can make your voice dry and rough. Be aware that green tea also contains caffeine. Avoid tea and coffee and try decaffeinated instead (although be aware these may not be completely free of caffeine), or herbal tea.
Get plenty of sleep
Like the rest of your body, your voice becomes tired if you use it a lot or if you are not getting enough sleep. If you have trouble sleeping seek advice from your GP.
Be aware of stress and tension
Stress and tension, either emotional or physical, can have a significant impact on the voice. It is useful to be aware of how you cope with stress. Consider speaking to your GP if you feel you would like some help.
Consider air quality
Dry, smoky, dusty or polluted environments can have a negative impact on your voice, as can chemicals such as cleaning products. If these affect you, consider ways to reduce your exposure, eg wear a mask, open a window or have a bowl of water under your radiator to humidify the air.
Be aware of posture and breathing
This may be addressed in therapy. If you feel these areas may be an issue speak to a Speech Therapist.
Take it easy on your voice
Make sure that you are not straining your voice unnecessarily. For example, turn the TV/stereo down if you are trying to talk and go speak to someone rather than shouting at them from across the room. Think of ways that you can get attention without yelling, eg clapping your hands, using a whistle or a microphone. If you feel strain on speaking, consider taking breaks and giving your voice a rest. Be aware whispering can also strain your voice.
If you have any of the symptoms mentioned, or have been diagnosed and would like to know your options, Mr Abir Bhattacharyya is available at Spire London East Hospital every Tuesday, Wednesday and Saturday. Call our Private Patient Executive team on 020 8709 7817 to book.
Mr Bhattacharyya has a special interest in management of Voice Disorders, and is faculty on National and International Phonosurgery, Voice and Laryngology courses. He has edited postgraduate textbooks on Laryngology and written undergraduate ENT textbooks for GPs, junior doctors and medical students.