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HEALTHY LIVING

What Your Voice May

Be Telling You About
Your Health
By Anne Harding
Last Updated: April 28, 2015

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Is That Change in Your Voice a

Disease Symptom?

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Usually when your voice gets a little raspy,

you can blame an upper respiratory tract
infection — a cold or a throat infection, for
example — and count on having your regular
voice back in a few days. Rarely, however, a
hoarse, shaky, or weak voice can be a sign of
a more serious illness. “When we get
concerned is if the hoarseness goes on for
more than three weeks,” says Milan Amin,
MD, director of the New York University Voice
Center in New York City. For the following
conditions, a change in your voice such as
raspiness, tremor, or breathiness may be one
of the !rst symptoms.

Autoimmune Illness: Hoarseness

Lester Lefkowitz/Getty Images

Certain diseases in which the immune system

launches an abnormal attack on the body can
lead to in"ammation of the vocal cords,
causing hoarseness. The problem may be
particularly severe with Sjogren's syndrome,
which causes damage to glands that produce
tears and saliva, causing dry mouth and
throat. Other autoimmune conditions that
have been linked to hoarseness include
polymyositis, rheumatoid arthritis,
scleroderma, and lupus.

The National Institute of Arthritis and

Musculoskeletal and Skin Diseases o#ers tips
on how people with Sjogren's and similar
conditions can protect their voices: “Try not to
clear your throat before speaking. Instead,
take a sip of water, chew sugar-free gum, or
suck on sugar-free candy. Or else make an ‘h’
sound, hum, or laugh to gently bring the vocal
cords together so you can get sound out.”

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Nerve Injuries: Breathiness

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Damage to the nerves that control the vocal

cords can make the voice weak and breathy.
Operations on nearby areas — such as
surgery on the thyroid gland, spine, or heart
— can accidentally nick these nerves. “It
becomes a huge quality-of-life issue for a lot
of these folks,” Dr. Amin says. Rather than
waiting to see if nerve damage heals on its
own, which can take months, an ear, nose,
and throat specialist will usually intervene to
“plump up” the vocal cords by injecting them
with !llers — the same materials
dermatologists and plastic surgeons use to
temporarily erase wrinkles. “We're able to do
that without taking patients to the operating
room,” says Amin. “You can just literally numb
them up, inject them, and send them on their
way, and they're !xed.”

Viral Infections: Vocal Weakness

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Infections a#ecting the larynx — whether

they're viral, bacterial, or fungal — can cause
hoarseness, which will typically get better on
its own. But severe viral infections can
damage the nerves responsible for vocal
function. “Instead of a raspiness of their voice,
they have a weakness,” Amin says. “They have
to push really hard to be heard, or their voice
gets tired at the end of the day.” Injectable
!llers are also used to treat people with vocal
issues due to infection.

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Larynx, Lung, or Thyroid Cancer:

Voice Changes and Weakness

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Changes in the voice can, in rare cases, be

due to pre-cancerous or cancerous growths
on the larynx. Smokers are at the greatest risk
of laryngeal cancer, and excessive alcohol
consumption has also been implicated in the
disease. Symptoms include changes in the
voice, ear pain, sore throat, the sense of
having a lump in the throat, di$culty
breathing or swallowing, and lumps in the
neck. Cancers that a#ect nearby structures,
such as the lungs or thyroid gland, can also
push on the vocal nerves and weaken the
voice. If you have any of these symptoms,
especially if you are a smoker, see your
doctor.

Parkinson's Disease: Soft, Gruff,

or Shaky Voice

Alamy

People with Parkinson's often !nd their voice

becomes very soft and di$cult for other
people to hear. Their voice may also sound
gru# or hoarse or shaky. The National
Parkinson Foundation o#ers these and other
tips to help you maintain a stronger voice:

Express your ideas in short, concise

sentences.

Speak louder than you think is necessary,

but don’t try to shout over noise.

Ask your doctor to refer you to a speech-

language pathologist for an evaluation.

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Vocal Cord Atrophy: Weakness

and Hoarseness

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Typically, beginning in a person's sixties, the

voice can get weaker and more hoarse. That's
because the vocal cords begin to atrophy.
“Many of their friends or relatives or spouses
have hearing loss, so it becomes a real
problem,” Amin says. “Many [older people]
become somewhat socially isolated, they
don't feel comfortable going out to
restaurants or clubs or something like that
because they can't communicate all that well.”
And social isolation can also lead to
depression, he adds. Aging-related vocal
weakness can sometimes be treated by
injecting the vocal cords with !ller, which
allows the cords to touch better and helps
make the voice louder, he says.

GERD: Hoarseness

Alamy

Hoarseness as a symptom of GERD, or

gastroesophageal re"ux disease, started
getting a lot of attention from doctors a few
years ago — too much, in fact, Amin says.
“We're seeing lots of people who are being
overtreated for re"ux for their hoarseness.”
Many primary care doctors prescribe a course
of re"ux medication for patients with hoarse
voices, without examining them further, he
explains. This can be a big problem if a
person's hoarseness is actually due to cancer
or another serious illness. People with long-
standing hoarseness need to undergo
laryngoscopy, in which a lighted tube is
inserted into the throat so the larynx and
vocal cords can be examined, he adds. Then,
if no malignancy is found, re"ux treatment
may be warranted.

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Overusing Your Voice:

Hoarseness

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People in jobs that require them to project

their voice — think of middle-school teachers
in a raucous classroom, traders on the stock
exchange "oor, or exercise instructors calling
out moves over loud music — can develop
benign growths on their vocal cords that
cause hoarseness. It's a little bit like the way
football players expect some aches and pains
during the course of a season, Amin says. “If
you're using your voice that much, at some
point … you're going to have an injury that
puts you out for a while.” When a person who
uses their voice a lot feels some hoarseness
coming on, Amin adds, it's good idea for them
to rest their voice for a day or so if possible.
Fortunately, teachers and others who rely on
their voices to make a living can learn
strategies for speaking more e$ciently and
causing less strain on their vocal cords from a
speech pathologist.

Voice Symptoms That Could Be

Health Warnings

Zave Smith/Getty

If you notice changes in your voice that aren't

related to a cold or sore throat, or if
hoarseness lasts for more than three weeks
after you recover from an upper respiratory
tract infection, check with your doctor.
According to the National Institute on
Deafness and Other Communication
Disorders (NIDCD), these vocal changes can
signal underlying health problems:

Your voice is hoarse or raspy for a

prolonged period.

You lose the ability to hit high notes while

singing.

Your voice sudden gets deeper.

You frequently have a raw, achy, or

strained throat.

It takes more e#ort for you to simply talk.

You need to clear your throat repeatedly.

How to Protect Your Voice

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The American Academy of Otolaryngology-

Head and Neck Surgery, NIDCD, and others
suggest these ways to protect your voice:

Stay hydrated — drink six to eight glasses

of water a day.

Limit alcohol and ca#eine. Both can dry

out and irritate your throat.

Use a humidi!er in winter, or if you live in a

dry climate.

Avoid medications that dry out your throat,

for example some cold and allergy
medications.

Don't smoke; avoid second-hand smoke.

Stay away from spicy foods, which can

trigger throat-irritating re"ux.

Don't use mouthwash that contains

alcohol or other substances that can
irritate the throat.

Breathe deeply to support your voice,

which is less tiring than talking from the
throat.

Don't cradle the phone between your head

and shoulder, which can make neck
muscles tense.

Don't speak too loudly, or too softly. Both

yelling and whispering can strain your
voice.

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