Voice Problems Part 1
By Spencer Gilleon, M.D.
We have all at some point in our lives experienced a problem with our voice. While this may often be a temporary problem and resolve spontaneously, at other times the change is long lasting and possibly permanent. The temporary form of voice change is usually just a nuisance; however, to those who rely on their voice professionally, it can be devastating. Often the changes in voice occur acutely and resolve quickly, but other voice problems may occur gradually and go unnoticed for some time.
First, one has to recognize that the voice has changed. Awareness may occur as a result of a colleague or a family member mentioning that one’s voice has changed. A singer may notice that they cannot hit certain notes. Other symptoms such as pain during vocalization, shortness of breath, and the appearance of a small amount of blood when we cough will often bring the patient to their physician sooner.
We expect voice change with aging. Usually the pitch in the female voice will lower, while the male voice may rise in pitch. Also, the voice will decrease in volume. But voice changes do not just occur in the elderly. The younger population will experience a voice change in males at the time of puberty and during hormonal shifts, with women on a monthly basis. In addition, we all expect voice change if we happen to be straining our voice during other activities, such as coaching, cheerleading, singing and teaching.
So what kind of voice problems are we talking about? Usually, it is hoarseness. This has a raspy quality and often associated with the inability to raise our voice or hit higher notes. A breathy voice with very little volume may indicate another problem. Voice abuse is the number one cause of hoarseness in children. A sudden loss of voice during voice straining could be an indication of bruising or bleeding beneath the surface layers of the vocal cord. A more gradual onset of hoarseness, especially if associated with pain, will need immediate attention. This is certainly true in patients who are smokers or have been past smokers. Voice problems in singers are especially common, usually in the untrained singer, but occasionally can occur in even the best-trained vocalist. This is associated with singing in the incorrect pitch or improper technique.
So what does the individual do? Usually it involves resting the voice and avoiding the abusive vocal behavior. Physicians would love to have our patients quit smoking or at least decrease the amount of smoking, resulting in better health and voice. Staying well hydrated and controlling other illness, such as gastroesophageal reflux, will often result in gradual recovery. For the singers out there, it is imperative that you stay in your pitch range and review your vocal technique. If the voice is still a problem after these measures, it is important that you approach your physician to see if there are other medical reasons for a voice change. Remember, it is no longer acceptable for your physician to simply state that you are getting older and something you will just have to accept. You need to request that you see an ear, nose and throat physician, who has the ability to visualize the vocal cords directly with fiber optic endoscopy and in turn give you an answer regarding your voice change. This examination can be very reassuring to the patient who is worried about serious illness of the vocal cords or simply a reminder to the singer that they need to change their technique. It is a short and easy examination in the office and will lead to specific instructions regarding voice care.
Stay tuned for Part II of this discussion as we go into the more common medical causes of voice change and the available treatment.