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What You Need to Know About Hoarseness and Voice Loss

Woman caressing her throat

As singers, we talk about our voice as an intangible phenomenon and perhaps take it for granted, until we lose it – says voice health specialist, Dr. Rachael Gates.

But what happens when something goes wrong? What do we do when something feels wrong? To whom can we turn and whom can we trust? How could we have prevented “it” and ensure “it” won’t happen again?

What happens when my voice gets hoarse?

Hoarseness is a combination of excessive air leaking through the vocal folds as they phonate (because the folds are not entirely closed), vocal fold stiffness (due to a lesion or vocal fold swelling) and pressed or constricted laryngeal muscles. The result is often a tight, raspy sound.

In order for the vocal folds to vibrate well and produce what we recognize as a clean sound, they must be hydrated, have smooth edges (i.e. no lesions), and be uniform in weight (i.e. no haemorrhaged blood vessels, which would weigh down the bruised vocal fold down).

Do I have laryngitis?

Laryngitis is the general term for inflammation of the larynx and is characterized by temporary hoarseness or a complete “loss of voice.”

Physicians distinguish between three types: traumatic laryngitis, infectious laryngitis, and non-infectious laryngitis.

Chronic hoarseness may be due to reflux. A gradual onset of hoarseness may be due to allergies, excessive smoking, excessive drinking, or vocal abuse (such as talking too loudly, too long).

A sudden inability to phonate well or at all is often a sign of infectious laryngitis, in which case symptoms should not persist longer than two weeks.

If symptoms do persist, see a physician. You may have traumatic laryngitis in which a vocal fold pathology (such as a polyp) was brought on by a one-time voice misuse (such as one big yell).

What happens when I lose my voice completely?

Having no voice usually implies that the folds have become so swollen that they are weighed down and stiff. Vibration is absent or severely decreased, irregular and slow.

More phonatory pressure and increased breath flow is needed to initiate a tone.

If you have to push to get a tone started, something is wrong. In such cases, voice rest is better than phonation.

What are nodules and how can I avoid getting them?

Vocal fold nodules are similar to calluses on hands that develop from chronic overuse. They are the most common type of lesion found in singers!

Nodules occur in pairs and are symmetrical bumps that form on the inner edge of each vocal fold. Over time, chronic friction slowly causes the affected area of the vocal folds’ cover to thicken until nodules are formed.

You lessen your risk of getting nodules when you: stay hydrated, don’t talk too loudly or too much, warm-up properly before singing, avoid pressing or straining to speak or sing, control reflux if you have it.

Any sensation felt in the neck while singing or talking suggests constriction and is a good sign that you’re doing something inefficiently.

Try this: Find your optimal speaking tessitura and speak like you sing. Use good breath support, keep tone and varied inflection in your speech and maintain the same resonance that you use for singing.

Should I go on voice rest?

Rest can help damaged vocal folds heal. Depending on the circumstances, a laryngologist (voice doctor) may recommend that a singer stays completely quiet for three but no longer than fourteen days. (Long periods of voice rest can cause voice muscles to weaken.)

During this time, avoid throat clearing, coughing and throwing up so that vocal folds can heal effectively and the condition doesn’t worsen.

After the voice rest period, use the voice conservatively.  Begin healthy, light voice exercises as soon as you’re permitted and gradually increase practice. Limit talking and loudness until the condition is completely resolved.

My Reaction to This Week's Singing Competition Entry

Gail Attard Gail Attard - Missed

Overall this is a lovely performance. She is convincing and beautiful. Gail has a mature sound that sometimes sounds manufactured so tension is present. Her left hand occasionally upstages her – moving in a conducting fashion, rather than connected to the thoughts and emotion she is singing. The voice sounds a little swollen, hoarse at times and her quiet tones are too breathy. She shows much promise, but the belt technique needs more ease.

  • Kim Chandler

    There was a fascinating research paper presented to the British Voice Association last year (that won the “Van Lawrence Prize”) conducted by leading voice specialists in the UK as an analysis of the various pathologies found in 255 singer patients. Here is a sentence from the conclusion: “It was thought that nodules were common, however this study shows that nodules in the singer with dysphonia are rare, accounting for 3% of pathologies seen.” http://www.britishvoiceassociation.org.uk/awards_van-lawrence-2016_abstract.htm

  • Kathy Coneys Alexander

    Thanks, Kim. That is fascinating. So nodules are less common than we thought. I wonder if localized ‘swellings’ found on the vocal folds due to overuse are being mis-diagnosed as nodules?