How our voices work, and what to do when a voice doesn't work

How our voices work, and what to do when a voice doesn't work

By K. Linnea Peterson
Medical Director, Swedish Otolaryngology

A voice is an amazing thing.

With our voice, we convey information, express emotion and provide entertainment. We each have our own unique vocal ‘fingerprint’ that allows our friends to recognize us when we call them on the phone. We rely on our voice to win a debate, negotiate a contract, reassure a frightened child, and to celebrate a victory. Our tone conveys honesty, anger, happiness and fear. A song can inspire a spectrum of emotions, and recall past memories.

So how does our voice work? And what do you do when it doesn’t work?

Voice is produced when air is pushed up from the lungs to the level of the vocal cords. The vocal cords vibrate, producing sound. The vocal cords tense, lengthen and stretch to produce different frequencies. The sound is then shaped by the upper airway to add resonance and articulation resulting in speech or song.

The vocal cords themselves are thin bands of tissue over muscle. They sit within a framework that has a complex nerve supply and multiple paired muscles that allow very nuanced changes in vibration of the vocal cords, well demonstrated in professional singers.

Subtle differences in vibration or movement can result in audible changes in voice quality. For some this may be a minor nuisance and for others it could be career changing.

When is that change in sound a short term, self limited issue and when does it represent something potentially more ominous?

The initial answer may be varied, but things to consider include: risk factors such as smoking, the severity of the change, history of recent surgery or past radiation, and occupation of performer or singer. Severity, impact on livelihood, and suspicion of a serious underlying cause warrant immediate evaluation. At the farside, hoarseness that fails to resolve within three months should be evaluated.

How is an evaluation done?

An evaluation starts with a look at the vocal cords. This can be done with a mirror through the mouth, a small flexible scope placed through the nose, or a straight scope placed in the mouth. You may be asked to talk or sing to examine how the vocal cords are moving and vibrating. From there, additional studies may be ordered or there may be recommendations for medication, surgery, and/or voice therapy. Often voice problems are affected or exacerbated by a variety of factors, including stress, tension, allergies, asthma and reflux. Routine vocal health includes staying well hydrated, avoiding reflux triggers, avoiding smoke exposure and other irritants. Throat clearing causes additional laryngeal irritation and should be avoided. (Here are some additional vocal health tips that may be helpful.) Optimizing your vocal health can take some work. But at the end of the day, your voice is telling on you.

Here’s a video that shows a flexible laryngoscopy exam of four different sets of vocal cords singing a song together. (Ed. note - warning, you may not want to be eating when you watch this video.) A new perspective on a quartet!

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