Michael J. Stephen, MD, pulmonologist, associate professor at Thomas Jefferson University in Philadelphia, director of its Adult Cystic Fibrosis Center and author of Breath Taking: The Power, Fragility, and Future of Our Extraordinary Lungs.
Unless you make your living from your voice, chances are you rarely think about your vocal cords. But that’s a mistake.
Even though we associate these two thin strips of fibrous tissue with our ability to speak and sing, they’re also involved in a number of other crucial functions. Examples: When you breathe, your vocal cords must remain open, but they have to close shut when you speak, sing or swallow and even when you need to generate the pushing force that’s required for heavy lifting or moving your bowels. Here’s what you need to know to preserve a strong and steady voice and keep your breathing and swallowing capacity in top form…
When people have breathing problems, such as shortness of breath, their doctors may not pay close attention to the voice box, or larynx, the organ that houses the vocal cords. Example: In a landmark study involving 148 athletes suffering from shortness of breath, most were initially thought to have asthma. When the athletes got a second opinion from a pulmonologist, 70% were found to have vocal cord dysfunction (VCD).
VCD causes shortness of breath in a similar way to asthma, obstructing the flow of air at the level of your windpipe, or trachea. During inhalation, instead of the vocal cords opening and staying in a relaxed position until the full breath is taken, people with VCD will let in some air, but then the vocal cords will collapse together prematurely. Asthma and VCD get confused because both create a typical wheeze, the high-pitched musical sound of obstructed air. Also like asthma, with VCD this happens only intermittently, typically when under stress or during physical exercise. But there’s an important distinction: The classic asthma symptom is wheezing when exhaling. If the wheezing occurs while inhaling, that’s a telltale sign of a vocal cord problem rather than asthma.
If you’ve had a raspy voice, wheeze when you inhale or experience unexplained shortness of breath for more than a week, consider seeing an otolaryngologist (ear, nose and throat specialist). Even better is a laryngologist, an otolaryngologist who specializes in voice, airway and swallowing disorders.
With just a cursory look with a scope, your vocal cords might seem fine because they can quickly return to normal. During a thorough evaluation, it’s often necessary to re-create the situation that causes your problem, such as mimicking the fast inhalation that an athlete may take or even having a patient imagine a stressful situation. This could take 30 to 40 minutes. To find a laryngologist near you, consult the American Academy of Otolaryngology—Head and Neck Surgery (ENTHealth.org).
If the evaluation doesn’t uncover any underlying problem with your vocal cords but you’re still having any of the symptoms described earlier, ask for a referral to a speech pathologist. Your ENT likely will want you to be evaluated by a lung doctor as well, but working with a speech pathologist and doing specific vocal exercises twice a day for three to four months can help if suspicion for VCD is high enough.
VCD most often occurs as you grow older or following a neurologic disorder, such as a stroke, which can damage the brain’s ability to effectively communicate with the voice box. But VCD also can develop as a result of an underlying cause that may not seem obvious, such as…
Upper-respiratory infections. These infections, along with postnasal drip and allergies, can involve the vocal cords and cause hoarseness and cough.
Laryngopharyngeal reflux (LPR). Unlike gastroesophageal reflux disease (GERD), LPR—in which stomach acid washes up into the larynx—may not cause heartburn but rather changes in your voice (e.g., hoarseness or raspy-ness), difficulty swallowing and/or breathing, and a chronic cough.
Voice misuse and overuse. Shouting or singing forces a huge amount of air past the vocal cords, which can injure them. Plus, our vocal cords become more fragile as we age.
Healing your vocal cords from misuse takes a lot more rest than you might think. When hoarseness from overusing your voice occurs, you should avoid talking for a full day or two. For the next seven to 10 days, speak as little as possible, always using a slow and even voice. Then start the exercises in the box at left. Drinking herbal teas with honey or lemon also can help heal the larynx and vocal cords.
Dehydration. Your vocal cords are more prone to dehydration than other body tissues because of their poor blood supply. Drinking water, herbal tea and chicken soup is helpful because it provides hydration. Drinking eight to 10 glasses of liquid a day, including sipping while you’re doing a lot of talking, will bathe the back of your throat and keep your vocal cords moist. If your voice cracks, that’s an indication that your vocal cords are dried out.
Poor air quality. We all do our best to avoid outdoor air pollution, but it’s also crucial to limit indoor air pollution. To protect your vocal cords, limit time in front of an open fireplace, and try to stay a safe distance from obvious smoke. If your fireplace screen has glass doors, use them to minimize the amount of particulate matter in the air. Keeping the humidity inside at a consistent level of 30% to 50% gives your lungs the appropriate hydration.
A humidifier is needed in winter, while a dehumidifier may be necessary on a muggy summer day. Put these in bedrooms to help ensure healthy breathing at night. Air purifiers can be helpful if there are issues with pollen or animal dander in the house. If outside pollen counts are not high and pollution levels are low (check your weather app), opening the windows for fresh air is very healthy.