How to look after your voice Dr. Christopher G. L. Hobbs BSc(Hons) MB BS(Lond), MRCS(Eng), DLO(RCSEng), MD(Bris), FRCS(ORL-HNS), FAMS (ORL) Director and Lead Specialist Nobel ENT Head Neck & Thyroid Surgery Centre Gleneagles Medical Centre #08-08

Why is it important? Why is it important? What problems can you get with your voice? What problems can you get with your voice? How common are they? How common are they? What are the causes? What are the causes? How to look after your voice? How to look after your voice? What can be done if you have a problem? What can be done if you have a problem? OUTLINE

What we use at work – hands or voice? P. Belafsky 2011

SingersActorsBroadcastersPerformers Professional voice users TeachersLecturers Childcare staff Telephone operators Call centre staff Sales persons InstructorsLawyersDoctors Health workers Priests Secretarial staff Service staff

Voice problems Hoarse voice - weak, rough, or breathy voice Hoarse voice - weak, rough, or breathy voice Loss of voice Loss of voice Pain whilst talking Pain whilst talking Problems singing Problems singing Other symptoms Sore throat Sore throat Throat clearing Throat clearing Excess throat mucus Excess throat mucus Difficulty swallowing Difficulty swallowing Cough Cough Feeling of a lump in the throat Feeling of a lump in the throat Breathing difficulty or choking episodes Breathing difficulty or choking episodes Throat symptoms

Hoarseness has a lifetime prevalence of 30% Hoarseness has a lifetime prevalence of 30% Point prevalence of 7% in adults under 65 years Point prevalence of 7% in adults under 65 years Certain occupations are badly affected Certain occupations are badly affected – teachers 58% – aerobics instructors 44% Women are more often affected then men (3:2 ratio) Women are more often affected then men (3:2 ratio) Children are affected, particularly between ages 8 to 14 Children are affected, particularly between ages 8 to 14 How common is hoarse voice?

What are the causes of hoarse voice?

HOARSENESS Inflammatory Neoplastic Neuromuscular PsychogenicSystemic Infections Irritants Trauma

Papilloma Dysplasia Cancer HOARSENESS Inflammatory Neoplastic Neuromuscular PsychogenicSystemic

Local Global Nerve injury HOARSENESS Inflammatory Neoplastic Neuromuscular PsychogenicSystemic

Reaction to stress Manifestation of psychiatric disorders HOARSENESS Inflammatory Neoplastic Neuromuscular PsychogenicSystemic

Acromegaly Hypothyroidism Sarcoidosis Amyloidosis Arthritis HOARSENESS Inflammatory Neoplastic Neuromuscular PsychogenicSystemic

Left vocal cord palsy in a 62-year-old male FLEXIBLE LARYNGOSCOPY

RIGID VIDEOSTROBOSCOPY 51-year-old female call-centre worker with muscle tension dysphonia

How to look after your voice “Prevention is better than cure” Desiderius Erasmus (1466 –1536)

DON’T SMOKE! Smoking is one of the worst things you can do to your voice Smoking is one of the worst things you can do to your voice Irritation to the vocal cords from cigarette smoke can lead to chronic laryngitis, vocal cord polyps, or cancer of the larynx Irritation to the vocal cords from cigarette smoke can lead to chronic laryngitis, vocal cord polyps, or cancer of the larynx If your voice is valuable to you, smoking is just not worth the risks If your voice is valuable to you, smoking is just not worth the risks How to look after your voice

Hydration Good water intake helps keep the lubricating mucus on your vocal cords thin, creating the ideal environment for your vocal cords to work Good water intake helps keep the lubricating mucus on your vocal cords thin, creating the ideal environment for your vocal cords to work Drink cups (1.5-2L) of water a day to maintain adequate hydration Drink cups (1.5-2L) of water a day to maintain adequate hydration The goal is to drink until your urine is pale The goal is to drink until your urine is pale Take a water bottle with you to work and refill it at the water fountain Take a water bottle with you to work and refill it at the water fountain Avoid drinks that contain caffeine Avoid drinks that contain caffeine (coffee, tea, most soft drinks) How to look after your voice

Thick Mucus Increasing your water intake will often help people who complain of thick mucus in their throat Increasing your water intake will often help people who complain of thick mucus in their throat A mucolytic drug may help A mucolytic drug may help Sometimes, persistent mucus in the throat is due to backflow of stomach acid into the throat - Gastroesophageal reflux disease (GERD) Sometimes, persistent mucus in the throat is due to backflow of stomach acid into the throat - Gastroesophageal reflux disease (GERD) How to look after your voice

Throat Clearing This is a common problem with many professional voice users. It is often seen in people with excessive mucus or reflux disease This is a common problem with many professional voice users. It is often seen in people with excessive mucus or reflux disease Throat clearing is extremely traumatic to the vocal cords, leading to excessive wear and tear Throat clearing is extremely traumatic to the vocal cords, leading to excessive wear and tear IT IS IMPORTANT THAT THIS HABIT IS STOPPED IT IS IMPORTANT THAT THIS HABIT IS STOPPED Try the following strategies: swallow, have a sip of water, or clear your throat silently without allowing your vocal cords to touch Try the following strategies: swallow, have a sip of water, or clear your throat silently without allowing your vocal cords to touch How to look after your voice

Gastroesophageal Reflux Disease (GERD) This is common among professional voice users This is common among professional voice users Many patients never experience heartburn Many patients never experience heartburn Treatment of this condition first involves changes in your diet and lifestyle Treatment of this condition first involves changes in your diet and lifestyle Medications can be used to reduce the acid production from your stomach Medications can be used to reduce the acid production from your stomach How to look after your voice

Vocal Abuse/Overuse Don't speak excessively - avoid lengthy conversations on the phone. If your on the phone all day, rest for 10mins every 2-3hrs Don't speak excessively - avoid lengthy conversations on the phone. If your on the phone all day, rest for 10mins every 2-3hrs Talk at a low to moderate volume - minimize talking when there is excessive background noise (cars, parties, airplanes, restaurants) Talk at a low to moderate volume - minimize talking when there is excessive background noise (cars, parties, airplanes, restaurants) You may need amplification to talk in a noisy environment You may need amplification to talk in a noisy environment Avoid shouting and screaming. Use alternative strategies for getting peoples attention: using a whistle or clapping your hands Avoid shouting and screaming. Use alternative strategies for getting peoples attention: using a whistle or clapping your hands Rest if you get a respiratory infection Rest if you get a respiratory infection How to look after your voice

Drugs that Affect the Voice Antihistamines/Decongestants: these drugs are commonly found in cold preparations and allergy medications. They will result in a drying effect on the vocal cords which is detrimental Antihistamines/Decongestants: these drugs are commonly found in cold preparations and allergy medications. They will result in a drying effect on the vocal cords which is detrimental Local Anaesthetics: these medications should be avoided. Numbing the throat with one of these sprays is an especially bad idea if you are about to perform or sing Local Anaesthetics: these medications should be avoided. Numbing the throat with one of these sprays is an especially bad idea if you are about to perform or sing Other medications that dry the vocal tract include: antihypertensives, diuretics, antidepresants, antipsychotics Other medications that dry the vocal tract include: antihypertensives, diuretics, antidepresants, antipsychotics How to look after your voice

Work Environment Avoid smoke filled and dusty environments Avoid smoke filled and dusty environments Dry environments are also bad for the voice Dry environments are also bad for the voice – Reduce aircon exposure – If you travel by plane a lot, you should increase your water intake accordingly – If you travel to dry environments (e.g. Middle East, North Africa, Southern US, Central Australia) use humidifier at night, and maintain good water intake How to look after your voice

CONSERVATIVE Vocal hygiene Dietary advice Speech therapy Medical treatment of reflux Gastroenterology input Neurology input What can be done if you have a problem SURGERY Vocal cord injections Botox injections for spasmodic dysphonia Endoscopic laryngeal microsurgery +/- laser External framework surgery Gender reassignment surgery

SUMMARY BAD THINGS Smoking Smoking Alcohol / Caffeine Alcohol / Caffeine Vocal abuse / overuse Vocal abuse / overuse Throat clearing Throat clearing Aircon Aircon Mentholated lozenges Mentholated lozenges GOOD THINGS Hydration Hydration Humidification Humidification Good dietary habit Good dietary habit Treat reflux Treat reflux

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