By Darrell Klotz, MD Parents, matchmakers, and social psychologists all agree: You have only one chance to make a good first impression. Whether it’s that first date, a big presentation at work, or a job interview, our voice is extremely important to each and every one of us. We learn a lot about a person within the first few minutes of meeting by taking stock of two important features: facial appearance and voice quality. While many of us spend a lot of time and money on improving our facial appearance through beauty and cleansing products, designer eyeglasses, even elective cosmetic surgery, we generally don’t give much thought to our voice until it fails us. We often forget that attitude, emotional state, and personality are conveyed by our voice. As such, vocal health is at least as important as facial appearance in making a first impression. What is hoarseness? Unfortunately for many of us, the first time we notice our voice is when we lose it. Have you ever experienced a strained voice for days after shouting your support for your favorite sports team? Or have you suffered with laryngitis long after your cold or flu had resolved because you never thought to take a “vocal rest” along with your sick day from work? For others, the voice may become chronically strained by the daily vocal demands of being a teacher, lawyer or parent. For example, we have all come across someone who has a rough, gruff or raspy voice to which usually comes the quick response, “Oh my, are you sick? You sound terrible!” If in fact that person were sick, they might well appreciate the empathy. But for some, the attention given to their chronically tired or gravelly voice is a source of frustration. These scenarios describe a condition commonly referred to as “hoarseness.” This general term is used to describe a strained, raspy or breathy voice – with associated changes in loudness and pitch – that requires increased effort to use. What causes hoarseness? Hoarseness can be acute or chronic, and is commonly caused by the formation of benign lesions such as nodules, polyps, cysts or generalized swelling of the vocal folds due to vocal abuse or overuse. Each time we speak, clear our throats, or utter any sound, our vocal folds contact each other briefly. If this contact is excessively forceful or straining, nodules, polyps and cysts can occur. Exposure to irritants (acid reflux, air pollution, allergies, smoke, etc) can also contribute significantly by causing excessive throat clearing or irritation to the surfaces of the vocal folds. For many of us, the risk of voice strain describes our everyday life – talking during a full day of work, taking care of our family in the evening, extracurricular activities such as sports, catching up with friends, and squeezing in a quick, heartburn-producing meal between it all! Professional or recreational singers can also develop these problems by using incorrect singing technique or by trying to sing out of their range – issues easily avoided by employing a qualified voice teacher. Hoarseness may also result from weakness of the vocal folds. Weakened vocal folds can be experienced after a common cold or the flu or as part of the natural aging process. Floppy or weak vocal folds result in decreased loudness and raspiness. Similarly, if our lungs are in poor health from years of smoking, surgery or other disease processes, we are unable to generate a strong column of air or breath to support and project a strong voice. Likewise, if our breathing technique is not well coordinated with our speaking efforts, inefficient voicing occurs that adversely affects vocal quality, loudness and stamina. This change can be subtle over time and, like any other bad habit we develop, goes unnoticed in the bustle of our daily lives until someone points out how strained or gravelly our voice has become. How do we care for our voices? Treatment of voice disorders typically involves the use of medications, voice therapy, and possibly surgery. Chronic uncontrolled allergies, acid reflux, or postnasal drip may be fixed easily with regular use of medications or by simple avoidance measures once the problem is correctly identified. Weak vocal folds can be strengthened with voice therapy much in the same way physical therapy can help a bad knee or hip (The vocal folds are actually composed of a muscle and controlled by a cartilaginous joint). Voice therapy can also reduce tension in our voice and improve the coordination of our breathing and speaking. This results in a much more powerful, confident, and reliable voice for our workplace (presentations, meetings, interviews, etc) and social interactions. In some cases, surgery may be required as a last resort. Stay hydrated The good news is that you don’t have to wait until something goes wrong with your voice in order to strengthen and care for it. In fact, there are many simple steps you can take to maintain a strong, healthy voice. First, take care to drink enough fluids throughout the day. Dehydration severely affects the lining (mucosa) of the throat and vocal folds by drying them out, decreasing the vocal folds’ ease of vibration and allowing irritants and potential infections (bacteria and viruses) an opportunity for entry into the throat mucosa. Best practices suggest that drinking at least half your body weight in ounces of water daily is sustaining for good bodily function and vocal health (more on days of increased loss with climbing temperatures or activity). Consider both the quantity and the quality of the fluids you are consuming. For example, is caffeine overrepresented in your fluid intake? Although coffee, tea, and cola are fluids, they actually produce a dehydrating effect on the body. If you routinely drink a large quantity of caffeinated beverages, you should compensate with a greater amount of water or other non-caffeinated fluids. Additionally, many of the medications that we take may cause excessive drying of mucous membranes as a side effect. Again, we should consume extra fluids when taking anything that may cause this drying effect such as allergy medications, antidepressants and some asthma inhalers. Watch carefully what you put into your body. Maintain good techniques Secondly, good vocal technique when speaking cannot be overlooked. Proper posture, synchronized deep breathing, and relaxed neck muscles are all components of an optimized voice. We all have stress in our life and many of us “hold” this stress in our voice, neck, and facial muscles. This can result in a gravelly, soft, or strained voice that makes speech effortful and causes vocal fatigue very quickly. Don’t forget to rest Lastly, don’t overlook the possibility that you may simply be overdoing it. There is only so much we can do with our voice, after which point problems may develop. One cannot expect to talk all day at work on conference calls, in meetings, and presentations, and then go home and talk all evening with family and sing in a church choir three nights a week. In our office, we often see injured singers at the height of the Christmas cantata season or schoolteachers suffering from vocal overuse toward the end of the term. If your voice frequently feels tired or strained midway through the day or if you frequently develop raspiness at the end of each day, you may be overdoing it. One way to combat injury due to overuse is to schedule “vocal breaks” into your day. In an eight-hour day, schedule several 15-minute periods where you close the door, stay off the phone and just be quiet. This will help extend your voice throughout the day. Perhaps most important to remember is that hoarseness is a warning sign that you should change something about your voice usage before it leads to a chronic condition. Along these lines, one of the best pieces of advice is to avoid overuse of your voice during sinus infections, colds, sore throats, etc. Your throat is already inflamed in this situation, including your vocal folds. If you were a runner, you wouldn’t think of going out for a run if your leg or foot were hurting, would you? Final thoughts It is important to note that the tips described above are intended as preventive maintenance. If you are already experiencing chronic hoarseness (i.e., more than two weeks), sudden loss of voice, pain, difficulty swallowing, or loss of range in singing, you may be experiencing a condition that requires medical attention. Assessment of your voice disorder and examination of your vocal folds sooner rather than later will help ensure that you are not doing any further damage to your voice. Even if you’re not suffering from serious hoarseness but you depend on your voice frequently for public speaking and often find yourself wanting more from your voice, it may be time to seek help at a qualified Voice Center. You may benefit from an evaluation by an Otolaryngologist or a speech-language pathologist with experience in voice therapy. It has been said that there is no greater index of character as sure as the voice. Our voice is, in essence, a reflection of who we are as individuals. While the voice is not a reflection that we can see in the mirror, it deserves at least the same attention that we give to our outward appearance. After all, you only have one chance to make a great first impression. This blog is for informational purposes only. For specific medical questions, please consult your physician. Dr. Klotz practices in our SouthPark office. To make an appointment with him, call 704-295-3000.