Protect Your Vocal Folds: The Little Muscles That Give you a Voice!
As a Speech Language Pathologist, I have been curious about the impact’s cystic fibrosis, COPD, and other respiratory illnesses have on vocal quality.
Having been around the CF community for a couple of years, I know that CF can impact numerous organ systems that require consistent medical attention. I know that vocal quality could potentially be impacted due to chronic coughing, yet it is not usually detrimental to one’s overall health.
Your voice says a lot about who you are and allows you to express yourself. A reduced vocal quality can impact your ability to work, as some individuals rely on their voice for their career (e.g., teaching, coaching, singers), it can create challenges in feeling comfortable expressing oneself, as well as can be painful and frustrating to experience.
After reaching out to the CF community, I have learned that vocal quality is a concern form some. Examples that came back from the CF community were:
- Feeling like one had a reduced vocal range: sometimes following TOBI and/or after post-transplant
- Reduced volume, specifically at the top end
- Sinuses impacting vocal quality
- Loss of voice when tired and sick, and sometimes waking up without a voice
- Raspy, deep voice: this was seen as both a pro and a con
It is important to note that the following information is only general information and should not be considered a treatment approach, but simply as recommendations to support vocal health.
Why is the voice impacted by CF?
Sound is produced when the air from the lungs is pushed between the vocal folds (two elastic structures in your larynx). Sufficient pressure is needed to cause them to vibrate.
The vibration is what produces voice/sound.
Breathing provides the force to initiate and sustain vocal ford vibration.
Reduced air pressure = reduced volume and ability to speak at longer sentences
Having a chronic respiratory illness, like CF or COPD, can severely impact your lung volume, which reduces the amount of sufficient air needed to build the pressure between the vocal folds to increase the volume of sound.
Voice Quality Symptoms resulting from CF:
- Dysfunctions in vocal fold movement due to the build-up of mucus on the vocal folds and chronic coughing.
- Medications that cause dry mouth/reduced saliva
- For example: TOBI is an inhaled medication. Inhaling medications can cause dryness, swelling, and irritation. Small traces of medication can get left of the vocal folds causing inflammation. This inflammation can result in a hoarse voice, croaking voice, breathy voice, and/or loss of voice.
- Lung Transplants
- Insufficient lung capacity
- Increased risk for gastroesophageal reflux (GER), which can cause inflammation to vocal folds if you have experienced GER for a long period of time
- Intubation during lung transplants causes increased risk for dysphonia (spasms of the vocal folds) and laryngeal stenosis (narrowing of the airway)
Research findings specifically focused on vocal quality and CF: (you are not alone!)
- Reduced vocal intensity (loudness)
- Increased levels of jitter and shimmer (excessive movement of vocal folds during sound production)
- Increased roughness, breathiness and weakness of vocal quality
- Increased dysphonia (dysfunction of vocal fold movements) causing a strained and strangled voice quality, and can cause no voice at times
- Impacts women more than men
- Phonotrauma to vocal folds (vocal fold abuse) due to: medications, reflux, and chronic coughing
Okay, enough about “why” the voice changes, and time to get to Three Tips!
1)Vocal Hygiene
- Hydration is the most important thing you can do for your vocal folds!
- What’s recommended?
- 2 liters of water/day: more than 62 oz a day
- Drink water after coughing to rehydrate vocal folds
- Use Glycerin Lozenges (halls, gummy bears)
- Reduce gum intake / chewing = it hyper stretches the vocal fold muscles
- Monitor caffeine and alcohol intake
- Gould’s gargle routine
- ½ tsp sea salt
- ½ tsp baking soda
- ½ tsp honey or maple syrup
- 1 cup warm water
- Gargle silently for 5 minutes
- 2 liters of water/day: more than 62 oz a day
2) Respiratory training – for your vocal folds!
- Avoid whispering … seems contrary, right? Whispering actually makes your vocal folds work harder
- Relax your throat muscles and shoulders
- Diaphragmatic breathing (belly breathing)
- Breathe from the diaphragm, keep your muscles relaxed.
- Let your volume increase gradually instead of all at once
- Speak as you exhale
- Inhale into abdomen, keep tongue on floor of mouth (relax tongue), lips gently closed
- Exhale from abdomen and gently exhale with “s” or “sh” sounds
- Do 5 breaths per day
- Singing is helpful!
- You expand the lungs more and exhale in a more prolonged way
- Have something to say but feel that your voice just isn’t quite right? Try saying it in a toon.
3) Reach out to a speech language pathologist for more specialized treatment approaches if it is an area of concern and/or symptoms are worsening
Don’t hesitate to reach out if you have any questions.
By: Nicole Ezcurra, CF- SLP, LSVT
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