By: Spencer Gilleon, MD
At some point in our lives, we have all experienced a problem with our voice. While this is often a temporary problem and resolves spontaneously, at other times the change is long lasting or even permanent. The temporary form of voice change is usually just a nuisance; however, to those who rely on their voice professionally, it can be devastating. Often, changes in voice are sudden, severe and resolve quickly, but other voice problems may occur gradually and go unnoticed for some time.
First, one has to recognize that the voice has changed. It may occur as a result of a colleague or a family member mentioning that one’s voice has changed. A singer may notice that they cannot hit certain notes. Other symptoms such as pain during vocalization, shortness of breath, or the appearance of a small amount of blood when coughing will often bring patients to their physician sooner.
We expect voice changes to occur with aging. Usually the pitch in the female voice will lower with old age, while the male voice may rise in pitch. Also, the voice will decrease in volume. But voice changes do not just occur in the elderly. In the younger population, males will experience a voice change during puberty and women will experience a monthly voice change connected to normal hormonal shifts. In addition, we all expect voice change if we happen to be straining our voice during activities such as coaching, cheerleading, singing or teaching.
So what kind of voice problems are we talking about? The most common problem is hoarseness. This has a raspy quality and is often associated with the inability to raise our voice or hit higher notes. A breathy voice with very little volume may indicate another problem. Voice abuse is the number one cause of hoarseness in children. A sudden loss of voice during voice straining could be an indication of bruising or bleeding beneath the surface layers of the vocal cord. A more gradual onset of hoarseness, especially if associated with pain, will need immediate attention. This is certainly true in patients who are smokers or have been past smokers. Voice problems in singers are especially common, usually in those who are untrained, but occasionally in even the best-trained vocalists. This is associated with singing in the incorrect pitch or improper technique.
So what does the individual do? Usually, treatment involves resting the voice and avoiding the abusive vocal behavior. Physicians would love to have our patients quit smoking or at least decrease the amount of smoking, resulting in better health and voice. Staying well hydrated and controlling other illnesses, such as gastroesophageal reflux (GERD), will often result in gradual recovery. For the singers out there, it is imperative that you stay in your pitch range and review your vocal technique. If the voice is still a problem after these measures, it is important that you approach your physician to see if there are other medical reasons for a voice change. Remember, it is no longer acceptable for your physician to simply state that you are getting older and must accept the change in your voice.
Request to see an ear, nose and throat physician, who can visualize the vocal cords directly with fiber optic endoscopy and, in turn, give you an answer regarding your voice change. This examination can be very reassuring to the patient who is worried about serious illness of the vocal cords or can simply serve to remind singers that they need to change their technique. It is a short and easy examination in the office and will lead to specific instructions regarding voice care.