Voice at riskMan developed speech as a by-product of evolution. It is up to us to maintain a healthy voice. Voice
is the sound produced by the inward movement of vocal cords when the air from lungs passes through and brings the vocal cords together. The voice box or larynx is a unique organ responsible for producing sounds. This sound or `voice' is modulated and modified by structures like the lips, tongue and palate to produce decipherable speech. Voice and speech are invaluable resources for communication, social interaction and occupation.
Changes in voice can be very subtle but are noticeable early. Hoarseness is a general term, which describes abnormal voice changes. The voice may sound breathy, raspy, strained and rough in quality. People with voice problems often complain of or notice changes in the pitch or the volume, loss of voice or endurance and sometimes a sharp or dull pain or change in singing ability. Coughing or spitting blood or mucus along with breathlessness denotes a more serious problem. Common causes Voice problems arise from a variety of causes including abuse or misuse of voice, infections, injury and cancer. The changes in the voice are due to disorders related to the structure and movements of the vocal cords. Swellings and nodules over the medial margins of the vocal cords prevent them coming together resulting in changes in the quality, volume and pitch. Weakness of the laryngeal
muscles leads to restriction or paralysis of the vocal cords. Cancers of the upper aero digestive tract can cause hoarseness either due to mass lesions preventing complete adduction of vocal cords or fixing the vocal cords by local infiltration or both. The most common cause of hoarseness of voice is acute laryngitis, which usually follows an upper respiratory tract viral infection resulting in the swelling and oedema of vocal cords. Another reason could be excessive usage of voice while having a cold. It is very important to be conscious about using voice during an episode of laryngitis as it may cause sub mucosal haemorrhages due to injury to the vessels traversing the vocal cords and then lead to permanent damage. Vocal cord lesions comprise benign, non-cancerous vocal cord growths, which are usually caused by excessive use, abuse or misuse of the voice. Vocal cord cyst and polyps are also mucosal lesions occurring on one vocal cord. These affect both the structure and vibration of the vocal cords and causes chronic changes in the quality of voice. Speaking at an abnormal or uncomfortable pitch can lead to hoarse voice. Young women, speaking at a lower than appropriate pitch, are usually at risk. Whispering is an example of this poor technique. Speaking too loudly, focusing and stressing certain syllables can result in injury or trauma to the vocal cords and muscles causing vocal fatigue. Talking on a mobile phone with the instrument cradled to one's shoulder causes excessive tension in the neck and laryngeal muscles and changes the speaking technique leading to a voice problem. These are usually seen in professional voice users like teachers and politicians. In patients with reflux-related voice problems, the voice is worse in the morning and improves during the day. They have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat and throat irritation. Coughing or throat clearing injures vocal cords and should be minimised and treated accordingly. Primary causes such as Acid Reflux Laryngitis, allergy should be identified and treated. Vocal cord paralysis occurs because of the involvement of superior and recurrent laryngeal nerves that regulate the muscles of the vocal cords.