How to Prevent and Repair Vocal Damage

A man came to the Baylor University Speech-Language and Hearing Clinic one day with a simple goal: He wanted to be able to read stories to his children after work. As a professor, he regularly exhausted his voice teaching and interacting with students during the day — a necessary reality of his career that often left him strained.

A variety of occupations, art forms, and hobbies require the ability to speak and project. But the demands of these roles can take their toll, and people may find themselves dealing with vocal strain or fatigue, struggling to keep pace.

“When your voice is your livelihood, that can be especially problematic and debilitating,” said Jana Parker, M.S., CCC-SLP, clinical assistant professor in the Department of Communication Sciences and Disorders at Baylor University’s Robbins College of Health and Human Sciences.

Parker, who serves as clinical faculty at Baylor’s clinic, believes voice therapy with a speech-language pathologist (SLP) can extend a career and support professional and personal goals. The key is understanding how we damage our voices and how to better protect them.

Three types of behaviors can put a someone at risk for vocal damage: vocal abuse, misuse, and overuse. (Because of overlap between the terms, some experts use vocal misuse and vocal abuse interchangeably.)

Vocal abuse refers to behaviors that strain or injure the vocal folds, also called vocal cords. Vocal folds are the bands of muscle that vibrate to create sound inside the larynx, which is the hollow organ managing airflow and sound at the top of the windpipe. Abusive behaviors include smoking and vaping, not drinking enough water, screaming and yelling, coughing, and frequent throat clearing.

Vocal misuse means improper use of the voice. An example is speaking at a higher or lower pitch than is natural, which can happen when an individual repeatedly uses their voice in a different register or adapts a different tone to meet the demands and needs of their environment.

Another example of potential misuse is vocal fry (also called glottal fry), which is when a person speaks in a low, creaky tone. Vocal fry causes vibrations in the ventricular folds, rather than the true vocal folds. Vocal fry doesn’t necessarily cause harm to the voice, however if a speaker tries to project a louder voice while maintaining vocal fry, then there is a higher risk for vocal injury. Chronic use of vocal fry could lead to laryngeal tension and vocal fatigue, according to Parker.

Vocal overuse is using the voice frequently without having enough rest. Overuse can happen when someone regularly extends their voice beyond normal capacity. Potentially risky scenarios include a podcast host recording several episodes in a row to accommodate a holiday break or a fitness instructor capitalizing on their growing popularity by livestreaming three more classes a day.

Vocal abuse, misuse, and overuse all can lead to strain and fatigue. If these behaviors do not change, individuals may experience serious vocal damage or even a voice disorder.

Other causes of vocal damage include certain allergy and sinus infection medications, acid reflux, dry environments, and neurological disorders (such as vocal paresis, a nerve injury).

Best Practices for Vocal Health and Hygiene

With small changes in routine and environment, individuals can make a significant difference in their vocal health and longevity. Speech@Baylor offers advice from therapists and vocal practitioners below.

Practice overall good health behaviors.

Caring for the body supports a healthy voice. “It’s not just a violin that you tune up,” said Esther Atkinson, a student in the Maryland Opera Studio. “It’s your whole biological system that you have to take care of.” Eat well, get a healthy amount of exercise, avoid too much stress, sleep enough, and cease any smoking or vaping behaviors.

Warm up and cool down.

Warming up before using your voice and cooling down afterward can help reduce strain. Try the following quick vocal warm-up exercises and vocal cool-down exercises:

• Lip trills: Keeping your mouth closed, send air between your lips, allowing them to vibrate while making sound on any note. Take a deep breath beforehand. As you build endurance, trill a familiar song.
• Resonant hums: Resonant humming differs from a regular hum in that it resonates in the face, rather than the throat. Hum lightly for one to two minutes.
• Cup bubbles (straw phonation): This exercise involves blowing bubbles through a straw into a water bottle or cup filled with water. Gather your supplies and look up “straw phonation vocal exercise” online for an instructional video.

Adjust the environment when possible.

Lauren Polovoy, a therapeutic specialist in articulation and language disorders, suggests making small adjustments to protect your voice. Ask yourself:

• Instead of shouting feedback to an entire class or team, can I get closer and provide individual cues?
• For physical demonstrations, can I explain the exercise first and then demonstrate to avoid speaking while my muscles are tense?
• In loud environments, can I lower the volume or noise level before using my voice?

Maintain hydration.

“I can’t even say it enough times, hydration is so important,” said Parker. She typically recommends clients drink between 0.5 to one ounce of water for every pound they weigh, every day. Reduce consumption of caffeine, soda, and alcohol, which can dry the vocal folds. If you drink coffee, balance it with water to avoid dehydration.

Consider the realistic limits of your voice.

Parker encourages clients to think of their voices as a finite savings account: People can draw funds when needed but must spend wisely. Careful management practices include:

• Only use an effortful voice when needed.
• Speak to people in close proximity (e.g., a coach can use a hand gesture to have players gather around closely before speaking to the group).
• Reduce talk time before and after long speaking or singing engagement.
• Incorporate vocal rest into the day.

Use a personal amplifier if possible.

A personal amplifier is a microphone that people can wear to safely project their voices without having to yell or speak from the back of the throat. “I always tell my clients to trust the mic,” said Polovoy. “Just trust the mic.”

Try physical tension reduction exercises.

• Tongue stretch: Place the tip of your tongue behind the bottom row of your teeth. Lower your jaw and push your tongue out of your mouth, keeping the tip behind your teeth.
• Neck roll: Drop your chin to your neck and inhale. Lift your head back up and gently roll it to the left, completely around and exhale. Repeat several times, then reverse the roll.
• Sighs and yawns: Spend a couple of minutes sighing or allowing yourself to yawn. While simple, these behaviors can be helpful, especially in a warmup.

Capitalize on breath support and airflow.

“If you’re trying to get loud by muscling from the throat, that’s going to cause a lot more strain and fatigue and trauma to the vocal cords,” said Brown. Instead, use full breaths and release the air slowly while speaking to increase volume.

Try to avoid coughing and throat-clearing.

Coughing and throat clearing cause the vocal folds to slam together and can be traumatic for them, according to Parker. Unfortunately, these behaviors can easily become habitual. Instead, try to cough without using your voice by blowing air through an open mouth. “Another great trick is to drink water when you feel like you need to clear your throat or are about to cough,” said Parker.

Participating in voice therapy, even one to two sessions, is an investment in career longevity and quality of life for those whose careers or hobbies involve their voices.

“We want to empower people to have that voice, so that they can share all that they have to share with others,” said Parker.

Vocal damage is more common than many realize. “Voice problems are present in about 3% to 9% of the population,” said Parker, citing the most current from the American Speech-Language-Hearing Association.

However, more recent studies of specific populations suggest even higher numbers: A 2017 Journal of Voice study indicated 28.4% of soccer coaches reported two or more frequently occurring vocal symptoms, such as throat clearing and hoarseness. In another 2017 study published in the Journal of Voice, researchers conducted a meta-analysis regarding the prevalence of dysphonia among singers at various stages in their careers, including students, singing teachers, and classical and nonclassical singers. They found almost half (46.1%) of singers surveyed self-reported dysphonia, or vocal disorders.

Instead of seeking professional help, many of those experiencing vocal disorders may simply push through, not realizing that voice treatments exists.

“A large number of people who have voice problems don’t try to look for treatment unless it’s really affecting their job,” said Parker.

People at risk of vocal damage in their vocations include:

• Educators
• People working in noisy environments (such as restaurant employees, construction workers, manufacturers, and those fulfilling warehouse orders)
• Singers, actors, and other vocal performers

• Salespeople
• Podcast hosts
• Pastors, preachers, priests
• Fitness instructors
• Sports coaches
• Trial lawyers

Non-vocational voice users may also be at risk. High school theater students whose rehearsals and performance runs last for weeks can wear out their voices, as can cheerleaders entertaining audiences for several games a week. Even singular instances, such as shouting encouragement from the sidelines or going to an arena concert, can cause a lesion on the vocal folds.

“It could be just one incident or screaming or yelling really loudly,” said Parker.

People experiencing vocal problems should first see a physician, either a laryngologist or voice-specialized otolaryngologist, who can evaluate the vocal cords and identify treatment options. When recommended, voice therapy with an SLP can treat and prevent damage by offering clients ways to use their voices safely and efficiently. Parker and Sarah Brown — a trained operatic singer, voice teacher, and clinical specialist in voice therapy at Mount Sinai Grabscheid Voice and Swallowing Center — identified five ways a voice-specialized speech-language pathologist can offer support.

Finding motivation to care for the voice.

Caring for the voice takes time and energy, which can be hard to summon after a long workday. An SLP can assist clients in identifying a specific motivation for healthy vocal practices to help them stick to their goals.

Understanding what good vocal technique feels like.

With clinical technology, an SLP can project a visual of the client’s vocal tract while they work through vocal exercises, so the client can learn how appropriate vocal use physically feels.

Offering guidance informed by medical research.

While a general voice teacher or coach can offer experiential advice, SLPs can offer insights informed by medical research. As clinical experts, they are equipped to provide accurate and evidence-based advice that prioritizes vocal health in the long term — not just for strong, short-term performance.

Learning how to reduce tension in the vocal tract.

An SLP can teach clients physical exercises that can help lessen any tension in the vocal tract and reduce the risk of vocal injury, such as a tongue stretch, neck roll, or sighs and yawns (see #7 under “Best Practices” for a full description).

Applying therapeutic lessons to everyday use.

“A lot of what we do in voice therapy is actually speaking-voice training, and that can make a huge difference in a singer’s sustainability,” said Brown.

Atkinson agrees. “The most vocal fatigue I get is when I realize that I don’t talk correctly,” she said. When vocal performers of any kind can optimize the way they talk throughout the day, they will have better stamina for their performances.

Search for an SLP near you by using the ProFind tool on the American Speech-Language-Hearing Association (ASHA) site. Filter by “Voice Disorders.” To find out if voice therapy is covered by your health plan, contact your insurance provider.

Legal Disclaimer: Please note that this article is for informational purposes only. Individuals should consult their health care provider before following any of the information provided.

Citation for this content: The online speech pathology program from Baylor University’s Robbins College of Health and Human Sciences