What Your Voice May Be Telling You About Your Health

By Anne Harding

Reviewed: April 29, 2015

Fact-Checked

Is That Change in Your Voice a Disease Symptom?

Thinkstock

Usually when your voice gets a little raspy, you can blame an upper respiratory tract infection — a cold or a throat infection, for example — and count on having your regular voice back in a few days. Rarely, however, a hoarse, shaky, or weak voice can be a sign of a more serious illness. “When we get concerned is if the hoarseness goes on for more than three weeks,” says Milan Amin, MD, director of the New York University Voice Center in New York City. For the following conditions, a change in your voice such as raspiness, tremor, or breathiness may be one of the first symptoms.

Autoimmune Illness: Hoarseness

Lester Lefkowitz/Getty Images

Certain diseases in which the immune system launches an abnormal attack on the body can lead to inflammation of the vocal cords, causing hoarseness. The problem may be particularly severe with Sjogren’s syndrome, which causes damage to glands that produce tears and saliva, causing dry mouth and throat. Other autoimmune conditions that have been linked to hoarseness include polymyositis, rheumatoid arthritis, scleroderma, and lupus.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases offers tips on how people with Sjogren’s and similar conditions can protect their voices: “Try not to clear your throat before speaking. Instead, take a sip of water, chew sugar-free gum, or suck on sugar-free candy. Or else make an ‘h’ sound, hum, or laugh to gently bring the vocal cords together so you can get sound out.”

Nerve Injuries: Breathiness

Getty Images

Damage to the nerves that control the vocal cords can make the voice weak and breathy. Operations on nearby areas — such as surgery on the thyroid gland, spine, or heart — can accidentally nick these nerves. “It becomes a huge quality-of-life issue for a lot of these folks,” Dr. Amin says. Rather than waiting to see if nerve damage heals on its own, which can take months, an ear, nose, and throat specialist will usually intervene to “plump up” the vocal cords by injecting them with fillers — the same materials dermatologists and plastic surgeons use to temporarily erase wrinkles. “We’re able to do that without taking patients to the operating room,” says Amin. “You can just literally numb them up, inject them, and send them on their way, and they’re fixed.”

Viral Infections: Vocal Weakness

Thinkstock

Infections affecting the larynx — whether they’re viral, bacterial, or fungal — can cause hoarseness, which will typically get better on its own. But severe viral infections can damage the nerves responsible for vocal function. “Instead of a raspiness of their voice, they have a weakness,” Amin says. “They have to push really hard to be heard, or their voice gets tired at the end of the day.”  Injectable fillers are also used to treat people with vocal issues due to infection.

Larynx, Lung, or Thyroid Cancer: Voice Changes and Weakness

Peter Dazeley/Getty

Changes in the voice can, in rare cases, be due to pre-cancerous or cancerous growths on the larynx. Smokers are at the greatest risk of laryngeal cancer, and excessive alcohol consumption has also been implicated in the disease. Symptoms include changes in the voice, ear pain, sore throat, the sense of having a lump in the throat, difficulty breathing or swallowing, and lumps in the neck. Cancers that affect nearby structures, such as the lungs or thyroid gland, can also push on the vocal nerves and weaken the voice. If you have any of these symptoms, especially if you are a smoker, see your doctor.

Parkinson’s Disease: Soft, Gruff, or Shaky Voice

People with Parkinson’s often find their voice becomes very soft and difficult for other people to hear. Their voice may also sound gruff or hoarse or shaky. The National Parkinson Foundation offers these and other tips to help you maintain a stronger voice:

• Express your ideas in short, concise sentences.
• Speak louder than you think is necessary, but don’t try to shout over noise.
• Ask your doctor to refer you to a speech-language pathologist for an evaluation.

Vocal Cord Atrophy: Weakness and Hoarseness

Zephyr/Getty

Typically, beginning in a person’s sixties, the voice can get weaker and more hoarse. That’s because the vocal cords begin to atrophy. “Many of their friends or relatives or spouses have hearing loss, so it becomes a real problem,” Amin says. “Many [older people] become somewhat socially isolated, they don’t feel comfortable going out to restaurants or clubs or something like that because they can’t communicate all that well.” And social isolation can also lead to depression, he adds. Aging-related vocal weakness can sometimes be treated by injecting the vocal cords with filler, which allows the cords to touch better and helps make the voice louder, he says.

GERD: Hoarseness

Hoarseness as a symptom of GERD, or gastroesophageal reflux disease, started getting a lot of attention from doctors a few years ago — too much, in fact, Amin says. “We’re seeing lots of people who are being overtreated for reflux for their hoarseness.” Many primary care doctors prescribe a course of reflux medication for patients with hoarse voices, without examining them further, he explains. This can be a big problem if a person’s hoarseness is actually due to cancer or another serious illness. People with long-standing hoarseness need to undergo laryngoscopy, in which a lighted tube is inserted into the throat so the larynx and vocal cords can be examined, he adds. Then, if no malignancy is found, reflux treatment may be warranted.

Overusing Your Voice: Hoarseness

David Jakle/Getty

People in jobs that require them to project their voice — think of middle-school teachers in a raucous classroom, traders on the stock exchange floor, or exercise instructors calling out moves over loud music — can develop benign growths on their vocal cords that cause hoarseness. It’s a little bit like the way football players expect some aches and pains during the course of a season, Amin says. “If you’re using your voice that much, at some point … you’re going to have an injury that puts you out for a while.” When a person who uses their voice a lot feels some hoarseness coming on, Amin adds, it’s good idea for them to rest their voice for a day or so if possible. Fortunately, teachers and others who rely on their voices to make a living can learn strategies for speaking more efficiently and causing less strain on their vocal cords from a speech pathologist.

Voice Symptoms That Could Be Health Warnings

Zave Smith/Getty

If you notice changes in your voice that aren’t related to a cold or sore throat, or if hoarseness lasts for more than three weeks after you recover from an upper respiratory tract infection, check with your doctor. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), these vocal changes can signal underlying health problems:

• Your voice is hoarse or raspy for a prolonged period.
• You lose the ability to hit high notes while singing.
• Your voice sudden gets deeper.
• You frequently have a raw, achy, or strained throat.
• It takes more effort for you to simply talk.
• You need to clear your throat repeatedly.

How to Protect Your Voice

Thinkstock

The American Academy of Otolaryngology-Head and Neck Surgery, NIDCD, and others suggest these ways to protect your voice:

• Stay hydrated — drink six to eight glasses of water a day.
• Limit alcohol and caffeine. Both can dry out and irritate your throat.
• Use a humidifier in winter, or if you live in a dry climate.
• Avoid medications that dry out your throat, for example some cold and allergy medications.
• Don’t smoke; avoid second-hand smoke.
• Stay away from spicy foods, which can trigger throat-irritating reflux.
• Don’t use mouthwash that contains alcohol or other substances that can irritate the throat.
• Breathe deeply to support your voice, which is less tiring than talking from the throat.
• Don’t cradle the phone between your head and shoulder, which can make neck muscles tense.
• Don’t speak too loudly, or too softly. Both yelling and whispering can strain your voice.

What Causes a Raspy or Weak Voice

Have you noticed that you or a loved one has a raspy or weak voice? One of the most common causes of a raspy voice is laryngitis, or an inflammation in your larynx. Most cases of laryngitis will get better with some rest, but some cases will need some extra help. Here’s everything you need to know about laryngitis and what you can do to get your voice back.

What is Laryngitis?

If you have a raspy or weak voice you may have laryngitis. This is an inflammation of your larynx or your voice box. Laryngitis affects your vocal cords which are in the voice box. The vocal cords are two folds of membrane that cover a structure of cartilage and muscle. When you speak, sing, or make other sounds, the vocal cords will open and close. Air passes over the vocal cords, and the movement of the muscles creates sound.

When you have laryngitis, the vocal cords become irritated. Inflammation of the vocal cords will make it harder to open and close the vocal cords. The inflammation also changes the sound of your voice since the swelling affects the shape and size of the vocal cords. This is what creates a hoarse, raspy, or weak voice. 

Most cases of laryngitis will last just a few days short of a week. This is called acute laryngitis, and your vocal cords will recover quickly. Other people may experience chronic laryngitis, which can last a long time.

The Symptoms of Laryngitis

The most common symptoms of laryngitis are changes in the sound of your voice. You may have a raspy or weak voice for several days or weeks. You may also experience pain when talking, or discomfort in the throat and neck. Other symptoms of laryngitis include:

• A hoarse voice
• Losing your voice
• A sore or dry throat 
• A tickling feeling in the throat
• A dry cough

If you have any of these symptoms, it’s time to rest your vocal cords. Take a break from talking for a few days and let your voice rest. If the symptoms persist for more than a few days, you should visit your doctor or ENT to find out if you have laryngitis. 

What Causes Laryngitis?

There are two main types of laryngitis: acute and chronic. Acute laryngitis is temporary, and you’ll often recover your voice in a few days. The causes of acute laryngitis include:

• Overuse of the vocal cords, such as yelling. This overuse can lead to swelling
• An irritation of the voice box that leads to inflammation
• A viral or bacterial infection that causes an inflammation in the larynx 

Chronic laryngitis will last a lot longer than acute laryngitis. Most cases of chronic laryngitis will last longer than three weeks. Chronic laryngitis is usually caused by irritants or allergens in your environment. The causes of chronic laryngitis include:

• Irritants like chemical fumes
• Allergens such as pollen or dust mites
• Acid reflux, or stomach acid that travels back up to your esophagus
• Chronic sinus infections 
• Overconsumption of alcohol
• Habitual strain on the vocal cords, such as performing as a singer or working as a waiter in a loud bar.

Caring for Raspy or Weak Voice

If you have a raspy or weak voice caused by overuse, then the best thing you can do is rest your vocal cords. Avoid talking or any strenuous use of your vocal cords. Spend a few days speaking only when necessary so that the swelling in your larynx can go down. Look after your raspy voice by:

• Rest your voice and avoid talking while you recover from laryngitis. 
• Drink lots of fluids including water and tea. Avoid drinking caffeine or alcohol.
• Use a humidifier to add moisture to the air. You can also use a steam bowl or take a hot bath. This moisture will soothe your vocal cords and reduce swelling.
• Speak in your normal voice. You may think that speaking softly will help your vocal cords, but whispering will actually put even more strain on your swollen vocal cords. 

If your laryngitis persists for more than a few days, visit an ENT to find out your next steps. If you have a bacterial infection you may need to take antibiotics for a few days to clear up the infection.

20 Tips to Improve Your Voice

Here are some professional tips to help you improve your voice no matter how you sing:

1. Open your mouth, drop your jaw. While doing this, try to keep the muscles around the mouth and jaw loose. This will make the sound richer, fuller. 2. Raise the soft palate. No need to yawn, I’m not talking about the “academic dome”. Lower your tongue with a spatula, relax. All this will increase the space in the mouth and the sound will become more voluminous. 3. Do not allow saliva to accumulate in your mouth so that it does not interfere with sound production and does not interfere with you. 4. The tongue should touch the lower teeth , do not cover the larynx with it, it should be open. 5. The articulatory apparatus (muscles of the jaw, lips, tongue, palate) must be active and relaxed at the same time. It’s easy! When you feel these muscles well, you can do anything with them, they will not interfere with you and “make a clamp”, but just the opposite! 6. Sit or stand up straight, chest up. This is one of the most important things. The head should not be pushed forward, like a goose, it should be at the level of the neck, back and coccyx. The quality of your breathing, and, therefore, the sound production depends on this production. 7. Breathing should be deep. Feel it all the way down your back and abdomen. From there, help the air along with the sound to go out through the mouth. At the same time, it is very important to relax the muscles of the neck so that the breath does not “get stuck” at the level of the collarbones. 8. Try to sing with an even tone, do not swing it (unless you want to sing like a pensioner). Hold the volume (resonator singing). When controlling the dynamics (switching soft-loud and vice versa), imagine how your sound fills the chest, nasal (maxillary sinuses, nose), head resonators. 9. Be sure to sing before you sing songs. This is not only the health of your voice, but also free “top”, free flying sound. 10. A good feeling of all the muscles of the lips and tongue helps to understand how to connect breathing with vocals and muscles … Take your time, everything has its time. 11. Find a good, professional teacher. Nothing can replace the feedback you get from another. A good teacher will give you detailed information about your voice and ideally show you how to fix problems. He will explain the basics of voice production, help you find your own style, manner of singing. If you can’t afford it, read our articles, order chants, write and ask about everything that interests you. In any case, this will also bring results. 12. Water is the best drink for the voice. She should always be with you. Neither alcohol, nor milk, nor anything else will make your voice better, much less make it more professional than it is! 13. Listen carefully to professional vocalists. Understand how they breathe in, what a surround sound they have, how they work with articulation; study their vocal features and habits. 14. Not only listen to them, but also watch their performances. Study, observe, criticize! We are all living people: false notes, “roosters”, incorrect breathing and technique happen to everyone from time to time! 15. Find singers you like and don’t. Find out why. What exactly is the difference? Timbre? Manner? Pronunciation? Behavior on stage? Appearance? It will develop you, your musical tastes and professionalism. 16. Compare how an artist sounds when performing the same song on a recording and “live”. Analyze what is the difference. How much is real, and how much is “made” by a sound engineer? Dig into it, figure it out before you decide “you can never sound that good.” 17. After these steps, you must decide for yourself once and for all that you want to improve the sound of your voice and finally start working on it. 18. If you want to make singing your life’s work, then be prepared to put years of hard work into it. 19. Ask those whose opinion is especially important and valuable to you, what they did in order to get the sound that you like so much. Don’t be shy, most of them will be flattered and happy to share this information with you. 20. But NOTHING can replace a good teacher… Vocal lessons with a professional have always been, are and will be the most profitable investment in your victory.

Why does the voice sink?

Imagine vocal folds – two outgrowths along the walls of the larynx (approximately in the middle of the neck), consisting of connective tissue and muscles. In a relaxed state, they are wrinkled, leaving room for air. In a tense state, they straighten, while their internal parts, the vocal cords, are closed.

The cords tremble, vibrate, and a sound wave arises – a rhythmic vibration of the air. The harder the ligaments hit the air, the louder the sound. The more frequent the vibration of the ligaments, the more frequent the vibrations of the air, the higher the sound, and the thinner the voice.

A “shrunken” voice differs from the usual one in three ways: it is low, hoarse and quiet. If the voice is quiet, this means that the amplitude of the oscillations is small, that is, the vocal cords hit the air weaker than usual. The voice is low – it means that the frequency of the sound is reduced, that is, the vibrations become less frequent. And hoarseness in this case indicates that the vocal cords do not hit the air at the same time, as a result of which sounds of different frequencies arise, which add up in our ear into a discordant choir, and the voice seems “dirty”, trembling. In other words, the voice sits down when the vocal cords stop closing quickly and synchronously.

There may be several reasons for this. The first, most common cause is problems in the vocal cords themselves. The nerve impulse goes to the vocal cords, but there is not enough muscle strength to properly close them. Most often this is due to swelling of the vocal cords.

Edema – accumulation of fluid and swelling of tissue – most often occurs due to inflammation. For example, some bacteria settled in our throat (we regularly breathe them, and usually the immune system has time to destroy them, but sometimes it can’t cope). Their waste products enter the bloodstream, activating the immune system. The first thing that happens in this case is a vascular reaction: the walls of blood vessels become more permeable to blood. This is necessary so that immune cells can penetrate tissues and attack bacteria there. Therefore, when the airways become inflamed, all nearby tissues swell, including the vocal cords. At the same time, their shape changes, their size increases, and it becomes more difficult to close them. Hence the quiet, low and hoarse voice.

But swelling of the vocal cords is not always caused by colds. The voice can sit down in people suffering from gastroesophageal reflux, a disease in which gastric juice is thrown up into the esophagus. It reaches the vocal cords and irritates them, resulting, again, in inflammation. Another example is a “smoky” voice. The tars that the smoker inhales settle on the walls of the respiratory tract and cause inflammation not only in the lungs, but also in the larynx.

Swelling of the vocal cords can be treated, like any inflammation, with anti-inflammatory drugs, warming and hot drinks. But the popular warming with the help of alcohol can lead to the opposite effect. Alcohol is hygroscopic, meaning it absorbs water. Therefore, settling on the vocal cords, it only increases their swelling. And a few glasses of wine can deprive an enterprising patient of even the remnants of a dead voice.

There are more serious problems of the vocal cords besides edema, such as mechanical rupture or swelling of the throat. In these critical cases, surgery is required.

The second cause of a dead voice is problems with the work of the muscles that stretch the vocal cords. As a rule, such problems arise when a person is very tired or nervous, and the recipe here is simple – to calm down and relax.

There is a third, much rarer cause – problems with the transmission of nerve impulses to the vocal cords. This is observed, for example, in partial paralysis or Parkinson’s disease.