After President Clinton’s heart surgery, his voice was noticeably changed. Sounding a little raspy, weaker and breathy, the former President said he was feeling good and had made a full recovery but had his voice betrayed him?
Maybe. Maybe not.
“Bill Clinton may have either had vocal cord damage during surgery where you’d see that voice change, or acid reflux could also cause it,” says laryngologist Dr. Jamie Koufman.
“The left vocal cord is clustered near the chest so in any type of heart or lung surgery the nerve in the left vocal cord can be inflamed, tweaked or damaged, and will leave you with a breathy sounding voice,” explains Koufman.
Sometimes the voice change is temporary, other times it can be permanent. The point is, voice can tell you a lot about your health-- if you’re listening.
A voice change can indicate anything from a cold or allergies to cancer or vocal cord issues. Here are a few voice changes that can speak to your health:
“First, throat hoarseness that lasts for longer than a few weeks needs to be checked out by an ear, nose and throat specialist,” says Koufman. A voice that progressively gets softer implies something is going on with the nerves that run the vocal cords.
It could be a sign of thyroid cancer, throat cancer, multiple sclerosis, lime disease or brain tumors. Koufman says the most common of these bad things are cancer and lime disease. Anyone who smokes or smoked in the past should pay particular attention to a hoarse voice change and get it checked out immediately. Laryngeal cancer is highly curable if diagnosed in its early stages.
Acid reflux, when stomach contents back up into the esophagus while you’re sleeping, is also the number one cause of hoarseness. Laryngeal acid reflux, also called silent reflux, does not cause indigestion or heartburn but leaves you with chronic voice raspiness, a dry cough or the chronic need to clear the throat.
A raspy quality can spell a vocal cord polyp. “A polyp is a blister filled with water which typically goes away on its own just like blisters on your feet,” says Dr. Michelle Yagoda.2
It can also be caused by a nodule, which is similar to a hard callous on the foot. Both can be confirmed with a physical exam by a laryngologist.
Vocal cord nodules can be caused by misuse of the voice, the way cheerleaders or spin instructors yell, or anyone who chronically projects their voice loudly. They can also be caused by acid reflux and can be surgically removed to improve voice quality.
A hoarseness that gets worse as the day goes on, where the voice sounds like its running out of gas can indicate a number of things including polyps, nodules and reflux. The voice typically fatigues at the end of the day. It starts strong in the morning and peters out by dusk. If your voice is fatiguing, see a specialist to get to the root cause.
If you think Kathleen Turner, Demi Moore or Bette Davis sport sexy gravelly voices, that rough voice may be due to cord nodules (also called Singer's Nodes or Screamer's Nodes), and are typically caused by misuse or chronic over-projection. Nodes generally appear on both sides of the vocal cords opposite each other. A gravelly voice can also be due to thyroid conditions and of course, smoking. A laser procedure can remove or shrink cord nodes. However, “sometimes with professionals, it’s a signature voice that they don’t want to change,” says Koufman.
A nasal voice or what’s called hyponasal is typically caused by a structural problem like a deviated septum (the thin wall of cartilage dividing the nose becomes crooked or off-center). It can also signal a cold or chronic allergies. “When mucus membranes are inflamed they take up more physical space, so a person who is allergic to animals, lives with four dogs and has a chronically swollen airway and less space for air to pass, have a hyponasal sounding air quality in their voice,” says Yagoda. Treatment for the deviated septum or the allergy may help.
Parkinson’s patients lose fine motor skills so variation in the voice gets more difficult to make as muscles weaken or become affected. “It becomes harder for them to make inflections in tone,” says Yagoda. Patients with multiple sclerosis may also experience monotone voice. Koufman says most times though, the voice change isn’t the first sign of the disease but happens well after diagnosis.
A tight, odd, strained sounding voice with frequent breaks in sentences or words is called spasmodic dysphonia, a rare neurological disorder that affects the voice muscles. The muscles spasm, which interfere with the ability of the vocal cord folds to vibrate and produce voice. Diane Rehm of NPR http://www.npr.org/people/2101067/diane-rehm and Robert Kennedy Jr. both have the condition. What happens is the vocal chords close and open randomly because of a glitch in the brain, explains Koufman. The condition can be treated and voice improved with Botox.
Most of us take our voice for granted. But if you notice a voice change, get it checked right away. Drink plenty of water, skip misuse like screaming, never smoke, and avoid clearing your throat often. It’s like slamming your vocal cords together. Try water or a gentle airy cough instead. And when you’re already hoarse from a cold or a good football game, give your voice a rest. It will appreciate it.
Additional sources not cited or linked to above:
1 Dr. Jamie Koufman, Laryngologist, Director of the Voice Institute of New York, and author of The Chronic Cough Enigma: http://www.voiceinstituteofnewyork.com/
2 Dr. Michelle Yagoda, Otolaryngologist, Assistant Adjunct Attending Physician and Clinical instructor at Manhattan Eye, Ear and Throat Hospital, and one of New York City's most well-respected voice care experts specializing in the professional voice. http://www.dryagoda.com/voice-care.html
This material is intended for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult with your doctor
By Jennifer Nelson
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