PowerPoint Presentation

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How to look after your voiceHow to look after your voice

Dr. Christopher G. L. HobbsDr. Christopher G. L. Hobbs

BSc(Hons) MB BS(Lond), MRCS(Eng), DLO(RCSEng), MD(Bris), FRCS(ORL-HNS), FAMS (ORL)BSc(Hons) MB BS(Lond), MRCS(Eng), DLO(RCSEng), MD(Bris), FRCS(ORL-HNS), FAMS (ORL)

Director and Lead SpecialistDirector and Lead Specialist

Nobel ENT Head Neck & Thyroid Surgery CentreNobel ENT Head Neck & Thyroid Surgery Centre

Gleneagles Medical Centre #08-08Gleneagles Medical Centre #08-08

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•Why is it important?•Why is it important?

•What problems can you get with your voice?•What problems can you get with your voice?

•How common are they?•How common are they?

•What are the causes?•What are the causes?

•How to look after your voice?•How to look after your voice?

•What can be done if you have a problem?•What can be done if you have a problem?

OUTLINEOUTLINE

What we use at work – hands or voice?What we use at work – hands or voice?

P. Belafsky 2011

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SingersSingers

ActorsActors

BroadcastersBroadcasters

PerformersPerformers

Professional voice usersProfessional voice users

TeachersTeachers

LecturersLecturers

Childcare staffChildcare staff

Telephone operatorsTelephone operators

Call centre staffCall centre staff

Sales personsSales persons

InstructorsInstructors

LawyersLawyers

DoctorsDoctors

Health workersHealth workers

PriestsPriests

Secretarial staffSecretarial staff

Service staffService staff

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Voice problemsVoice problems

•Hoarse voice - weak, rough, or breathy voice•Hoarse voice - weak, rough, or breathy voice

•Loss of voice•Loss of voice

•Pain whilst talking•Pain whilst talking

•Problems singing•Problems singing

Other symptomsOther symptoms

•Sore throat•Sore throat

•Throat clearing•Throat clearing

•Excess throat mucus•Excess throat mucus

•Difficulty swallowing•Difficulty swallowing

•Cough•Cough

•Feeling of a lump in the throat•Feeling of a lump in the throat

•Breathing difficulty or choking episodes•Breathing difficulty or choking episodes

Throat symptomsThroat symptoms

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•Hoarseness has a lifetime prevalence of 30%•Hoarseness has a lifetime prevalence of 30%

•Point prevalence of 7% in adults under 65 years•Point prevalence of 7% in adults under 65 years

•Certain occupations are badly affected•Certain occupations are badly affected

– teachers 58%– teachers 58%

– aerobics instructors 44%– aerobics instructors 44%

•Women are more often affected then men (3:2 ratio)•Women are more often affected then men (3:2 ratio)

•Children are affected, particularly between ages 8 to 14•Children are affected, particularly between ages 8 to 14

How common is hoarse voice?How common is hoarse voice?

What are the causes of hoarse voice?What are the causes of hoarse voice?

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HOARSENESS

Inflammatory

Neoplastic

Neuromuscular

Psychogenic

Systemic

Infections

Irritants

Trauma

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Papilloma

Dysplasia

Cancer

HOARSENESS

Inflammatory

Neoplastic

Neuromuscular

Psychogenic

Systemic

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Local

Global

Nerve injury

HOARSENESS

Inflammatory

Neoplastic

Neuromuscular

Psychogenic

Systemic

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Reaction to stress

Manifestation ofpsychiatric disorders

HOARSENESS

Inflammatory

Neoplastic

Neuromuscular

Psychogenic

Systemic

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Acromegaly

Hypothyroidism

Sarcoidosis

Amyloidosis

Arthritis

HOARSENESS

Inflammatory

Neoplastic

Neuromuscular

Psychogenic

Systemic

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Left vocal cord palsy in a 62-year-old male

FLEXIBLE LARYNGOSCOPY

RIGID VIDEOSTROBOSCOPY

51-year-old female call-centre worker

with muscle tension dysphonia

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How to look after your voiceHow to look after your voice

“Prevention is better than cure”“Prevention is better than cure”

Desiderius ErasmusDesiderius Erasmus

(1466 –1536)(1466 –1536)

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DON’T SMOKE!DON’T SMOKE!

•Smoking is one of the worstthings you can do to yourvoice•Smoking is one of the worstthings you can do to yourvoice

•Irritation to the vocal cordsfrom cigarette smoke can leadto chronic laryngitis, vocal cordpolyps, or cancer of the larynx•Irritation to the vocal cordsfrom cigarette smoke can leadto chronic laryngitis, vocal cordpolyps, or cancer of the larynx

•If your voice is valuable toyou, smoking is just not worththe risks•If your voice is valuable toyou, smoking is just not worththe risks

How to look after your voiceHow to look after your voice

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HydrationHydration

•Good water intake helps keep the lubricating mucus onyour vocal cords thin, creating the ideal environment foryour vocal cords to work•Good water intake helps keep the lubricating mucus onyour vocal cords thin, creating the ideal environment foryour vocal cords to work

•Drink 6 - 8 cups (1.5-2L) of water a day to maintainadequate hydration•Drink 6 - 8 cups (1.5-2L) of water a day to maintainadequate hydration

•The goal is to drink until your urine is pale•The goal is to drink until your urine is pale

•Take a water bottle with you to work and refill it at thewater fountain•Take a water bottle with you to work and refill it at thewater fountain

•Avoid drinks that contain caffeine•Avoid drinks that contain caffeine

(coffee, tea, most soft drinks)(coffee, tea, most soft drinks)

How to look after your voiceHow to look after your voice

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Thick MucusThick Mucus

•Increasing your water intake will often help people whocomplain of thick mucus in their throat•Increasing your water intake will often help people whocomplain of thick mucus in their throat

•A mucolytic drug may help•A mucolytic drug may help

•Sometimes, persistent mucus in the throat is due tobackflow of stomach acid into the throat -Gastroesophageal reflux disease (GERD)•Sometimes, persistent mucus in the throat is due tobackflow of stomach acid into the throat -Gastroesophageal reflux disease (GERD)

How to look after your voiceHow to look after your voice

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Throat ClearingThroat Clearing

•This is a common problem with many professional voiceusers. It is often seen in people with excessive mucus orreflux disease•This is a common problem with many professional voiceusers. It is often seen in people with excessive mucus orreflux disease

•Throat clearing is extremely traumatic to the vocal cords,leading to excessive wear and tear•Throat clearing is extremely traumatic to the vocal cords,leading to excessive wear and tear

•IT IS IMPORTANT THAT THIS HABIT IS STOPPED•IT IS IMPORTANT THAT THIS HABIT IS STOPPED

•Try the following strategies: swallow, have a sip of water,or clear your throat silently without allowing your vocalcords to touch•Try the following strategies: swallow, have a sip of water,or clear your throat silently without allowing your vocalcords to touch

How to look after your voiceHow to look after your voice

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Gastroesophageal Reflux Disease (GERD)Gastroesophageal Reflux Disease (GERD)

•This is common among professional voice users•This is common among professional voice users

•Many patients never experience heartburn•Many patients never experience heartburn

•Treatment of this condition first involves changes inyour diet and lifestyle•Treatment of this condition first involves changes inyour diet and lifestyle

•Medications can be used to reduce the acid productionfrom your stomach•Medications can be used to reduce the acid productionfrom your stomach

How to look after your voiceHow to look after your voice

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Vocal Abuse/OveruseVocal Abuse/Overuse

•Don't speak excessively - avoid lengthy conversations on thephone. If your on the phone all day, rest for 10mins every 2-3hrs•Don't speak excessively - avoid lengthy conversations on thephone. If your on the phone all day, rest for 10mins every 2-3hrs

•Talk at a low to moderate volume - minimize talking when there isexcessive background noise (cars, parties, airplanes, restaurants)•Talk at a low to moderate volume - minimize talking when there isexcessive background noise (cars, parties, airplanes, restaurants)

•You may need amplification to talk in a noisy environment•You may need amplification to talk in a noisy environment

•Avoid shouting and screaming. Use alternative strategies forgetting peoples attention: using a whistle or clapping your hands•Avoid shouting and screaming. Use alternative strategies forgetting peoples attention: using a whistle or clapping your hands

•Rest if you get a respiratory infection•Rest if you get a respiratory infection

How to look after your voiceHow to look after your voice

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Drugs that Affect the VoiceDrugs that Affect the Voice

•Antihistamines/Decongestants: these drugs are commonly foundin cold preparations and allergy medications. They will result in adrying effect on the vocal cords which is detrimental•Antihistamines/Decongestants: these drugs are commonly foundin cold preparations and allergy medications. They will result in adrying effect on the vocal cords which is detrimental

•Local Anaesthetics: these medications should be avoided.Numbing the throat with one of these sprays is an especially badidea if you are about to perform or sing•Local Anaesthetics: these medications should be avoided.Numbing the throat with one of these sprays is an especially badidea if you are about to perform or sing

•Other medications that dry the vocal tract include:antihypertensives, diuretics, antidepresants, antipsychotics•Other medications that dry the vocal tract include:antihypertensives, diuretics, antidepresants, antipsychotics

How to look after your voiceHow to look after your voice

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Work EnvironmentWork Environment

•Avoid smoke filled and dusty environments•Avoid smoke filled and dusty environments

•Dry environments are also bad for the voice•Dry environments are also bad for the voice

–Reduce aircon exposure–Reduce aircon exposure

–If you travel by plane a lot, you should increase your waterintake accordingly–If you travel by plane a lot, you should increase your waterintake accordingly

–If you travel to dry environments (e.g. Middle East, NorthAfrica, Southern US, Central Australia) use humidifier at night,and maintain good water intake–If you travel to dry environments (e.g. Middle East, NorthAfrica, Southern US, Central Australia) use humidifier at night,and maintain good water intake

How to look after your voiceHow to look after your voice