How the voice works and how to look after your voice - Information for patients and visitors
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Information for patients and visitors How the voice works and how to look after your voice Speech and Language Therapy Department Community and Therapy Services This leaflet has been designed to give you important information about how your voice works.
Information for patients and visitors
How the Voice Works: sets of muscles involved and the following
happens:
What is voice? Muscular activity brings the vocal cords
Voice is the sound produced by the vibration together precisely
of the two vocal cords. The vocal cords are Air from the lungs passes between the
located in the larynx or the ‘voice box’ and vocal cords which makes them vibrate
are two bands of smooth muscle that lie and producing a sound- the voice
opposite each other, and are stretched
across the larynx from front to back. This sound then travels in the air stream
through the resonating cavities of the
The Larynx / Voicebox throat, nose and mouth
The larynx sits at the top of your trachea or Voice quality
‘windpipe.’ More specifically it is positioned
between the bottom of your tongue and the The size and shape of the vocal cords and
top of the windpipe. It is made up of the resonating cavities (throat, nose and
cartilages, muscles and soft tissue. The mouth) help to determine voice quality and to
largest cartilage in the larynx is called the the give us our individual ‘voice print.’ This is
thyroid cartilage, and this is more commonly why we each have a different voice that is
known as the ‘Adam’s apple.’ This can be recognisable as our own.
seen or felt protruding from the front of the To change the pitch of the voice, the size
neck and is more prominent in men. The and shape of the vocal cords are altered
vocal cords are tiny; in fact they are no through fine muscle control. High pitch
bigger than a five pence piece, and sounds are made when the vocal cords
extremely sensitive to irritants. become thin and taut and vibrate at a higher
frequency, much like when you stretch an
Voice production elastic band. Low pitched sounds are
Voice production relies on three key produced when the vocal cords are thicker
elements working together: and more lax, and therefore vibrate at a
slower rate.
1. Breathing
2. Phonation - vibration of the vocal cords What can go wrong?
within the larynx There are many different elements involved
3. Resonance - the shaping and colouring in good voice production and voice problems
of sounds usually arise due to a combination of
different factors. Your Speech and
When we are breathing in and out at rest the
Language Therapist will spend time
vocal cords are wide apart and the air
explaining how the voice is made and how
passes freely through the larynx. Voice and
things can go wrong. Voice therapy involves
speech is produced when we are breathing
working with a Speech and Language
out. When we produce voice, messages are
Therapist to identify factors affecting your
sent from the brain through our nerves to the
voice. The therapist will then provide advice,
strategies and specific techniques toInformation for patients and visitors
enhance vocal health and help you use your http://freedomfromsmoke.co.uk
voice better. Tel. 0845 603 2166 (local rate calls)
How to Look After Your Voice: http://www.ash.org.uk/information/facts-and-
stats/fact-sheets
1. Give up smoking http://www.gosmokefree.co.uk
The single most important thing you can do
to help your voice is to give up smoking. 2. Drink sensibly
This is because smoking causes the throat Water
and vocal cords to become inflamed and
swollen from the dryness, heat and tar from To keep your vocal cords healthy, your body
the tobacco smoke. This can lead to a deep- needs enough fluid.
pitched hoarse voice. General opinion is that 8 glasses (2 litres) a
Smoking is the single biggest cause of day is about right.
cancer in the world, and accounts for one in The best fluids for the body are water,
four UK cancer deaths. squash, herbal teas and juices.
http://www.cancerresearchuk.org/cancer- Caffeine
info/healthyliving/smoking-and-cancer
Fluids such as tea, coffee, and fizzy drinks
People who smoke and drink alcohol account contain caffeine which dehydrates your body.
for 75% of cancers affecting the upper part of Caffeine also has a drying effect on the vocal
the respiratory and digestive tract. cords causing voice changes.
http://www.cancerresearchuk.org/cancer- Alcohol
info/cancerstats/incidence/
Alcohol in moderation is fine. The
Benefits to your health begin the minute you Department of Health recommends that men
stop smoking: don’t drink more than three or four units of
After 3 days breathing becomes easier alcohol a day, and that women limit their
and your energy levels increase intake to two or three units a day. You
shouldn't save up units through the week and
After 2 weeks withdrawal symptoms use them to binge at the weekend, and at
begin to ease and walking and daily least one day a week should be alcohol-free
tasks become easier to do
A pint of strong lager (alcohol 5% vol) equals
After 1 month withdrawal symptoms have 3 units.
stopped and your breathing and energy
One standard (175ml) glass of wine (alcohol
levels continue to improve
12%) equals 2 units.
After 6 months risk of heart attack,
Excess alcohol dries out the vocal cords and
cancer and other ‘smoking’ related
causes voice changes.
diseases begins to fall
You can find out more information on the
following websitesInformation for patients and visitors
3. Eat sensibly 6. Shouting / Raising voice / Voice
Some people find that eating spicy foods or rest
dairy products makes their voice worse. If When shouting or raising your voice your
you think this might be a problem for you try vocal cords come together with force and
reducing the amount you have. Research you increase the muscular tension in your
shows that indigestion / acid-reflux can neck. Constant shouting and raising your
cause voice problems resulting in voice voice can cause vocal strain (making it work
changes such as hoarse voice. This can be much harder and requiring much more
improved by making lifestyle changes and / effort). This in turn may increase the
or medication. For more information about likelihood of developing changes to your
reflux / silent reflux and how it affects your vocal cords and as a result affecting the
voice, please ask your voice therapist. sound of your voice.
4. Medication / Remedies 7. Whispering
Some drugs can affect your voice e.g. Often people feel that whispering can help by
inhalants for asthma and some giving the voice a rest, however, whilst you
antihistamines. If you notice any changes to are not using your voice it can still cause
your voice as a result of new medication damage to your voice box. Most people use
consult your doctor. If you are using an more pressure, and strain the muscles more
inhaler you should always rinse your mouth when they are whispering then when they
with water after use. are talking. Try to speak in a soft voice
Avoid use of medicated / menthol lozenges instead to reduce effort.
and cough sweets. Some throat sweets
contain anaesthetic, which masks throat pain 8. Stress
and lets you carry on misusing your voice. A degree of stress is a necessary part of life
This means that you might not be aware of but when it becomes prolonged or over
the amount of damage you are causing. powering it can cause physical symptoms,
There is also no evidence to show that including voice changes.
gargling helps.
You may notice that your voice quality
5. Throat clearing / Coughing changes becoming more strained and
hoarse.
When you cough or clear your throat your
vocal cords come together with force. If this 9. Relaxation (time for self...)
happens repeatedly you can cause them to
become sore, causing voice changes and The voice is part of the muscular system of
producing more mucous. This can also the body. Since tension in the body may be
cause voice changes. This may have transmitted to the voice, the ability to relax is
developed into a habit. Instead of coughing fundamental. True relaxation involves the
or clearing your throat drink water, swallow mind and body. It does not just happen, you
hard, yawn, or suck a sugar free sweet need to learn how to do it and practice
instead. This will help you to break the habit. regularly. It is recommended that you take
time out to pursue an interest or hobby;Information for patients and visitors
engage in physical activity e.g. swimming, cords. If you decide to continue to use
walking, yoga or learn a relaxation technique aerosols, do so in a well-ventilated room.
to increase your ability to identify and release
tension. 14. Dry air (Central Heating / Air
Conditioning)
10. Posture
Breathing in dry or dusty air can dry out the
Any imbalance in posture can cause muscle mucous linings of your throat and vocal cords
tension in the body. The best posture for resulting in voice changes. Centrally heated
voice is an open relaxed one e.g. uncrossed or air-conditioned environments can cause
legs and arms, and a centrally aligned body. the air you breathe to become dry. If you
If you spend a lot of time talking with your spend large amounts of time in these
neck twisted, or tilted you will be using your environments (e.g., home or work) increase
muscles unevenly e.g. when using the your fluid intake to ensure your body is fully
telephone, or talking to someone over your hydrated.
shoulder. Especially consider your volume
and the posture of your head / neck while on In a centrally heated environment, try placing
the telephone. water near a heat source e.g., under or near
a radiator, as this will add moisture to the air.
11. Lifting / Straining If your throat feels dry, you could try inhaling
steam. Do not put any scents, especially not
Avoid speaking when lifting or straining.
menthol / Olbas oil in to the water, as these
Talking while lifting or straining will result in
products are designed to dry out the mucous
your vocal cords coming together with force
linings in the body.
and causing strain.
Places you go: 15. Background noise
We tend to talk louder if our surroundings are
12. Passive smoking noisy e.g., home, work, in the car, pubs /
clubs, sports events etc. Often we are not
Evidence shows that individuals who spend
aware of raising our voices even slightly e.g.,
time in smoky environments can display
in response to continuous sounds such as air
similar changes to the voice as smokers.
conditioning.
Passive smoke causes the throat and vocal
Avoid speaking for long periods in noisy
cords to become inflamed and swollen from
environments and wherever possible remove
the dryness, heat and tar.
or reduce unnecessary noise e.g., turning the
television off or down whilst speaking.
13. Chemicals / Sprays
Avoid air fresheners, plug-ins, and aerosols 16. Reducing dryness
(e.g. spray deodorant, perfumes, hairsprays).
Sucking sugar free sweets (boiled sweets
These release chemicals into the air which
not medicated) and chewing gum helps to
are inhaled when you breathe. This can
stimulate saliva flow. Many people find that
irritate the lining of your throat and vocal
pieces of fruit relieve dryness as well. TryInformation for patients and visitors
orange, lemon or grapefruit or if these are Contact details for Further
too acidic try apple, pear or cucumber. Information
17. Hot compresses If you require any further information
please contact the Speech and Language
These will help soothe an inflamed or painful Therapy Department on Tel: 01472 875405
throat and improve the blood circulation for Grimsby and 01724 290043 for
which helps to reduce oedema. Scunthorpe.
Fill a basin with hot water, soak and wring
out a face flannel, fold it up and press it to Concerns and Queries
your throat. Hold there until it cools down. If you have any concerns / queries about any
Repeat three to four times. If you find this of the services offered by the Trust, in the
helpful, try to do it several times a day, first instance, please speak to the person
especially when your throat is sore or tired. providing your care.
18. Steam inhalation For Diana, Princess of Wales Hospital
All the air you breathe passes over your Alternatively you can contact the Patient
vocal cords. Steam inhalation will soothe Advice and Liaison Service (PALS) on
them if they are dry, sore or irritated. (01472) 875403 or at the PALS office which
is situated near the main entrance.
Half fill a large bowl or sink with a kettle of
water which has just boiled. Sit comfortably For Scunthorpe General Hospital
and cover your head, shoulders and the bowl Alternatively you can contact the Patient
with a large towel. Breathe in and out Advice and Liaison Service (PALS) on
through your mouth. Continue until the water (01724) 290132 or at the PALS office which
stops steaming. situated on C Floor.
Your throat will need time to cool down after Alternatively you can email:
this so allow 30 minutes before you go out nlg-tr.PALS@nhs.net
into cooler / outdoor air. Try to do this twice
daily or more often if your throat is especially Confidentiality
irritated. For a quicker option when you are
on the go or at work for example, fill a cup Information on NHS patients is collected in a
with boiling water to steam. variety of ways and for a variety of reasons
(e.g. providing care and treatment, managing
Do not add any oils, for example Olbas oils, and planning the NHS, training and
to the water as these will irritate the vocal educating staff, research etc.).
cords rather than help. Two drops of
camomile essential oil or one tablespoon of Everyone working for the NHS has a legal
camomile flowers may be added if you wish duty to keep information about you
as camomile contains a natural anti- confidential. Information will only ever be
inflammatory agent. shared with people who have a genuine
need for it (e.g. your GP or other
professionals from whom you have beenInformation for patients and visitors
receiving care) or if the law requires it, for Patients are always encouraged to help
example, to notify a birth. themselves as much as possible when
mobilising, and if unable to do so, equipment
Please be assured however that anyone who
may be used to assist in their safe transfer.
receives information from us is also under a
legal duty to keep it confidential. If you have any questions regarding moving
and handling of patients within the Trust,
Zero Tolerance - Violent, please speak to a member of staff in the
Threatening and Abusive Behaviour ward or department you are visiting.
The Trust and its staff are committed to Northern Lincolnshire and Goole NHS
providing high quality care to patients within Foundation Trust
the department. However, we wish to advise
all patients / visitors that the following Diana Princess of Wales Hospital
inappropriate behaviour will not be tolerated: Scartho Road
Grimsby
Swearing 01472 874111
Threatening / abusive behaviour Scunthorpe General Hospital
Verbal / physical abuse Cliff Gardens
Scunthorpe
The Trust reserves the right to withdraw from 01724 282282
treating patients whom are threatening /
abusive / violent and ensuring the removal of Goole & District Hospital
those persons from the premises. Woodland Avenue
Goole
All acts of criminal violence and aggression 01405 720720
will be notified to the Police immediately. www.nlg.nhs.uk
Risk Management Strategy Date of issue: January, 2015
The Trust welcomes comments and Review Period: January, 2018
suggestions from patients and visitors that Author: Speech & Language Therapy
could help to reduce risk.
IFP-843
Perhaps you have experienced something
whilst in hospital, whilst attending as an © NLGFT 2015
outpatient or as a visitor and you felt at risk.
Please tell a member of staff on the ward or
in the department you are attending / visiting.
Moving & Handling
The Trust operates a Minimal Lifting Policy,
which in essence means patients are only
ever lifted by staff in an emergency situation.You can also read
