Are the People Around You Losing Their Hearing, Or Could *You* Be Losing Your Voice?
Learn how to spot the signs of strained vocal cords and other vocal cord disorders.
Damaged vocal cords are more common than you might think
When I arrive at a family reunion, relatives crank up their hearing aids. During a recent stint working in a jewellery shop, I would greet customers, then wonder if they were ignoring me or simply couldn’t hear what I was saying. These encounters worry me—I have memories of trying to converse with my mother as her own voice grew quieter and quieter. Phone calls became torturous, then impossible.
While hearing and vision issues are prominent in many discussions of aging, we rarely explore how growing older affects our vocal cords. After 65, about three in 10 people have difficulties serious enough to be diagnosed as a voice disorder. Problems can start earlier in those with ailments such as gastrointestinal reflux disease, or who have jobs that require speaking loudly. Fortunately, there are strategies that can help you retain—or regain—the ability to make yourself heard.
At least half of all teachers suffer from voice problems
Working in a field that involves loud or relentless talking can strain your vocal system. According to some estimates, more than half of all teachers develop voice problems in their careers.
Jane Schultz-Janzen, 52, a high school music teacher in Kitchener, Ontario, spent most days projecting at top volume before she was suddenly struck by a throat virus in May 2005. Although most of the health symptoms cleared up quickly, Schultz-Janzen’s voice still hadn’t regained its former strength weeks later. Her GP believed her vocal cords would heal with rest and expected she would feel better after the summer break. Come autumn, however, Schultz-Janzen’s ability to speak and sing continued to deteriorate. She saw her doctor several times before booking an appointment with an otolaryngologist (a specialist in ear, nose and throat, or ENT) in the spring of 2006.
It isn’t unusual to experience voice fluctuations, says Dr. Françoise Chagnon, a Montreal-based ENT specialist. “But if it hasn’t returned to normal after 10 days—especially if there aren’t at least some brief periods of improvement—then an exam of your vocal cords is warranted.”
Typically, this involves feeding a scope with a tiny camera attached to its tip down the throat.
Schultz-Janzen had yet to undergo a scope exam when, in May 2006, she opened her mouth to make an announcement and no sound came out. “That was the most frightening moment of my life,” she says. “So much of my identity was wrapped up in my voice. It’s my tool for everything I do—professional, musical and social.”
Schultz-Janzen was diagnosed with a blister-like lesion called a throat polyp on her left vocal fold. This condition can be triggered by long-term exposure to irritants such as cigarette smoke; it can also result from chronic allergies and/or excessive voice use. In Schultz-Janzen’s case, the ailment was likely caused by 18 years of teaching and singing and exacerbated by the virus. She opted for day surgery to remove the polyp with a laser.
The operation, which took place in January 2007, went well. Afterwards, however, Schultz-Janzen took no chances. She limited her speech, remaining completely silent for the first five days, then gradually adding talk time over the next six weeks. She also followed up with voice-therapy sessions. These “involve working on your vocal technique just as a physiotherapist would work on your muscle patterning,” says Suzanne Bassett, head of the voice department at Speech Therapy Centres of Canada.
Today, Schultz-Janzen is back in the classroom, but she now sports a Voice Buddy. Consisting of a headset and a speaker attached to a belt, the device allows her to be heard above the hubbub of a music room without forcing her to strain. “My problem was like a sports injury, insofar as my voice will never be quite as forgiving of abuse as it was before,” she says. “I feel it getting crackly when I don’t use the amplifier. But I’m in good condition now.” Having become passionate about helping others avoid or navigate similar ordeals, she leads vocal-hygiene workshops through her school board and receives emails from fellow sufferers seeking advice and moral support.
Read the terrifying true story of one woman’s rapidly weakening voice.
Giving vocal cords a workout
Bruce Lyon, 75, was convinced his wife, Kathie, needed to have her hearing checked—she’d ask, “What did you say?” multiple times a day. But after his adult children repeatedly complained and his granddaughter remarked on his quiet voice, Lyon acknowledged the problem was his.
“It was a struggle to project enough to be heard, especially at restaurants or places with background noise,” says Lyon, a retired university administrator in Carrollton, Georgia. His ENT specialist referred him to the Emory Voice Center at Emory University Hospital.
The diagnosis: vocal fold atrophy, or presbyphonia. Vocal folds can thin with age, especially after menopause in women or when the muscles aren’t used enough. Lyon, for example, spent far less time talking than he had before he retired several years earlier. During speech, vocal folds vibrate as air pushes through. As muscles lose volume, strength and coordination, it takes more effort for the folds to move together—and sometimes, as atrophy worsens, they can’t close at all. The result is a softer, less resonant voice that requires far more effort to make audible. “Presbyphonia is a double whammy because it occurs at the same time that friends may have age-related hearing changes,” says Edie Hapner, a professor of otolaryngology at the University of Southern California, who worked with Lyon at Emory.
With Hapner, Lyon did a series of exercises called PhoRTE (pronounced “forte,” like the Italian term used in music notation as a command to play loudly or strongly). The techniques start at about 50 per cent of maximum effort, gradually building up in intensity. At home, Lyon practised in two 15-minute sessions a day, energetically sustaining a vowel sound, gliding up and down his pitch range and calling out simple sentences in a loud voice. He also used a respiratory resistance device to improve his breath control.
The process worked. “The change was gradual, but within a couple of months, we weren’t asking him to repeat himself,” says Kathie. Like any type of muscle conditioning, however, the maximum improvement lasts only with continued practice.
Lyon’s voice problems were considered moderate, but in some people, bowing of the vocal folds is so extreme that even with therapy they won’t touch. More dramatic treatments can be employed in those cases. “We can inject a filler—some people use the same material used to fill facial wrinkles—to augment the vocal cords,” says Dr. Elizabeth Guardiani, an assistant professor of otorhinolaryngology and head and neck surgery at the University of Maryland School of Medicine.
As for me, a chat with a voice specialist indicated nothing particularly abnormal about my voice. I’m determined to drink more water and use my voice more—enunciating with French-language CDs or singing in the car. And if those strategies don’t result in improvements, I won’t hesitate to consult a pro. Much like Schultz-Janzen, Lyon says he wishes he’d obtained an expert’s help much earlier.
Now that you know what it’s like to live with damaged vocal cords, check out the oral cancer symptoms you should never ignore.