Five voice care rules for people who speak for a living

1. Keep your vocal folds moist: water and humidity

The vocal folds vibrate most easily when the thin layer of mucus covering them stays fluid. The simplest way to achieve this is to drink enough water throughout the day.

• Keep a bottle of water on your desk or lectern and take small, frequent sips.
• In air-conditioned or centrally heated rooms, a humidifier or steam inhalation can help.
• Caffeine and alcohol can increase fluid loss; keep them limited on days of heavy voice use.
• Breathing through your nose humidifies the air. If a blocked nose makes you breathe through your mouth all the time, that is worth having assessed too.

2. Rest your voice and don't shout

The most common cause of vocal fatigue is using the voice loudly, for long periods and without breaks.

• Plan a few minutes of silent rest between long lessons, calls or meetings.
• In a large classroom or noisy setting, use a microphone or voice amplifier instead of raising your voice, and use hand signals or a bell to get attention.
• Avoid long conversations in noisy venues and shouting on the phone.
• Whispering can also strain a hoarse voice; talk less if you can, and when you need to speak, use a soft, relaxed voice.

Not forcing your voice when you have a cold is an important way to prevent lasting problems.

3. Take reflux seriously

Acid and digestive fluids from the stomach can travel up as far as the larynx. This is called laryngopharyngeal reflux, and it does not always cause heartburn. Morning hoarseness, a constant feeling of something stuck in the throat, frequent throat clearing and coughing can all be signs of it.

• Eat your evening meal at least 2–3 hours before going to bed.
• Fatty and spicy food, chocolate, fizzy drinks and alcohol can make symptoms worse.
• Raising the head end of the bed slightly may help.
• Constant throat clearing irritates the vocal folds; try a sip of water instead.

If reflux is suspected, the decision on medication should be made after an examination.

4. Stop smoking and avoid smoky places

Cigarette smoke directly irritates and dries the surface of the vocal folds and causes swelling. Long-term smoking is a major risk factor for laryngeal cancer as well as for vocal fold swelling and permanent voice changes. Second-hand smoke and smoky environments also affect the voice.

Stopping smoking is one of the most effective steps any professional voice user can take. E-cigarettes and shisha cannot be considered a safe alternative for the vocal folds either.

5. Warm up and use good technique

Just as athletes warm up before training, the voice should be prepared before heavy use. A few minutes of gentle humming, lip trills and soft glides from low to high pitch get the vocal folds ready. At the end of the day, similar light exercises can serve as a cool-down.

Good breath support and a relaxed posture let you use your voice without straining your throat. If you often experience vocal fatigue, voice training with a speech and language therapist can be very helpful in correcting speaking habits. For singers, regular singing lessons serve the same purpose.

When does hoarseness need an examination?

Hoarseness from a cold usually settles within a few days to two weeks. Hoarseness lasting longer than 2–3 weeks, however, should always be assessed by an ENT specialist. During this examination the vocal folds are viewed with a thin camera passed through the mouth or nose (laryngoscopy). It is usually a quick procedure carried out in the clinic.

People who use their voice heavily can develop benign changes on the vocal folds such as nodules, polyps or cysts. Many of these can be managed in the early stage with voice rest, voice therapy and control of irritants; some may need surgery.

We recommend seeking help without waiting if you have:

• Sudden loss of voice after heavy shouting or singing,
• Shortness of breath, difficulty swallowing or painful swallowing,
• Blood in your phlegm or a lump in your neck,
• Hoarseness that does not go away and you smoke.

Your voice is the basic tool of your profession. If your symptoms persist, we identify the cause at an examination and plan suitable voice care with you; consultations can be held in English. For general questions, see our frequently asked questions page.