Ask Dr James: Why is my voice so croaky all the time?
Dear Dr James,
My voice, entirely normal in the morning, loses its volume as the day progresses becoming raspy and whispery. This first started several years ago when speaking at a meeting. At the meeting my throat became so parched I was unable to continue. As the problem persisted I consulted an ear nose and throat (ENT) specialist but his investigations including inspecting my throat through an endoscope were apparently negative. I always used to enjoy reading and singing in church but sadly this is no longer possible.
Dear Reader,
The vocal cords are amongst the most hard working structures of the body, opening and closing as we talk, laugh and sing hundreds and thousands of times a day. They also convey messages of who we are, our mood and feelings through the pitch and inflection of the sounds transmitted. Their action can be impaired by many things – laryngitis, overuse, the presence of warts or nodules – but when, as here, their appearance is unremarkable there are in essence three possible explanations.
A dry throat
The vocal cords are surrounded by a mucus membrane that must constantly be kept moist to facilitate the movement of their sound generating vibrations. Their drying out either by dehydration or insufficient salivary secretions can particularly be an issue for professional voice users – teachers, politicians, actors and singers.
A singing teacher explains: “If a plant wilts and its leaves droop it tells us it needs water. Not so easy for humans! I was taught to always carry a water bottle and take frequent sips throughout the day to lubricate the moving parts. I now insist my students do the same”. It is sensible too to reduce the intake of tea and coffee which, being natural diuretics, promote the excretion of fluid through the kidneys.
The salivary glands in the mouth produce an impressive litre of watery secretions a day that helps to moisten the vocal cords. Their volume tends to decline with age or may be significantly reduced in those taking commonly prescribed medicines such as antihistamines, antidepressants and beta-blockers. This can be compensated for by regular use of an artificial saliva spray, but many find sugar free chewing gum – which boosts the glands’ production of saliva – to be more convenient. Sucking on peardrops or liquorice and menthol Vigroid pellets can be similarly effective.
Vocal muscle impairment
Beneath the mucus membrane lies the muscles of the vocal cords. The vocal chord’s constant, sublimely orchestrated opening and closing, lengthening and shortening makes possible the miracle of phonation by altering the shape of the aperture and flow of air between them.
Their coordination can be compromised in two ways, the first and easier to understand being ‘spasmodic dysphonia’.
With spasmodic dysphonia, the movement of the vocal muscles is controlled by nerves that originate in the brain. Their erratic firing can cause them to contract spasmodically in a manner similar to a tic. Depending on whether those involved in opening or closing the cords are affected, the voice can either be tight and jerky or weak and husky. There is no long-term cure though regular injections of botulinum toxin (Botox) directly into the muscles can, by abolishing the spasm, render speech more fluent.
The other way the vocal chords could be compromised is through muscle tension dysphonia. Here the speaker strains the voice by exerting too much effort or pressure on the laryngeal muscles so it sounds variously rough, gravelly, squeezed or tight and tires easily. This is primarily a functional condition brought on by overuse or stressful life events. Speech therapists deploy a range of vocal techniques to retrain the affected muscles.
Email comments and queries in confidence to Drjames@telegraph.co.uk
