I have a research paper coming up, and my subject of choice is vocal abuse in modern society. In order to be able to write about this, I not only need to know examples of vocal abuse and what the consequences are, but also WHY certain activities cause fatigue or damage. I’ll explain in my list.

1) Yelling/belting – of course I know that these activities are unhealthy when done incorrectly, but I need to know why. What is it about pushing lots of air through the vocal cords that is unhealthy? How does this contribute to the development of vocal problems?

2) Smoking – what is it about the smoke or the heat from the cigarette that hurts the vocal folds? What does it do?

3) Dehydration – when somebody doesn’t have enough water in the body or throat (such as from a dry/smoking environment, not enough water, or drinking too much coffee), why does using the voice too much cause injury? Why is it necessary to keep the vocal cords lubricated?

4) Drinking – what are the negative effects of drinking on the voice?

5) Breathy speech – what part of breathy speech is dangerous to the voice? What does it do?

Finally, I’d like to know about what healthy speaking/singing habits consist of and maybe how to counteract some of the negative effects of bad vocal habits.

If possible, I’d also like some info on how speech therapists and master teachers help recover damaged voices. Obviously it doesn’t need to be a whole treatise on the subject, but maybe a brief overview on how these techniques work in rebuilding voices that have been hurt in various ways. I think it’d make a great addition to my paper.

These are several great questions we should all be aware of during our daily activities. The health of our instrument depends on it. Like many things, big problems are just small problems that are allowed to grow. Nowhere is this more true than with the voice. Rarely do we experience an acute injury to the voice. Occasionally someone may burst a blood vessel in their vocal fold and lose their voice for a while. But real vocal damage happens over a period of time of relatively minor vocal abuse.

In order to answer your questions, we need to first understand what is the physical realization of abuse. There has been a lot of progress in the research into heart disease, and we can take a page out of what they are finding is the cause.


Inflammation of the tissue lining the blood vessels is the cause of accumulation of plaque in the arteries. This accumulation is the body trying to repair itself and causes the blockage that results in heart attacks or stroke. The remedy is to reduce inflammation in the body so the body won’t react and create the problem.

This same relationship between injury/inflammation and the body repairing itself exists in the vocal tissue. We can trace just about any condition of vocal abuse to inflammation-injury. With that in mind we can now look at the specific situations you ask about.

1) Yelling/Belting – When we yell, and in singing belting is related to yelling (at least how I define belting), the condition that defines the act as yelling is the forceful expulsion of breath through the glottal opening. What we want for a healthy voice is a balanced condition so that the only breath going through the glottis is the rapid, regular puffs that are part of the vibration. If we force the breath so more goes through than can escape in puffs we create a condition where the air blows over the surface of the folds. This is increased by the level of pressure that exists when we yell. The molecules in the air, when rushing over the surface of the fold, can irritate the tissue. This irritation, if severe enough, can cause the tissue to become inflamed. This is what the voice doctor looks for when visually checking the voice. Inflammation looks reddish. Healthy tissue is more white. If the injury is minor the body will normalize within a day or so. The problem becomes more serious if the abusive activity continues. With no opportunity for the body to heal itself because of repeated habitual injury, the vocal folds stay in a state of inflammation. That is when the body starts trying to protect itself by adding to the tissue. This is what then develops into nodes or some other condition that requires medical attention.

2) Smoking – Each of these are going to come down to irritation that turns into inflammation. They just will be different causes. With smoking the smoke is actual particles in the air that gets inhaled through the larynx. As the particles pass over the tissue of the vocal folds they get irritated. This irritation is compounded by the drying effects of the extreme heat of the air and smoke particles. As with yelling, the voice can normalize if given the chance. But in the case of a regular smoker that doesn’t happen and the vocal tissue exists in a constant state of inflammation.

3) Dehydration – First, staying hydrated is critical for general health. The body is comprised mostly of water. It plays a role in just about all functions of the body. So it just makes sense that we should keep the water level replenished. In relation to the voice, the larynx is one of the first places we notice dehydration. Sufficient water is needed to keep the lubricant of the voice liquid. If our water level is low the lubricant of the voice gets thicker and can develop into a more mucous-like substance. The folds themselves will be dryer than ideal, making them more susceptible to irritation from the air-flow or from the normal contact with each other during phonation.

4) Drinking – The first thing to know is alcohol is a diuretic. Which means it takes water out of your system and causes dehydration. The effects of that were covered in the previous point. But the effects can be expected to be more severe from drinking because the dehydration level will most likely be more significant. The next thing that makes drinking more dangerous for the voice is the effect on motor control and mood. Whatever direction someones mood goes when drinking it is usually exaggerated compared to their norm. This often translates into louder talking. More extreme use of the voice. Especially considering the atmosphere where drinking takes place is usually a party, bar, or club with many people talking and loud music. A lot of background noise to compete with. When this is combined with the decrease in motor control, we can pretty much guarantee vocal abuse. So drinking causes a triple whammy. Vocal fold irritation just from the drying effects of the alcohol, irritation from louder voice use from heightened mood and loud environment, and the irritation levels multiplied by the lowered level of coordination because of the loss of fine motor control.

5) Breathy Speech – Breathy speaking also has a couple different levels of abuse. First is the level of irritation from the breath passing over the surface of the folds, as was stated above. Often we make the assumption that breathy speaking is gentle and is good for the voice, or at least can’t be bad. The reality is exactly the opposite. Breathy phonation puts the voice in a constant state of irritation which can easily develop into a more significant problem. Many examples can be found of singers of the “crooning” style that have suffered from nodes. This style of singing is exemplified by the gentle, intimate manner of phonating. It sounds like it can’t possibly be harmful.

The second level of abuse caused by breathy phonation is the muscular atrophy of the laryngeal muscles. Breathiness is a sign of excess relaxation of the larynx. The larynx is a muscular valve system and requires a certain level of activity to function correctly. It can certainly be over-active, resulting in excess tension. This is a condition that makes phonation more difficult than necessary. But there is just as much danger in too little activity. The larynx must find a balanced condition with the air-pressure from the breathing system. If the larynx doesn’t do a sufficient job of resisting the air pressure the vibration of the vocal folds will be deficient. If this condition becomes chronic the muscular coordination of the larynx will atrophy, losing the instinctive impulse to adjust the glottis.

Healthy Habits – Basic healthy vocal habit recommendations can be found in many places. I will give a list of what I think are important.

Maintain healthy hydration levels. Dehydration has a big affect on the voice. There are different recommendations for this, but I tend to go by the formula – drink half your weight in ounces per day. Increase if hot/humid and/or exercising.

Speak with a regular vibration. Don’t whisper or mumble. Don’t habitually talk loud. Beware of loud, noisy surroundings that you may try to compete with.

Try to minimize coughing when sick. And clearing your throat.

Try to be well rested. Lack of sleep tends to affect the voice significantly.

Rehabilitation of Damaged Voices – This could turn into a very lengthy dissertation. But the reality is all we do to rehabilitate a damaged voice is first remove the injurious behavior. We can’t heal if we continue to injure. Then we exercise the voice in much the same way we would to develop any voice.

The fact is the only thing that can heal the voice, and the body in general, is itself. But this only can happen if we stop hurting it. Once we stop the habitual repetitive injury, which is what causes vocal damage, the body will start healing a little.

But rest will rarely fulfill the whole process of healing. We have to exercise in a particular way to get the voice to behave in a new way. Through stimulating new behaviors and ways of using the voice the healing process will also be stimulated.

This is a long post that has been sitting unfinished for a long time. I hope it helps with gaining a deeper understanding of the relationship between unbalanced voice use and vocal injury.

Questions and comments are welcome below. And come over to the VocalWisdom Facebook page for shorter discussions.

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