Otolaryngology, Head and Neck Surgery

General Voice Care/Vocal Hygiene


C. Blake Simpson, M.D.


If you rely on your voice for your livelihood, then you are a professional voice user. This includes clergy, attorneys, teachers, telephone operators, actors, broadcasters, and singers. If you are a professional voice user, then it is of the utmost importance that you take good care of your voice. The following are some helpful hints to help you maintain good vocal hygiene:


1. Hydration

It cannot be overemphasized how important it is to maintain good water intake. We recommend 6 to 8 eight-ounce glasses of water a day to maintain adequate hydration. Bring a water bottle with you to work and refill it at the water fountain. The goal is to drink until your urine is pale. Good water intake helps keep the lubricating mucus on your vocal cords thin, creating the ideal environment for your vocal cords to work. Coffee, tea, and most soft drinks contain caffeine that tend to lead to dehydration - it is best to avoid these altogether,


2. Thick Mucus

Increasing your water intake, as outlined above, will frequently help take care of problems with thick mucous. Sometimes, your doctor will prescribe a mucolytic drug to help thin the mucus. The most common mucolytic is Humibid LA (generic name: guaifenesin). You must drink 6 to 8 glasses of water per day for this medication to have significant effects. In most cases, this will adequately thin the mucus. Despite these measures, some people continue to have the sensation of thick mucus in their throat or on their vocal cords. In many instances, this is due to backflow of stomach acid into the throat - so called gastroesophageal reflux disease, or GERD. This is discussed in detail in another handout.


3. Throat Clearing

This is a common problem with many professional voice users. It is often seen in people with excessive mucus or GERD (reflux disease). Your doctor will give you medications to help treat these conditions, but it is important that this habit be eliminated. Throat clearing is extremely traumatic to the vocal cords, leading to excessive wear and tear. When you feel the need to clear your throat you should try the following strategies: swallow, have a sip of water, or clear your throat silently without allowing your vocal cords to touch (your doctor or one of our speech therapists/pathologists will be glad to demonstrate this).


4. Gastroesophageal Reflux Disease (GERD)

This is quite common among professional voice users. Although the reflux of stomach contents into the esophagus and throat commonly leads to heartburn, many of our patients never experience this symptom. So, just because you're not having heartburn, that does not mean you are safe from the effects of acid reflux on your vocal cords. Treatment of this condition involves changes in your diet and lifestyle, as well as medications to reduce the acid production from your stomach.


5. Vocal Abuse/Overuse

It has been said, "everything in moderation". This is especially true when it comes to the use of your voice. Don't speak excessively; choose your words carefully. Avoid lengthy conversations on the phone. If your job involves talking on the phone all day, then rest your voice for ten minutes every 2-3 hours. This will go a long way towards easing the strain on your voice.


Talk at a low to moderate volume; this will sometimes mean using different strategies when there is excessive background noise (cars, parties, airplanes, restaurants). Our best advice is to minimize talking in these environments. If you must talk in these situations, you should get as close to the person you are talking to as possible, preferably facing them. In some instances, you may need amplification to talk in a noisy environment. We have many suggestions for portable amplification systems. Please talk to your doctor or speech therapist/pathologist for more details.


Avoid shouting and screaming. There are much better ways to get people's attention, and these methods will not traumatize the vocal cords as screaming will. Examples would include using a whistle or clapping your hands.


Needless to say, smoking is one of the worst things you can do to your voice. Irritation to the vocal cords from cigarette smoke can lead to chronic laryngitis, vocal cord polyps, or cancer of the larynx. If your voice is valuable to you, smoking is just not worth the risks.


6. Drugs that Affect the Voice

Antihistamines/Decongestants: These drugs are commonly found in cold preparations and allergy medications. They will result in a drying effect on the vocal cords which is detrimental. Common medications in this category include Benadryl, Tavist, Dimetapp, Sinutab, Dristan, Entex, Sudafed, etc. If you have allergic rhinitis (allergic nasal disease), a more suitable medication may be a nasal steroid such as Beconase or Flonase.


Other medications that dry the vocal tract include Catapress (clonidine), Aldochlor (methyldopa-chlorothiazide), Aldomet (methyldopa), Aldoril (methyldopa-hydroclorothiazide), Tenex (guanfacine hydrochloride), Wytensin (guanabenz acetate), Combipress, Elavil (amitriptyline), Pamelor (nortriptyline), Sinequan and Adapin (doxepin), Tofranil (imipramine), Vivactil (protriptyline), Prolixin (fluphenazine), Thorazine (chloropromazine), Mellaril (thioridzine), Transderm Scop (scopolamine), Lomotil, Donnagel, Cogentin (benztropine), Artane (trihexyphenidyl), Lasix (furosemide), and all diuretic pills (water pills)


Local Anesthetics (Chloraseptic, etc): These medications should be avoided. Numbing the throat with one of these sprays is an especially bad idea if you are about to perform or sing. Performing under the influence of one of these has been likened to playing the piano with gloves on.


7. Work Environment

Avoid smoke filled and dusty environments. Traveling to dry environments such as Las Vegas or Phoenix may also cause voice problems. It is best to keep a humidifier on at night, and to maintain good water intake. Airplanes are also notoriously dry environments. If you are traveling by plane a significant amount, you should increase your water intake accordingly.


Copyright C. Blake Simpson, 1996