Many things can adversely affect the vocal cords, including smoking (tobacco or marijuana), secondhand smoke and other air pollution; a cold or laryngitis; very dry conditions, dehydration or excessive alcohol intake; and severe emotional stress. Certain drugs (such as oral contraceptives, antihistamines, steroids & some antidepressants) can contribute to hoarseness. So can reflux of stomach acids, particularly while you sleep, as well as various benign growths or malignant tumors.
Vocal cords also age along with the rest of the body. These twin bands of connective tissue are located in the voice box, or larynx, just above the windpipe. In the delicate system that allows human speech, the vocal cords remain open above the airway when you are silent. When you speak, the cords move together and vibrate, creating sound in a wide range. Poor vocal techniques that strain your voice, and simple fatigue from overuse can all take their toll.
Don’t smoke or spend a lot of time around smokers, charcoal grills and other sources of smoke. Avoid indoor air polluted with fragrances, harsh cleaners and the like. Get enough sleep. If you are required to talk all day, rest your voice at night. Drink plenty of fluids. Limit alcoholic beverages.
Avoid continual clearing of your throat, shouting, rooting too loudly for the home team or competing with loud noise. If you must whisper, don’t do so forcefully or for long; it's hard on vocal cords. If your job demands lots of talking, consider consulting a voice coach or therapist. Ask your physician for a referral, or consult the American Speech-Language-Hearing Association.
If you grow hoarse or lose your voice temporarily, you may have some idea what the problem is. Maybe your voice just needs a rest. But if you lose your voice for more than two days or have a lump in your throat or difficulty swallowing, or if hoarseness persists for two weeks, you should get medical advice. Your regular physician will probably send you to a specialist, who should be able to diagnose (or rule out) serious conditions by looking at your voice box with a laryngoscope and/or doing acoustic analyses. Don’t forget to mention what kind of work you do, and symptoms such as waking up with a sour taste in your mouth (this might indicate reflux).
Hoarseness is the most common symptom of any vocal disorder. Vocal tremors may also occur—these often come from fatigue or misuse of the voice, but can also be caused by underlying conditions such as “essential tremor” (unexplained shaking), more common in older people. Or you may have dysphonia—a cracked or squeaky voice and general loss of voice quality. This may progress to intermittent loss of voice. Occasionally people “lose” their voices without warning. A rare condition called vocal cord paralysis is sometimes to blame.
Treatments vary from voice retraining to injections to surgery. One common diagnosis is “non-organic dysphonia,” meaning that nothing apparent is wrong. In this case, you may be referred to a voice therapist who can train you in vocal techniques that will reduce strain on your voice, as well as vocal rehabilitation exercises. Go only to a licensed, certified voice specialist. For some conditions, especially tumors of any kind, surgery may be the best or even the only option. Other chronic problems may be improved by injections to “plump up” aging vocal cords, or by repositioning vocal cords with surgical implants. Always get a second opinion before having surgery.