Put Your Best Voice Forward

Michael Benninger, M.D.


Christine, an attorney and mother of three young children, uses her voice all the time. She really never thought much about it -- until she had a bad cold over the winter holidays, a gift from her youngest child. She developed laryngitis with notable coughing and significant hoarseness. Although this had happened to her before, her voice always recovered after a few days. Not this time. Her hoarseness persisted, and her voice was low pitched and raspy. It got better with rest, but with her work and family responsibilities, there was no way to reduce her voice use, and the hoarse voice persisted.

Christine's story is not unique. In fact, temporary hoarseness occurs in almost everyone, and almost 20 percent of the population in the United States has some degree of chronic voice dysfunction. This number is dramatically worse in voice-intensive occupations. School teachers have reported problems with their voices 60 percent of the time in their lifetime and 11 percent at any given time.

Most people use their voices as their primary means of communication without thinking about it. And each voice is a personal signature that carries great weight.

Researchers in the United Kingdom studied the vocal ranges of men and women in courtship scenarios. Results show that men and women vary the strength, tone and pitch of their voices when speaking to members of the opposite sex whom they find attractive. Another study shows that hearing a mother's voice helps develop the brain of a preemie.

Yes, your voice is powerful, and it plays an essential role in your life.

In addition to normal daily use, events such as sports games or concerts where you cheer and talk loudly may strain your voice. It is actually possible to bruise your vocal folds, which can create a scar and may result in your voice sounding less clear.

To protect and preserve your vocal asset, here are tips to keep your voice healthy:

-- Warm up your voice before teaching, giving speeches or singing. Do neck and shoulder stretches, glide from low to high tones on different vowel sounds, hum, do lip trills (like the engine of a motorboat) or tongue trills. Check this series of exercises.

-- Get a full chest of air so you can really project your voice.

-- Keep your yells and cheers brief. Use a little bit of loud voice, and then bring it back to a conversational level.

-- Monitor your voice. If your voice is hoarse or your throat starts to feel scratchy due to overuse, rest your voice as much as possible, and drink water to help lubricate your vocal folds.

-- Avoid frequent throat clearing or harsh coughing. Try sipping water or sucking on a cough drop instead.

-- If you have acid reflux, it can damage your vocal folds in your throat. Signs of acid reflux include frequent heartburn, a bad taste in your mouth in the morning, frequent bloating or burping, a lump in the back of your throat or getting hoarse frequently. Check with a specialist to manage this condition.

When is It Cause for Concern?

Short periods of hoarseness following a respiratory infection or after a long or loud period of voice use is not uncommon. With some voice rest, these should resolve within a short period of time.

If your hoarseness lasts more than two or three weeks and is not gradually improving, particularly if you smoke or do not have cold-like symptoms, it should prompt a visit to your doctor.

If there is significant concern, primary care physicians and emergency department doctors will likely refer patients to an ear, nose and throat doctor (also known as ENT doctor or an otolaryngologist), who is specially trained to diagnose and treat problems of the larynx.

Fortunately, even with prolonged hoarseness, there are rarely truly worrisome or life-threatening conditions, and treatment is usually effective.

In the long run, if you have a healthy lifestyle and approach the care of your voice alongside your overall health and wellness, you will keep your voice strong and vigorous.


Dr. Michael S. Benninger is the Chairman of the Head and Neck Institute at The Cleveland Clinic and a Professor of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. The Head and Neck Institute comprise the specialties of Otolaryngology, Audiology, Speech and Language Sciences, Oral Surgery and Dentistry.

In addition to his work at the hospital, Dr. Benninger has been very involved in regional, national and international medical organizations. He is the president of the American Laryngologic Association, the President-Elect of the International Association of Phonosurgery and a member of the Board of Directors of the Voice Foundation. He served on the Board of Directors of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) for 12 years, having been a former Vice President and Chairman of the Board of Governors of that organization. He is also a Past-President of the American Rhinologic Society and the Michigan Oto-Laryngological Society. He is the former Editor-in-Chief of the Journal, Otolaryngology-Head and Neck Surgery, which is the largest peer-reviewed journal in the world for that specialty. He has served on the Residency Review Committee for Otolaryngology and as a member of the Medical Advisory Board for WebMD. He is the Past-Chairman of the Steering Committee for the Sinus and Allergy Health Partnership. Dr Benninger has authored or edited six books, including his most recent books, "The Performer's Voice" and "The Singer's Voice." He has two additional books in press. He has also has written over 50 book chapters and over 170 scientific articles, focusing primarily on voice care and laryngology, nasal and sinus disease and health care management. He has lectured extensively across the country and throughout the world. A graduate of Harvard University, Dr. Benninger received his medical degree from Case Western Reserve University in Cleveland, Ohio. He completed his residency at the Cleveland Clinic Foundation.