Take Care of Your Voice: Why You Sound Hoarse (Or Old) and What to Do About It

Dan Saelinger/Trunk ArchiveWhen I enter a family reunion, relatives crank up their hearing aids. Last summer, I worked in a jewelry shop, cheerfully greeting customers, then wondering if they were ignoring me or simply couldn’t hear me.

At parties, I’m often asked to repeat myself to the point of just smiling and giving up. This scares me because my mother’s puny voice eventually became so small that phone calls were torturous, then impossible. While hearing and vision issues are prominent in many discussions of aging, there’s often silence on how our voices age. In fact, after 65, about three in ten people have speaking difficulty serious enough to be diagnosed as a voice disorder. Problems can start with retirement, at menopause, or at even younger ages in those with certain diseases or who overuse their vocal system because their jobs require constant chatter or speaking in a noisy setting. Fortunately, there are a variety of ways—from easy maintenance tips to surgical fixes—that can help you avoid sounding old or losing the ability to make yourself heard.

Too Hoarse to Talk

Relentless, high-volume talking is in the job description for call-center employees, attorneys, and especially teachers. Half of all teachers develop voice problems at some point in their careers, according to some estimates. Self-described “talker” Kaysi Hamilton, 39, a math teacher and former cheerleader, rarely gets a break from speaking throughout the school day. When Hamilton, of Alvord, Texas, became hoarse last April, she figured it was just allergies. As Hamilton powered through her workdays, she couldn’t raise her pitch, at times her voice would drop out entirely, and her neck muscles were so tense that swallowing became difficult; she felt as if she were choking. She counted the days until summer break, but things didn’t improve.

“If your voice doesn’t recover over a week or even a season like summer, there’s likely a permanent voice problem that needs fixing, such as nerve damage or a growth on the vocal folds,” says Ingo Titze, PhD, director of the National Center for Voice and Speech.

A few months later, in July, Hamilton consulted ear, nose, and throat (ENT) specialists. They saw a pea-size polyp (a swelling in the vocal cord’s mucous membrane) dangling like a water balloon from one of her vocal cords. Polyps can occur with long-term exposure to irritants such as cigarette smoke and chemical fumes, as well as because of chronic allergies and excessive voice use. Hamilton’s doctor, Ted Mau, MD, director of the voice center at the University of Texas Southwestern Medical Center in Dallas, recommends that patients start with voice therapy to learn better habits, even if surgery to remove the polyp will almost certainly be needed.

Hamilton’s therapy focused on massaging and relaxing her tense throat and neck muscles. She learned techniques to make more use of natural cavities in the head to create volume without overusing the throat. One common exercise: blowing raspberries (as babies do, trilling your lips to a brruh sound). Another involves singing through a straw (through a range of pitches or a favorite tune). After surgery to remove her polyp and a tricky seven days of absolutely no talking, Hamilton responded to additional vocal exercises; within weeks, her vocal cords were working properly. She’s more careful now (see page 2), drinking plenty of water and taking voice breaks during the day. She hasn’t had to resort to using a microphone to teach and is confident that she can continue to be a talker into old age.

Too Quiet to Be Heard

Bruce Lyon, 74, thought his wife, Kathie, should have her hearing checked. He suspected she wasn’t paying attention when she’d ask “What did you say?” multiple times every day. But after his adult children repeatedly complained and even his grandson pointed out his very soft voice, Lyon acknowledged that the problem was his.

“It was a struggle to project enough to be heard, especially at restaurants or places with background noise,” says Lyon, a retired university administrator in Carrollton, Georgia. His ENT doctor referred him to the Emory Voice Center at Emory University Hospital, where Lyon’s vocal apparatus was videotaped through a scope while he performed various vocal exercises.

The diagnosis: vocal fold atrophy, or presbyphonia. Vocal folds can weaken with age, especially after menopause in women or when the vocal muscles aren’t used enough; Lyon, for example, had begun talking far less since his retirement several years earlier. During speech, vocal folds vibrate, rapidly touching and separating as air pushes through. As muscles lose volume, strength, and coordination, it takes more effort for the folds to close—and sometimes, as atrophy gets worse, they can’t. The result is a softer, less resonant voice that requires far more effort to make audible. “Presbyphonia is a double whammy because it occurs at the same time that friends may have age-related hearing changes,” says Edie Hapner, director of speech language pathology at the Emory Voice Center.

With Hapner, Lyon did a series of exercises called PhoRTE (pronounced “forte,” like music instruction in Italian to play loudly or strongly). Modeled after strength training with older adults in sports medicine and physical therapy, the exercises start at about 50 percent of maximum effort, gradually building up in intensity.

At home, Lyon practiced in two 15-minute sessions a day, energetically sustaining a vowel sound, gliding up and down his pitch range, calling out simple sentences in a loud voice, and using a respiratory resistance device to strengthen his breath.

It worked. “The change was gradual, but within a couple of months, we weren’t asking him to repeat himself,” says Kathie. Like any type of muscle conditioning, however, the maximum improvement lasts only with continued practice.

Lyon’s voice problems were considered mild to moderate, but in some people, bowing of the vocal folds is so extreme that even with vocal therapy they won’t touch.

“We can inject a filler to augment the vocal cords. Some fillers use the same material used to fill facial wrinkles,” says Elizabeth Guardiani, MD, an assistant professor of otorhinolaryngology and head and neck surgery at the University of Maryland School of Medicine.

As for me, a chat with a voice specialist indicated nothing particularly abnormal about my voice. I am determined to drink more water and use my voice more—enunciating with French-language CDs or singing in the car. If that doesn’t improve things, I won’t hesitate to consult a pro. Lyon says he wishes he’d gone for help three years earlier.

Voice-Changing Medical Conditions

Temporary hoarseness is normal when you get a cold (infection causes your vocal cords to swell, interfering with their normal vibration).

Allergy and sinus problems can create a postnasal drip that irritates vocal cords. Many allergy pills also dry out vocal cords, so ask about using alternative meds, sinus washes, and medications to thin mucus (such as Mucinex, used with plenty of water). Don’t clear your throat to get rid of phlegm (this bangs the vocal cords together and is a harmful habit).

Another vocal cord irritant is gastroesophageal reflux disease (GERD) that reaches the throat. GERD medication or lifestyle changes (such as avoiding foods that cause heartburn) may be all it takes to feel better.

In rare cases, voice changes can be the first sign of a vocal cord cancer or a symptom of a neurological problem such as Parkinson’s disease. Don’t ignore a voice change that lasts more than three weeks. While a workup will check for these conditions, it’s likely that changes in your once-youthful voice will turn out to be owing—at least in part—to your speaking habits or aging.

Dos and Don’ts for a Healthier Voice

DO: Drink plenty of water, especially if you take medication. Some 80 percent of OTC and prescription drugs dry out the moist mucous layer that protects your vocal cords. Avoid large amounts of coffee, caffeinated sodas, and alcohol, which can dehydrate you.

DON’T: Yell. Screaming can lead to bumps or calluses on the vocal folds, so move closer or find another way to get someone’s attention (sudden silence can work). Some teachers use amplification headsets like those worn by fitness instructors.

DO: Sing. Trained singers generally sound younger longer than people who don’t sing. If singing isn’t your thing, read aloud every day to keep your vocal muscles working.

DON’T: Go low. Vocal fry—the raspy, Kim Kardashian–like speech pattern increasingly popular among teens (both boys and girls)—may set them up for voice problems later because the vocal muscles don’t get exercised at the full range of pitch.

DO: Find your natural speaking resonance. Say “mmm-hmm.” That’s a good indicator of where your most comfortable resonance will be.