We strain our vocal cords more often than we realise. Under normal circumstances, plenty of rest and fluids should help, but there are times when you have to consult a specialist.

Speaking is a physical task that requires you to coordinate your breathing with the use of several muscle groups. Just like any other part of your body, excessive or prolonged voice use can lead to vocal difficulties.

The path of voice misuse

When you place excessive tension in the neck and laryngeal muscles, you may start experiencing several early symptoms of voice damage.These include vocal fatigue, having to speak with increased vocal effort and hoarseness in the throat.

The common situations that are associated with voice misuse and abuse are:

• Speaking in noisy situations
• Using inappropriate pitch when speaking
• Not using amplification when public speaking (for example, teaching in a classroom)
• Persistent coughing or throat clearing

In these situations, you risk developing more serious conditions such as benign vocal cord lesions and vocal cord haemorrhage.

Lesions and haemorrhage

Vocal misuse and abuse usually result in vocal cord swelling. With voice rest, these swellings will gradually subside and the voice will return to normal.

Continued voice misuse and abuse may however lead to the formation of benign vocal lesions. These lesions are
non-cancerous growths on the vocal cords. They alter vocal cord vibration which leads to hoarseness. The most common vocal cord lesions are nodules, polyps and cysts.

Vocal nodules occur on both vocal cords opposite each other at the point of maximal wear and tear. This condition is highly treatable and proper voice therapy is usually sufficient to eliminate the vocal trauma that is causing it.

Vocal cord polyps and cysts are the other common benign lesions. These are sometimes related to voice misuse or overuse. Unlike nodules, polyps and cysts need to be removed through microsurgery. In most cases, voice therapy is employed as a combined treatment approach.
If you experience sudden loss of voice after screaming,
shouting or other strenuous vocal tasks, you may have developed vocal cord haemorrhage. This is

when one of the blood vessels on the surface of the vocal cord ruptures and the soft tissues of the vocal cord fill with blood. Vocal cord haemorrhage is an emergency condition and is treated with absolute voice rest until the haemorrhage resolves.

Laryngeal cancer

If you are experiencing chronic hoarseness, you need to seek evaluation from a specialist to rule out laryngeal cancer.

Heavy drinking and smoking are particularly linked to cancer of the vocal cords. Exposure to high levels of wood, dust and chemicals can also lead to laryngeal cancer. People who have a first-degree relative diagnosed with a head and neck cancer have double the risk of contracting laryngeal cancer. The treatment options for laryngeal cancer include radiation therapy, surgery and chemotherapy.

Early treatment for results

It may come as a surprise that hoarseness or other frequently encountered vocal difficulties can be symptoms of a deeper condition. Conditions which are associated with vocal cord injury include nasal allergies, sinus infections and acid reflux disease. Your doctor needs
to evaluate and treat these conditions to optimise your recovery.

Swelling and inflammation associated with vocal misuse and abuse should resolve within two weeks.

If your hoarseness persists beyond that, you should consider seeing a voice specialist.

Do remember that if detected early, most of these conditions are highly treatable. Early diagnosis and treatment almost always lead to good outcomes.