The poster child for this syndrome is Steven Tyler, Aerosmith's frontman and lately the "voice" of American Idol -- so to speak. Hitting all the rock and roll high notes and all the lows of a rock star lifestyle beat up his vocal cords to such an extent that they ruptured and started to bleed. Fortunately, with surgery, rest and retraining, he recovered his vocal instrument. A recent National Geographic documentary included close-ups of his vocal folds vibrating together, like Eric Clapton's guitar strings as he reached and held the signature notes of "Dream On."
Then there is Bill, Hillary's husband and former leader of the free world, with his perpetually hoarse and weakened voice. Though Zoubareva has never met him, she suspects Clinton may have acid reflux, a stomach problem in which churning gastric acids perpetually creep up into the throat causing burning and inflammation. Zoubareva has observed that Clinton adds to his voice distress by clearing his throat a lot and not breathing properly.
Enduring hoarseness is very common in American speakers, Zoubareva explained. Besides acid reflux, it can be caused a number of other factors. Talk show host Rachel Ray, for instance, has publically stated that her chronically scratchy voice is the result of vocal cysts.
The aptly named Dr. Phillip Song, Zoubareva's medical collaborator, said that many Americans are prone to voicing everything from their opinions about health care reform to the latest on the weather with what speech experts call a hard glottal attack.
Voice is produced by three subsystems: the lungs, which provide the air for breath; the larynx or voice box, which houses the vocal cords that vibrate like string instruments to produce vocal sounds; and the oral nasal cavities, where the sounds resonate before they travel to the listener's ear.
Speakers with a hard glottal attack pronounce vowel sounds too severely because they expel too much air from the lungs and slam shut the space between the vocal cords known as the glottis with too much force. "The result is talking in a loud, harsh, stiff way. It's an abusive voice pattern which over time causes trauma to the vocal folds," Song said.
The worst offenders, both Song and Zoubareva agree, are Northerners with their discordant nasal honks and propensity to speak too loudly, too rapidly and too often. Over time, this forceful, repetitive impact on the aspects of the larynx can cause irritation and long-term voice disorders. As Song said, "The more you use the voice, the more you abuse it."
Keiko Ishikawa, the speech language pathologist from Massachusetts Eye and Ear Infirmary who consulted on FitVoice, said that Southern belles are the most likely American speakers to have the singsong, melodious voices with the fluid qualities preferred by most speech experts. "They often have a sweet, smooth way of talking, which doesn't have quite so much of a hard glottal attack," she said.
However, Song pointed out there is no evidence that Northerners are any more susceptible to voice problems than citizens of the South. He suspects difficulties are probably evenly spread throughout the country. And Americans may not be the only culture to mount the hard glottal attack. However, since vocal medicine is a relatively nascent field, Song said no global survey has yet mapped out verbal stylings from country to country.